Seroprevalence of dengue, Japanese encephalitis and Zika among long-term expatriates in Thailand

BACKGROUND

Travel to Southeast Asia increases the likelihood of acquiring mosquito-borne Flavivirus infections such as dengue (DENV), Japanese encephalitis (JEV) and Zika viruses (ZIKV). Expatriates are long-term travellers who have a higher risk of mosquito-borne illness at their destination country. The purpose of this study was to evaluate the seroprevalence of DENV, JEV and ZIKV infections and the determinants contributing to seropositivity among expatriates living in Thailand.

METHODS

A cross-sectional study was performed from December 2017 to February 2020. Expatriates from non-Flavivirus endemic countries were recruited. 5 mL of blood was collected for DENV 1-4, JEV and ZIKV antibody testing by plaque reduction neutralization test (PRNT50). Individuals with vaccination histories or diagnoses for dengue, Japanese encephalitis, yellow fever and tick-borne encephalitis were excluded.

RESULTS

Among 254 participants, most participants (83.1%) were male, the mean age was 65 years and the median duration of stay in Thailand was 6 years. Seroprevalence rate of any Flavivirus, non-specific DENV, DENV1-4, JEV and ZIKV were 34.3, 30.7, 20.5, 18.1, 18.9, 10.6, 4.7 and 2.8%, respectively. The presence of neutralizing antibodies against DENV1-4 positively correlates with the duration of stay in Thailand. DENV seropositivity was associated with living in urban areas (aOR 2.75, 95% CI 1.36-5.57). Expatriates were unlikely to have detectable anti-JEV antibodies regardless of time spent in a JEV-endemic area. No risk factors were identified that were significantly associated with JEV or ZIKV seropositivity. Only 48.4% received pre-travel counselling services, while only 18.9% visited a travel medicine specialist.

CONCLUSIONS

A high proportion (34.3%) of long-term expatriates living in Thailand were seropositive for flavivirus, mainly from dengue (30.7%). To minimize risk, travel medicine practitioners should provide adequate pre-travel health risk information on mosquito-borne flavivirus infection and offer advice on mosquito bite prevention strategies. Dengue vaccine might be considered in high-risk travellers such as long-term expatriate.

Acceptance, attitude, and factors affecting the intention to accept COVID-19 vaccine among Thai people and expatriates living in Thailand

Background

COVID-19 pandemic is a worldwide problem. Vaccination as primary prevention is necessary. Thailand is in the initial phase of the vaccination program. However, the demand for this vaccine among Thais and expatriates living in Thailand is still unknown. This study aims to assess acceptance, attitude, and determinants for COVID-19 vaccination among Thai people and expatriates living in Thailand.

Methods

This was a cross-sectional study conducted in Thailand during May 2021. An online survey (REDcap) was distributed through online social media platforms. Adult (>18 years old) Thai and expatriates living in Thailand were invited. Any person who already received any COVID-19 vaccine was excluded from this study.

Result

One thousand sixty-six responses were collected in this survey. A total of 959 were available for analysis. Six hundred thirty-seven 637 responses were from Thais and 322 responses from expatriates living in Thailand. The acceptance rate was significantly higher among expatriates than local people (57.8% vs 41.8%, p-value < 0.001). The acceptance rate increased up to 89.0–91.3% if they could select the vaccine brand, and 80.7–83.2% when they were recommended by the health care professionals. Both groups had a similar mean attitude score toward COVID-19 vaccination. Being Thai, health care worker, good compliance to social distancing, accepting serious side effects at level 1 per 100,000, and having a good attitude toward COVID-19 vaccination were associated with vaccine acceptance.

Conclusion

Thailand's COVID-19 vaccination program could improve the acceptance rate by informing the public about vaccine efficacy, vaccine benefit, and vaccine safety. Moreover, supplying free of charge high efficacy alternative vaccines and letting all people living in Thailand make their own vaccine choices could increase the acceptance rate.

Reasons for seeking care and adherence to pretravel preparation in expatriate or long-term travelers' children in the tropics: A French prospective study

BACKGROUND

Studies on pediatric travelers' health rarely address expat or long-term travelers' children.

METHOD

To investigate reasons for seeking care and adherence to pretravel preparation, we prospectively enrolled French children 0-15 years old, either expatriates or staying >6 months in tropical areas, who attended a French health center in Africa, Central America or Southern Pacific regions from October 01, 2011 to October 31, 2012. A standardized questionnaire was completed by a general practitioner at each visit, then anonymized and included in our database.

RESULTS

464 questionnaires were collected from 367 children (sex ratio M/F: 1:1). Median age was 6.4 years (IQR: 3.6; 10.3). Reasons for seeking care were mostly infections (n = 378), of which 12 (3.2%) were tropical. There were no deaths, but one child with tuberculosis was repatriated. Coverage was high for routine immunization, but less for travel-related vaccines. Personal antivectorial protection was significantly lower in children aged >5 y or in non-malarial areas. Where indicated, malarial chemoprophylaxis was prescribed to only one third of the children, of whom 60% were poorly compliant. Advice regarding measures against diarrhea and sunburn was followed significantly more for stays >2 yrs.

CONCLUSION

Mild cosmopolitan illnesses predominated but protection against tropical threats should be optimized before and during the stay.

Do immigrants who stutter confront speech related anxiety in a foreign country?

Purpose

The current study aimed at investigating the experience of immigrants who stutter in a foreign country.

Materials and methods

A questionnaire tapping details about the immigrants handling various communicative situations in a first and second language was configured and used in the current study. A total of 14 participants were enrolled in the study. Participants were sub-grouped based on the severity by using Stuttering Severity Instruments, 4th Edition (SSI-4). The composite scores on SSI-4 including the physical concomitants were used for sub grouping.

Results

The findings revealed that the amount of difficulty experienced by immigrants was directly proportional to the degree of stuttering. Participants had difficulty in communicating with boss and colleagues regardless of the language used. They experienced less difficulty while speaking in malls and courier persons. Participants who knew the native language Arabic could handle the situations better than individuals who did not know Arabic.

Conclusion

Stuttering would impede social participation and would increase anxiety. This speech-related anxiety is known to increase when these individuals immigrate to foreign countries.

Unique expatriate factors associated with job dissatisfaction among nurses

AIM

To assess whether expatriate-specific factors were associated with nurses' overall job dissatisfaction after controlling for known factors.

BACKGROUND

Current evidence about job dissatisfaction among nurses in Saudi Arabia is not specific to expatriate nurses. Specific aspects such as job insecurity, fear of litigation, and language barriers have not been assessed in the context of job dissatisfaction.

INTRODUCTION

The majority of nurses in the Arab Gulf countries are expatriate. The motive for employment here is purely financial because there is no path to permanent residency.

METHODS

This was a cross-sectional electronic survey of 977 expatriate nurses in Al-Qassim, Saudi Arabia. The survey included questions on demography, job dissatisfaction (overall and related to salary, workload, and teamwork), job characteristics, job duration as an expatriate, communication issues with patients and doctors, fear of litigation, and job insecurity. We used a hierarchical logistic regression to evaluate whether unique factors were associated with overall job dissatisfaction either as a group, or individually.

RESULTS

The mean age of the nurses was 32 years, and 19% reported overall job dissatisfaction. The unique expatriate factors as a group contributed significantly to the model. Job insecurity, patient communication problems, and shorter job duration were significantly associated with higher overall job dissatisfaction.

CONCLUSIONS

Job insecurity, job duration, and patient communication were significant correlates of overall job dissatisfaction among expatriate nurses.

IMPLICATIONS FOR NURSING POLICY

A longer job contract and organizational initiatives to help new expatriate nurses acculturate will likely decrease feelings of job insecurity and increase job satisfaction.

Experiences of expatriate university teachers in a health science university in Saudi Arabia-A Qualitative study

Background and Objective

A large number of university teachers in Saudi Arabia comprise of expatriates. Their experiences are unique in context of the challenges and benefits of academic expatriation. The purpose of this study was to describe the experiences of expatriate university teachers in Saudi Arabia.

Methods

A qualitative descriptive design was used based on in-depth interviews with academic expatriates, recruited through snowball sampling in a Health Science University in Saudi Arabia. The study was conducted from 12 September 2019 to 20 October 2019 after IRB approval. Graneheimian inductive approach was used for content analysis of the data. Standard principles of trustworthiness were applied.

Results

Three major themes emerged as 'conscious venture', 'spirit at work' and 'coping strategies'. Each theme had 2-3 subthemes, populated by 14-23 statements.

Conclusion

Expatriate faculty members described antecedents for their motivations at work. They shared their experiences regarding job adjustments, work environment and professional commitment.

Screen time and metabolic syndrome among expatriate adolescents in the United Arab Emirates

BACKGROUND

Both screen time and metabolic syndrome (MetS) are associated with health outcomes. However, limited data exist on the association between screen time and MetS among expatriate adolescents living in United Arab Emirates (UAE).

METHODS

We conducted a cross-sectional school-based study on 473 expatriate adolescents (47% girls) aged 12-18 years in Al-Ain district of Abu Dhabi Emirates in the UAE. Data was collected with the expertise of trained nurses & IDF criteria was used to define MetS. Information on screen time (computer, television, and video game use combined) during a regular day was self-reported, and divided into two categories: <2, or ≥2 h per day. Using logistic regression analyses, adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between screen time and MetS.

RESULTS

A high proportion of adolescents (75.3%) spent ≥2 h daily on screen. The prevalence of MetS was 8.5% in those with <2 h per day of screen time compared with 13.5% in those who reported ≥2 h per day. There was a graded positive association between screen time and MetS (P-trend = 0.01). Each hour increase in screen time was associated with 21% (OR, 1.21; 95% CI, 1.08-1.35) greater likelihood of having MetS. The adjusted OR value associated with ≥2 h of daily screen time was 2.20 (95% CI, 1.04-4.67), compared with adolescents who spent less than 2 h of daily screen time.

CONCLUSION

Higher screen time by expatriate adolescents was associated with increased likelihood of having MetS.

Portuguese expatriates' health in Angola and Mozambique-a cross-sectional study: increasing awareness and need for more surveillance

BACKGROUND

Increasing numbers of expatriates are working in sub-Saharan Africa. There is little published data on the complex population and this survey aimed at understanding expatriate morbidity by accessing self-reported health problems and malaria preventive practices.

METHODS

A cross-sectional web-based survey was conducted targeting Portuguese expatriates in Angola and Mozambique. Logistic regression analysis explored factors associated with self-reported health problems and psychological symptoms in the previous 3 months.

RESULTS

A total sample of 352 adult Portuguese urban civil occupational expatriates was obtained. Median length of expatriation was 3 years. Considering a 3-month timeframe, one in five expatriates reported new health problems and need of medical assistance, 5% were hospitalized and 64% reported general psychological symptoms. Less than 2% of subjects were on malaria chemoprophylaxis. Having chronic health conditions doubled the reporting of new health problems. Increasing length of expatriation was associated with decreasing reporting of general psychological symptoms. Directors and executive managers and expatriates living alone tended to report more general psychological symptoms.

CONCLUSION

Expatriate communities deserve enhanced surveillance for the health issues that affect them. This will improve evidence-based preparation and intervention by public and travel health practitioners.

High rate of multidrug-resistant organism colonization among patients hospitalized overseas highlights the need for preemptive infection control

We performed 4 years of active screening for multidrug resistant organism (MDRO) colonization among patients with a history of overseas hospitalization. Thirteen (56.5%) of 23 cases were positive for MDROs, which highlights the importance of preemptive infection control to prevent the spread of MDROs in this population.

The fate of the embedded virgin sand flea Tunga penetrans: hypothesis, self-experimentation and photographic sequence

We describe the morphological development of a single penetrated female sand flea (Tunga penetrans) in a medical expatriate working in Madagascar. The embedded parasite developed abnormally in two aspects. First, it lived twice as long as usually. Second, it did not expel a single egg during a period of two months. We explain these abnormalities by the fact that the female sand flea remained virgin after the penetration into the skin and, therefore, mature eggs did not develop. Our observations are seminal findings in a long dispute between entomologists and suggest that normally the fertilization of a female sand flea takes place on-host when it is already embedded in the epidermis. We conclude that a single sand flea lesion in a traveller may develop in a different way as compared to parasites penetrating into the skin of inhabitants living in endemic areas.