Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France.

PubMed

Pilkington, Hugo; Prunet, Caroline; Blondel, Béatrice; Charreire, Hélène; Combier, Evelyne; Le Vaillant, Marc; Amat-Roze, Jeanne-Marie; Zeitlin, Jennifer

2018-01-01

Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.

Geographic disparities in patient travel for dialysis in the United States.

PubMed

Stephens, J Mark; Brotherton, Samuel; Dunning, Stephan C; Emerson, Larry C; Gilbertson, David T; Harrison, David J; Kochevar, John J; McClellan, Ann C; McClellan, William M; Wan, Shaowei; Gitlin, Matthew

2013-01-01

To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients. Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 U.S. Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an "original" and "replacement" facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software. The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs. 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs. 6.8 miles). Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life. © 2013 National Rural Health Association.

Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility.

PubMed

Yeap, E E; Morrison, J J; Apodaca, A N; Egan, G; Jansen, J O

2014-06-01

The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

Travel Virginia

DOT National Transportation Integrated Search

2000-01-01

Prepared ca. 2000. This report summarizes the results of a fifteen-month study to assess the feasibility of expanding Travel Shenandoah, a pilot rural ATIS service developed for Virginia's Northern Shenandoah Valley, into a comprehensive, statewide s...

Travel Distance to Cancer Treatment Facilities in the Deep South.

PubMed

Wills, Mary J; Whitman, Marilyn V; English, Thomas M

Despite ongoing efforts to improve rural healthcare, the health problems facing rural communities persist. The lack of healthcare providers and infrastructure in rural areas has been linked to a number of negative consequences. Among the elderly rural population, the lack of proximal access presents greater barriers because many elderly people are further limited in their ability to travel and pay for services. In the Deep South specifically, rural residents experience limited access to care and overall poor health outcomes. With cancer in particular, the Deep South has been dubbed the "cancer belt," faring far worse in prevalence and mortality rates than other areas of the country. The present study examines the average travel distance for rural elderly patients residing in the Deep South who are receiving treatment for prostate, breast, or colorectal cancer. We analyzed Medicare claims data of beneficiaries residing in the five Deep South states who had received a primary diagnosis of prostate, breast, or colorectal cancer, with a service date ranging from January 1, 2011, through December 31, 2014. The findings reveal that rural Medicare beneficiaries in the Deep South travel significantly greater distances than do their urban counterparts. In addition, travel distances to prostate cancer treatment facilities are significantly greater than those to breast or colorectal cancer treatment facilities. With cancer incidence predicted to increase, the need to reduce travel distances to treatment is vital in efforts to curb the mortality rate in the Deep South.

Travel characteristics and health practices among travellers at the travellers' health and vaccination clinic in Singapore.

PubMed

Lee, Vernon J; Wilder-Smith, Annelies

2006-10-01

Singapore has a fast-growing travel industry, but few studies have been done on travel characteristics and travel health practices. This study describes the profile and healthseeking behaviour of travellers attending a travel health clinic in Singapore. A cross-sectional survey was conducted on travellers attending the Traveller's Health and Vaccination Centre (THVC) between September and November 2002 using a standardised questionnaire. Information obtained included individual demographic and medical information, travel patterns, vaccination status and travel health practices. Four hundred and ninetyfive (74%) eligible travellers seen at THVC responded to the questionnaire. Their mean age was 36 years; 77% were professionals, managers, executives, and businessmen, students, and white collar workers. Asia was the main travel destination, and most travelled for leisure and resided in hotels or hostels. The median duration of travel was 16 days. Although >90% had previously travelled overseas, only 20% had previously sought pre-travel advice. Malays were significantly underrepresented (P < 0.01); and Caucasians and Eurasians were significantly more likely (P < 0.01) to have previously sought pre-travel advice compared with Chinese, Indians and Malays. Factors associated with seeking pre-travel advice included travel outside of Asia, especially Africa and South America. Singaporean travellers travel more often to cities rather than rural areas, compared with non-Asian travellers. Asia is the preferred destination, and travel outside of Asia is perceived as more risky and is associated with seeking pre-travel advice and vaccinations. Travel patterns and behaviours need to be taken into account when developing evidence-based travel medicine in Asia.

Rural ITS

DOT National Transportation Integrated Search

1999-04-01

Rural intelligent transportation systems (ITS) refers to that portion of the ITS program that focuses on travelers' and operators' needs in non-urbanized areas of the United States. As such, it involves interurban/interstate travel, small communities...

Travel patterns in China.

PubMed

Garske, Tini; Yu, Hongjie; Peng, Zhibin; Ye, Min; Zhou, Hang; Cheng, Xiaowen; Wu, Jiabing; Ferguson, Neil

2011-02-02

The spread of infectious disease epidemics is mediated by human travel. Yet human mobility patterns vary substantially between countries and regions. Quantifying the frequency of travel and length of journeys in well-defined population is therefore critical for predicting the likely speed and pattern of spread of emerging infectious diseases, such as a new influenza pandemic. Here we present the results of a large population survey undertaken in 2007 in two areas of China: Shenzhen city in Guangdong province, and Huangshan city in Anhui province. In each area, 10,000 randomly selected individuals were interviewed, and data on regular and occasional journeys collected. Travel behaviour was examined as a function of age, sex, economic status and home location. Women and children were generally found to travel shorter distances than men. Travel patterns in the economically developed Shenzhen region are shown to resemble those in developed and economically advanced middle income countries with a significant fraction of the population commuting over distances in excess of 50 km. Conversely, in the less developed rural region of Anhui, travel was much more local, with very few journeys over 30 km. Travel patterns in both populations were well-fitted by a gravity model with a lognormal kernel function. The results provide the first quantitative information on human travel patterns in modern China, and suggest that a pandemic emerging in a less developed area of rural China might spread geographically sufficiently slowly for containment to be feasible, while spatial spread in the more economically developed areas might be expected to be much more rapid, making containment more difficult.

Utilization of travel reimbursement in the Veterans Health Administration.

PubMed

Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall

2014-01-01

To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living <50 miles from the nearest VHA facility increased their travel reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.

Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

PubMed

Jindal, Manila; Zheng, Chaoyi; Quadri, Humair S; Ihemelandu, Chukwuemeka U; Hong, Young K; Smith, Andrew K; Dudeja, Vikas; Shara, Nawar M; Johnson, Lynt B; Al-Refaie, Waddah B

2017-08-01

Centralization of complex surgical care has led patients to travel longer distances. Emerging evidence suggested a negative association between increased travel distance and mortality after pancreatectomy. However, the reason for this association remains largely unknown. We sought to unravel the relationships among travel distance, receiving pancreatectomy at high-volume hospitals, delayed surgery, and operative outcomes. We identified 44,476 patients who underwent pancreatectomy for neoplasms between 2004 and 2013 at the reporting facility from the National Cancer Database. Multivariable analyses were performed to examine the independent relationships between increments in travel distance mortality (30-day and long-term survival) after adjusting for patient demographics, comorbidity, cancer stage, and time trend. We then examined how additional adjustment of procedure volume affected this relationship overall and among rural patients. Median travel distance to undergo pancreatectomy increased from 16.5 to 18.7 miles (p for trend < 0.001). Although longer travel distance was associated with delayed pancreatectomy, it was also related to higher odds of receiving pancreatectomy at a high-volume hospital and lower postoperative mortality. In multivariable analysis, difference in mortality among patients with varying travel distance was attenuated by adjustment for procedure volume. However, longest travel distance was still associated with a 77% lower 30-day mortality rate than shortest travel among rural patients, even when accounting for procedure volume. Our large national study found that the beneficial effect of longer travel distance on mortality after pancreatectomy is mainly attributable to increase in procedure volume. However, it can have additional benefits on rural patients that are not explained by volume. Distance can represent a surrogate for rural populations. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights

Travel-related infections in children.

PubMed

Fox, Thomas G; Manaloor, John J; Christenson, John C

2013-04-01

Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

Travel Patterns in China

PubMed Central

Garske, Tini; Yu, Hongjie; Peng, Zhibin; Ye, Min; Zhou, Hang; Cheng, Xiaowen; Wu, Jiabing; Ferguson, Neil

2011-01-01

The spread of infectious disease epidemics is mediated by human travel. Yet human mobility patterns vary substantially between countries and regions. Quantifying the frequency of travel and length of journeys in well-defined population is therefore critical for predicting the likely speed and pattern of spread of emerging infectious diseases, such as a new influenza pandemic. Here we present the results of a large population survey undertaken in 2007 in two areas of China: Shenzhen city in Guangdong province, and Huangshan city in Anhui province. In each area, 10,000 randomly selected individuals were interviewed, and data on regular and occasional journeys collected. Travel behaviour was examined as a function of age, sex, economic status and home location. Women and children were generally found to travel shorter distances than men. Travel patterns in the economically developed Shenzhen region are shown to resemble those in developed and economically advanced middle income countries with a significant fraction of the population commuting over distances in excess of 50 km. Conversely, in the less developed rural region of Anhui, travel was much more local, with very few journeys over 30 km. Travel patterns in both populations were well-fitted by a gravity model with a lognormal kernel function. The results provide the first quantitative information on human travel patterns in modern China, and suggest that a pandemic emerging in a less developed area of rural China might spread geographically sufficiently slowly for containment to be feasible, while spatial spread in the more economically developed areas might be expected to be much more rapid, making containment more difficult. PMID:21311745

People living with HIV travel farther to access healthcare: a population-based geographic analysis from rural Uganda.

PubMed

Akullian, Adam N; Mukose, Aggrey; Levine, Gillian A; Babigumira, Joseph B

2016-01-01

The availability of specialized HIV services is limited in rural areas of sub-Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV) must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face when accessing healthcare compared with those not living with HIV in a rural area of sub-Saharan Africa with limited availability of healthcare infrastructure. We conducted a population-based cross-sectional study of 447 heads of household on Bugala Island, Uganda. Multiple linear regression models were used to compare travel time, cost and distance to access healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services. PLHIV travelled an additional 1.9 km (95% CI (0.6, 3.2 km), p=0.004) to access healthcare compared with those not living with HIV, and they were 56% less likely to access healthcare at the nearest health facility to their residence, so long as that facility lacked antiretroviral therapy (ART) services (aRR=0.44, 95% CI (0.24 to 0.83), p=0.011). We found no evidence that PLHIV travelled further for care if the nearest facility supplies ART services (aRR=0.95, 95% CI (0.86 to 1.05), p=0.328). Among those who reported uptake of care at one of two facilities on the island that provides ART (81% of PLHIV and 68% of HIV-negative individuals), PLHIV tended to seek care at a higher tiered facility that provides ART, even when this facility was not their closest facility (30% of PLHIV travelled further than the closest ART facility compared with 16% of HIV-negative individuals), and travelled an additional 2.2 km (p=0.001) to access that facility, relative to HIV-negative individuals (aRR=1.91, 95% CI (1.00 to 3.65), p=0.05). Among PLHIV, residential distance was associated with access to facilities providing ART (RR=0.78, 95% CI (0.61 to 0.99), p=0

Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa--methods and results in Northern Malawi.

PubMed

Houben, Rein M G J; Van Boeckel, Thomas P; Mwinuka, Venance; Mzumara, Peter; Branson, Keith; Linard, Catherine; Chimbwandira, Frank; French, Neil; Glynn, Judith R; Crampin, Amelia C

2012-11-15

Decentralised health services form a key part of chronic care strategies in resource-limited settings by reducing the distance between patient and clinic and thereby the time and costs involved in travelling. However, few tools exist to evaluate the impact of decentralisation on patient travel time or what proportion of patients attend their nearest clinic. Here we develop methods to monitor changes in travel time, using data from the antiretroviral therapy (ART) roll-out in a rural district in North Malawi. Clinic position was combined with GPS information on the home village of patients accessing ART services in Karonga District (North Malawi) between July 2005 and July 2009. Potential travel time was estimated as the travel time for an individual attending their nearest clinic, and estimated actual travel time as the time to the clinic attended. This allowed us to calculate changes in potential and actual travel time as new clinics opened and track the proportion and origin of patients not accessing their nearest clinic. The model showed how the opening of further ART clinics in Karonga District reduced median potential travel time from 83 to 43 minutes, and median actual travel time fell from 83 to 47 minutes. The proportion of patients not attending their nearest clinic increased from 6% when two clinics were open, to 12% with four open. Integrating GPS information with patient data shows the impact of decentralisation on travel time and clinic choice to inform policy and research questions. In our case study, travel time decreased, accompanied by an increased uptake of services. However, the model also identified an increasing proportion of ART patients did not attend their nearest clinic.

Health risks, travel preparation, and illness among public health professionals during international travel.

PubMed

Balaban, Victor; Warnock, Eli; Ramana Dhara, V; Jean-Louis, Lee Ann; Sotir, Mark J; Kozarsky, Phyllis

2014-01-01

Few data currently exist on health risks faced by public health professionals (PHP) during international travel. We conducted pre- and post-travel health surveys to assess knowledge, attitudes, and practices (KAP), and illnesses among PHP international travelers. Anonymous surveys were completed by PHP from a large American public health agency who sought a pre-travel medical consult from September 1, 2009, to September 30, 2010. Surveys were completed by 122 participants; travelers went to 163 countries. Of the 122 respondents, 97 (80%) reported at least one planned health risk activity (visiting rural areas, handling animals, contact with blood or body fluids, visiting malarious areas), and 50 (41%) reported exposure to unanticipated health risks. Of the 62 travelers who visited malarious areas, 14 (23%) reported inconsistent or no use of malaria prophylaxis. Illness during travel was reported by 33 (27%) respondents. Most of the PHP travelers in our study reported at least one planned health risk activity, and almost half reported exposure to unanticipated health risks, and one-quarter of travelers to malarious areas reported inconsistent or no use of malaria chemoprophylaxis. Our findings highlight that communication and education outreach for PHP to prevent travel-associated illnesses can be improved. Published by Elsevier Ltd.

The impact of a museum travelling exhibition on middle school teachers and students from rural, low-income homes

NASA Astrophysics Data System (ADS)

Badger, James; Harker, Richard J. W.

2016-06-01

Schools may be places of learning, but a great deal of learning occurs outside of school. A growing body of literature investigates how school field trips allow rural students to make real-life connections with their school curriculum. This paper contributes to that area of research by describing how students from five middle schools in the United States responded to a travelling museum exhibition hosted at a non-museum site. The authors explore the impact of the exhibition on students from poor, rural backgrounds, discussing how it helped them to engage with themes such as freedom of expression, democracy, citizenship and Holocaust education. The results show that, by connecting curricular content with real-life situations, field trips such as this have the potential to change not only students' understanding of the curriculum, but also their teachers' estimation of their abilities.

Advanced traveler information systems (ATIS) : development and testing of a surveillance and delay advisory system for rural areas, and evaluation of satellite communications system for mayday applications

DOT National Transportation Integrated Search

1999-04-01

In early 1993, the Federal Highway Administration (FHWA) initiated a comprehensive study of rural applications of Advanced Traveler Information Systems (ATIS). The study objectives were to guide Federal programs with respect to Intelligent Transporta...

Pre-travel health preparation for malaria prevention among Hong Kong travellers.

PubMed

Hung, Kevin K C; Lin, Agatha K Y; Cheng, Calvin K Y; Chan, Emily Y Y; Graham, Colin A

2015-03-01

Malaria remains a significant cause of travel-related mortality and morbidity. Asians are known to have higher risks because they are less careful in pre-travel health preparations. This study reports on a cohort of travellers to malaria-prone regions examined in a previous study, which explored general levels of pre-travel health preparation. To describe the preparations taken by travellers at Hong Kong International Airport going to destinations with significant malaria risks according to the WHO. A cross-sectional survey was conducted by personal interviews at the boarding gates of flights in April 2013. The flights were chosen from those to malaria-prone regions (type I or above) from the 2012 WHO International Travel and Health Country List. 403 respondents (75.6% Chinese ethnicity) were travelling to malaria-prone regions. 95.3% were travelling to developing countries including China, Thailand, Malaysia and India. 55.1% of respondents had taken at least one mosquito prevention measure and 8.9% of respondents had malaria chemoprophylaxis. Stepwise multivariate logistic regression analysis showed that female gender (OR=2.21, 95% CI 1.23 to 3.97), residence outside Hong Kong (OR=2.71, 95% CI 1.46 to 5.04) and travel including rural areas (OR=5.67, 95% CI 3.11 to 10.34) were predictors of optimum pre-travel health preparations. Underestimation of malaria risks was a major barrier to adequate pre-travel health preparations. Targeted health education and information about risk is necessary to improve levels of travel health preparedness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Making a case for telehealth: measuring the carbon cost of health-related travel.

PubMed

Ellis, Isabelle; Cheek, Colleen; Jaffray, Linda; Skinner, Timothy

2013-01-01

Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanism. In planning a range of new telehealth services to a rural community the authors sought to quantify the travel conducted by people from one rural area in Australia to access health care, and to calculate the associated carbon emissions. A population survey was conducted over a 1-week period of health-related travel events for the year 1 July 2011 to 30 June 2012 of all households on King Island, a community situated between the Australian mainland state of Victoria and the state of Tasmania. Validated emissions calculators were sourced from the Carbon Neutral website, including the vehicle and fuel use calculator and air travel carbon calculator, to calculate the total emissions associated with the fuel burned in tonnes of carbon dioxide equivalent (tCO2e). Thirty nine percent of the population (625 participants) reported a total of 511 healthcare-related travel events. Participants travelled a total of 346 573 km and generated 0.22 tCO2e per capita. Participants paid the cost of their own travel more than 70% of the time. Dependence on fossil fuels for transport in a carbon economy has a significant impact on total healthcare carbon emissions. Alternative models of care, such as telehealth, need be developed for an environmentally sustainable healthcare system for rural and remote areas.

Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

ERIC Educational Resources Information Center

Weichel, Derek

2012-01-01

Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…

Rural public transportation technologies : user needs and applications

DOT National Transportation Integrated Search

1998-09-01

Rural Intelligent Transportation Systems (ITS) have the ability to meet the needs of travelers in and through rural areas as well as the needs of agencies responsible for the operation and maintenance of rural transportation systems. To assist in the...

Meningococcal vaccination for international travellers from Greece visiting developing countries.

PubMed

Pavli, Androula; Katerelos, Panagiotis; Smeti, Paraskevi; Maltezou, Helena C

2016-01-01

Meningococcal meningitis is a serious disease. Travel-associated infection for the general traveller is low; however regular epidemics in indigenous population, particularly in sub-Saharan Africa are responsible for significant morbidity and mortality. Our aim was to assess meningococcal vaccination for international travellers from Greece. A prospective questionnaire-based study was conducted during 2009-2013. A total of 5283 travellers were studied (median age: 39.2 years); Meningococcal tetravalent vaccine (A,C,W135,Y) was delivered to 1150 (21.8%) of them. Of those who travelled to the Middle East and sub-Saharan Africa, 73.1% and 21.2% received meningococcal vaccine, respectively. Of those travellers who travelled to sub-Saharan Africa from November to June and from July to October, 22.1% and 20.6% were vaccinated with meningococcal vaccine, respectively. Of all travellers who travelled for <1 month and ≥1 month, 23.3%, and 20.5%, were vaccinated, respectively. Meningococcal vaccine was administered to 95.3% of pilgrims, 17.4% of those visiting friends and relatives (VFRs), 16.7% of those who travelled for recreation, and 13.8% of those who travelled for work. Of travellers who stayed in urban, in rural, and in urban and rural areas, 32%, 11.6% and 12.7% were vaccinated, respectively. Meningococcal vaccine was delivered to 29.2%, 21.1%, 19.4% and 5.1% of those who stayed in hotels, at local people's home, in camps, and on ships, respectively. The association of meningococcal vaccine administration with the destination, duration and purpose of travel, area of stay and type of accommodation was statistically significant. There is a need to improve meningococcal vaccine recommendations for travellers from Greece, particularly for high risk populations, such as VFRs, business travellers and those visiting sub-Saharan Africa especially during the dry season. Copyright © 2016 Elsevier Ltd. All rights reserved.

How Does Degree of Rurality Impact the Provision of Surgical Services at Rural Hospitals?

ERIC Educational Resources Information Center

Doty, Brit; Zuckerman, Randall; Finlayson, Samuel; Jenkins, Paul; Rieb, Nathaniel; Heneghan, Steven

2008-01-01

Context: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services. Rural communities vary in size…

Evaluation plan : the Branson Travel and Recreational Information Program field operational test

DOT National Transportation Integrated Search

1998-02-25

The Branson Travel and Recreational Information Program (TRIP) is a Field Operational Test (FOT) of Traveler Information Services in Tourism Areas funded through the National Advanced Rural Transportation Systems Program. Over the past ten years, Bra...

Travel burden and dentist bypass among dentally insured children.

PubMed

McKernan, Susan C; Pooley, Mark J; Momany, Elizabeth T; Kuthy, Raymond A

2016-06-01

Using administrative data from Iowa Medicaid and a large private dental insurer, we compared distance to the nearest primary care dentist for children ages 6-15 in 2012. Additionally, we examined rates of provider bypass in both populations as an indicator of spatial accessibility to dental care. We calculated measures of travel burden, including distance to the nearest primary care dentist and distance to current primary care dentist. Distance outcomes and rates of bypass, traveling beyond the nearest dentist for care, were compared by insurance type. We found that Medicaid-enrolled children lived farther from the nearest dentist and farther from their current dentist than privately insured children. However, rates of bypass were higher among the privately insured population. These results were consistent among urban and rural residents; additionally, both rural populations demonstrated greater travel distances than urban dwellers. Travel burden was greater among Medicaid-enrolled children. Lower rates of bypass, in conjunction with lower rates of dental utilization in this population, may indicate a distance threshold beyond which dental care becomes unattainable. © 2016 American Association of Public Health Dentistry.

Intercity travel in northeastern rural regions of the U.S.

DOT National Transportation Integrated Search

2015-06-01

Much research exists on intercity travel behavior between large metropolitan centers. : There is an opportunity for more research on travel from less populated areas to large : metropolitan ones. When planning a trip from Northern New England to majo...

Travel Agent. Occupational Simulation Kit.

ERIC Educational Resources Information Center

Peterson, Wayne

This career exploration instructional booklet on the travel agent's occupation is one of several resulting from the rural southwestern Colorado CEPAC Project (Career Education Process of Attitude Change). Based on a job analysis and utilizing a programed instructional format, the following content is included: A brief description of what a travel…

Typhoid vaccination for international travelers from Greece visiting developing countries.

PubMed

Smeti, Paraskevi; Pavli, Androula; Katerelos, Panagiotis; Maltezou, Helena C

2014-01-01

Typhoid fever is one of the most common diagnoses in returned international travelers. Our aim was to study the typhoid vaccine prescription practices for travelers from Greece visiting developing countries. A prospective questionnaire-based study was conducted during 2009-2012 in 57 Public Health Departments, which are the only sources of typhoid vaccine in Greece. A total of 3,680 travelers were studied (median age: 38.1 years). Typhoid vaccine was delivered to 1,108 (30.1%) of them. Of those who traveled to sub-Saharan Africa, South America, the Middle East, the Indian subcontinent, Southeast Asia, South Africa, East Asia, North Africa, and Central America, 31.6, 17.1, 35, 44.2, 36.9, 31, 17.7, 31.6, and 36.8% received typhoid vaccine, respectively. Of travelers who stayed <1 month, 1 to <3 months, 3 to <6 months, and ≥6 months, 21.4, 63.1, 32.3, and 34.9% were vaccinated, respectively. According to the purpose of travel, typhoid vaccine was administered to 32.7% of those who traveled for leisure, to 28.8% of those who traveled for business, and to 24.1% of those visiting friends and relatives (VFRs). Of travelers who stayed in urban areas, rural areas, and urban and rural areas, 36.3, 30.1, and 26.8% were vaccinated, respectively. The majority of travelers who received the typhoid vaccine stayed in camps (62.9%) or at local residences (41%). Typhoid vaccine administration was statistically significantly associated with destination, duration of travel, purpose of travel, area of stay, and type of accommodation. There is a need to increase awareness of travelers and public health professionals for typhoid vaccination and particularly for high-risk groups of travelers, such as travelers to the Indian subcontinent and VFRs. Strategies for continuing professional education should be developed for travel health professionals. © 2013 International Society of Travel Medicine.

Use of Prolonged Travel to Improve Pediatric Risk-Adjustment Models

PubMed Central

Lorch, Scott A; Silber, Jeffrey H; Even-Shoshan, Orit; Millman, Andrea

2009-01-01

Objective To determine whether travel variables could explain previously reported differences in lengths of stay (LOS), readmission, or death at children's hospitals versus other hospital types. Data Source Hospital discharge data from Pennsylvania between 1996 and 1998. Study Design A population cohort of children aged 1–17 years with one of 19 common pediatric conditions was created (N=51,855). Regression models were constructed to determine difference for LOS, readmission, or death between children's hospitals and other types of hospitals after including five types of additional illness severity variables to a traditional risk-adjustment model. Principal Findings With the traditional risk-adjustment model, children traveling longer to children's or rural hospitals had longer adjusted LOS and higher readmission rates. Inclusion of either a geocoded travel time variable or a nongeocoded travel distance variable provided the largest reduction in adjusted LOS, adjusted readmission rates, and adjusted mortality rates for children's hospitals and rural hospitals compared with other types of hospitals. Conclusions Adding a travel variable to traditional severity adjustment models may improve the assessment of an individual hospital's pediatric care by reducing systematic differences between different types of hospitals. PMID:19207591

Unmet supportive care needs of haematological cancer survivors: rural versus urban residents.

PubMed

Tzelepis, Flora; Paul, Christine L; Sanson-Fisher, Robert W; Campbell, H Sharon; Bradstock, Kenneth; Carey, Mariko L; Williamson, Anna

2018-07-01

Due to fewer cancer services in rural locations, rural survivors may have unique unmet needs compared to urban survivors. This study compared among rural and urban haematological cancer survivors the most common "high/very high" unmet supportive care needs and the unmet need scores for five domains (information, financial concerns, access and continuity of care, relationships and emotional health). Survivors' socio-demographics, rurality, cancer history and psychological factors associated with each unmet need domain were also explored. A total of 1511 haematological cancer survivors were recruited from five Australian state cancer registries and 1417 (1145 urban, 272 rural) allowed extraction of their residential postcode from registry records. A questionnaire that contained the Survivor Unmet Needs Survey was mailed to survivors. Dealing with feeling tired was the most common "high/very high" unmet need for rural (15.2%) and urban (15.5%) survivors. The emotional health domain had the highest mean unmet need score for rural and urban survivors. Rurality was associated with a decreased unmet emotional health domain score whereas travelling for more than 1 h to treatment was associated with increased unmet financial concerns and unmet access and continuity of care. Depression, anxiety and stress were associated with increased unmet need scores for all five domains. Unmet need domain scores generally did not differ by rurality. Travelling for more than 1 h to treatment was associated with increased unmet need scores on two domains. Telemedicine and increased financial assistance with travel and accommodation may help those travelling long distances for treatment.

Effects of patient load and travel distance on HIV transmission in rural China: Implications for treatment as prevention.

PubMed

Smith, M Kumi; Miller, William C; Liu, Huixin; Ning, Chuanyi; He, Wensheng; Cohen, Myron S; Wang, Ning

2017-01-01

Sustained viral suppression through ART reduces sexual HIV transmission risk, but may require routine access to reliable and effective medical care which may be difficult to obtain in resource constrained areas. We investigated the roles of patient load and travel distance to HIV care clinic on transmission risk in HIV serodiscordant couples in Henan Province, China. Cox proportional hazard models were used to compare HIV transmission events across couples living near, medium, or farther distances from their assigned HIV care clinics, as well as those attending clinics where clinicians bore high versus low patient loads. Most (84·4%) of the 3695 serodiscordant couples lived within 10 kilometers of their assigned HIV clinic, and most (73·5%) attended clinics with patient-to-provider ratios of at least 100:1. In adjusted Cox models, attending clinics where clinicians bore average patient loads of 100 or more elevated HIV transmission risk (aHR, 1·50, 95% CI, 1·00-4·84), an effect amplified in village tier clinics (aHR = 1·55; 95% CI, 1·23-6·78). Travel distance was associated with HIV transmission only after stratification; traveling medium distances to village clinics (5-10km) increased transmission risk (aHR = 1·83, 95% CI, 1·04-3·21) whereas traveling longer distances to township or county level clinics lowered transmission risk (aHR = 0·10, 95% CI, 0·01-0·75). Higher patient loads at HIV clinics was associated with risk of HIV transmission in our population, particularly at village level clinics. Farther travel distance had divergent effects based on clinic tier, suggesting unique mechanisms operating across levels of resource availability. The resource intensity of long-term HIV treatment may place significant strains on small rural clinics, for which investments in additional support staff or time-saving tools such as point-of-care laboratory testing may bring about impactful change in treatment outcomes.

Evaluation plan : the I-40 Traveler and Tourist Information System field operational test

DOT National Transportation Integrated Search

1998-02-25

The I-40 Traveler and Tourist Information System (TTIS) in northern Arizona is a Field Operational Test (FOT) of Traveler Information Services in Tourism Areas funded through the National Advanced Rural Transportation Systems Program. The segment of ...

Educating Australian Circus Children: Strategies To Reinvigorate Rural Education.

ERIC Educational Resources Information Center

Danaher, P. A.; Hallinan, P. M.; Moriarty, B. J.

1999-01-01

Explores the educational experiences of Australian travelling circus people, who regularly cross the boundaries between urban and rural, as evidence contradicting pervasive negative stereotypes about rural education. Discusses implications of these experiences for reinvigorating education in rural Australia. Calls for enactment of strategies that…

Signing on very low volume rural roads.

DOT National Transportation Integrated Search

1984-07-01

Research was undertaken to define an appropriate level of use : of traffic control devices on rural secondary roads that carry very : low traffic volumes. The goal of this research was to improve the : safety and efficiency of travel on the rural sec...

Rural Public Transportation Technologies: User Needs and Applications. Tech Brief.

DOT National Transportation Integrated Search

1998-09-01

Rural Intelligent Transportation Systems (ITS) have the ability to meet the needs of travelers in and through rural areas as well as the needs of agencies responsible for the operation and maintenance of rural transportation systems. To assist in the...

Space Invaders and Pedagogical Innovators: Regional Educational Understandings from Australian Occupational Travelers

ERIC Educational Resources Information Center

Danaher, Patrick Alan; Danaher, Geoff; Moriarty, Beverley

2003-01-01

Australian occupational Travelers such as circus and fairground people often enter territories normally occupied by permanent residents. This article examines the ways in which these Travelers act as "space invaders," disrupting the boundaries between urban and rural, and as pedagogical innovators, when they develop pioneering approaches…

Travel time and cancer care: an example of the inverse care law?

PubMed

Baird, G; Flynn, R; Baxter, G; Donnelly, M; Lawrence, J

2008-01-01

There is growing evidence that in rural areas cancer mortality is higher and referral occurs later, indicating different patterns of care. In Scotland services to rural areas have been organized through 'managed clinical networks'. In some cases, these organizational networks have been structured so that the referral hospital is not the one nearest to the patient's home. This study set out to discover if access to cancer specialist care in mainland Scotland altered with distance to tertiary care facilities. The aim was to explore the relationship between hospital admission rates, type of hospital and travel time. Retrospective analysis of all registered cancers in Scotland over the three-year period 2000-2002, examining incidence rates and accessibility of care over 3 years, measured by hospital discharge rates (equivalent to admission rates) and mean bed days for cancer patients. The type of hospital to which a cancer patient was admitted and the duration of admission varied with travel distance from a patient's home. All patients travelling more than one hour had lower admission rates to a specialist cancer centre. Those travelling more than 3 hours were not always admitted to the facility nearest their home address and were admitted for significantly fewer days than all other groups. Differences in tertiary cancer care obtained may explain some of the reasons behind late presentation and higher mortality rates. This study provides evidence that the recognized increased cancer mortality in rural patients is indeed compounded by an increased travel burden.

Update on Tick-Borne Bacterial Diseases in Travelers.

PubMed

Eldin, Carole; Parola, Philippe

2018-05-22

Ticks are the second most important vectors of infectious diseases after mosquitoes worldwide. The growth of international tourism including in rural and remote places increasingly exposes travelers to tick bite. Our aim was to review the main tick-borne infectious diseases reported in travelers in the past 5 years. In recent years, tick-borne bacterial diseases have emerged in travelers including spotted fever group (SFG) rickettsioses, borrelioses, and diseases caused by bacteria of the Anaplasmataceae family. African tick-bite fever, due to Rickettsia africae, is the most frequent agent reported in travelers returned from Sub-Saharan areas. Other SFG agents are increasingly reported in travelers, and clinicians should be aware of them. Lyme disease can be misdiagnosed in Southern countries. Organisms causing tick-borne relapsing fever are neglected pathogens worldwide, and reports in travelers have allowed the description of new species. Infections due to Anaplasmataceae bacteria are more rarely described in travelers, but a new species of Neoehrlichia has recently been detected in a traveler. The treatment of these infections relies on doxycycline, and travelers should be informed before the trip about prevention measures against tick bites.

Advanced traveler information services in rural tourism areas : Branson Travel and Recreational Information Program (Missouri) and Interstate 40 Traveler and Tourist Information System (Arizona)

DOT National Transportation Integrated Search

2000-06-30

The Branson Travel and Recreational Information Program (Branson TRIP) in Branson, Missouri, and the I-40 Traveler and Tourist Information System (I-40 TTIS) in northern Arizona are field operational tests (FOTs) being conducted through partnerships ...

"Finding my own time": examining the spatially produced experiences of rural RNs in the rural nursing certificate program.

PubMed

Place, Jessica; MacLeod, Martha; John, Norma; Adamack, Monica; Lindsey, A Elizabeth

2012-07-01

Rural nurses require access to education that exposes them to the most up-to-date information and skill development. However, since most education opportunities are located in urban centers and focused on providing skills to urban nurses, geography effectively acts as a barrier to accessing education that meets the needs of rural nurses. The Rural Nursing Certificate Program is a post-basic education program that addresses these concerns by providing rural-relevant content online, with limited campus sessions. Does online delivery of rural nursing curriculum overcome challenges related to geography? This study employed surveys with some open-ended questions. Analysis included descriptive statistics and content analysis. Students reported that online delivery improved access. Benefits included not having to relocate; being able to continue working; and, flexibility. Challenges included travel for practical experiences and time management related to staffing shortages, personal-professional overlap and family responsibilities. Online learning improved access to nursing education. However, the realities of rural nursing made it impossible to completely overcome geography: sense of obligation to work overtime, cost and time of traveling to workshops and practicums, uneven access to the Internet and computer services, and distance from peer and university support remained challenges. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Tale of Two Cancers: Traveling to Treat Pancreatic and Thyroid Cancer.

PubMed

White, Michael G; Applewhite, Megan K; Kaplan, Edwin L; Angelos, Peter; Huo, Dezheng; Grogan, Raymon H

2017-07-01

Patients diagnosed with a malignancy must decide whether to travel for care at an academic center or receive treatment at a nearby hospital. Here we examine differences in demographics, treatment, and outcomes of those traveling to academic centers for their care vs those not traveling, as well as compare travel for an aggressive vs indolent malignancy. All patients with papillary thyroid carcinoma (PTC) or pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection and in the National Cancer Database were examined. Travel for care was abstracted from "crowfly" distance between patients' ZIP codes and treatment facility, region, county size, urban/metro/rural status, and facility type. In total, 105,677 patients with PTC and 22,983 patients with PDAC were analyzed. There were no survival differences by travel in the PTC group. Survival was improved for patients with PDAC traveling from urban/rural settings (hazard ratio = 0.89; 95% CI 0.82 to 0.96; p = 0.002). Patients traveling with PDAC were more likely to have a complete resection and lymph node dissection. Those traveling were less likely to receive chemotherapy or radiotherapy (all p < 0.001). Those traveling with PTC were older, more likely to be male, have Medicare insurance, and had a higher stage of disease (all p < 0.001). Rates of radioactive iodine were lower, American Thyroid Association guidelines were more likely followed, and lymph node dissection was more common for those traveling for care of their PTC (all p < 0.001). There are improvements in both quality and survival for those traveling to academic centers for their cancer care. In the case of PTC, this difference in quality did not affect overall survival. In PDAC, however, differences in quality translated to a survival advantage. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Travel time on arterials and rural highways : state-of-the-practice synthesis on rural data collection technology.

DOT National Transportation Integrated Search

2013-04-01

"Travel time to a destination is a key piece of information that motorists want and need, and is vital for good decision-making by travelers. Technology now makes it feasible to provide drivers with real-time information about how long it takes to re...

Health, sustainability and student travel.

PubMed

Green, Gill; Morris, Jenny; Wade, Margaret

2012-01-01

A survey of 246 pre-registration nursing students in a University in the South West of England was carried out to explore the impact of course related travel on the student experience. Results from the survey indicated that students' main mode of transport to practice placements was by car which reflects the rural nature of the South West and the relative paucity of public transport. Long distances that many students travel to their study centre and to placements, and the concurrent financial strain that this creates, impacted negatively on the student experience. Students recognised the need to travel to a place of study and clinical placements and suggestions of minimising the negative impact of travel were offered. These included the increased use of electronic delivery of lectures, attendance at local university premises, the provision of shared transport to placements and placements closer to the student's home. Few students, however, considered the environmental impact of travel. Higher Education Institutions need to address issues of sustainability through promoting student wellbeing and taking steps to reduce greenhouse gas emissions. It is therefore important that student awareness of sustainability related issues is increased as well as focusing on reducing the environmental impact through organisational change. Copyright © 2011 Elsevier Ltd. All rights reserved.

78 FR 19586 - Grants for Transportation of Veterans in Highly Rural Areas

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... travel to VA medical centers, and to otherwise assist in providing transportation services in connection... travel to VA medical centers, and to otherwise assist in providing transportation in connection with the... grant funds are to be used to ``assist veterans in highly rural areas to travel to Department of...

On-time reliability impacts of advanced traveler information services (ATIS) : Washington, DC case study, executive summary

DOT National Transportation Integrated Search

1999-05-01

This report documents the development and testing of a Surveillance and Delay Advisory System (SDAS) for application in congested rural areas. SDAS included several techniques that could be used on rural highways to give travelers advance information...

A week in the life of a travel clinic.

PubMed Central

Blair, D C

1997-01-01

International travel has increased enormously in recent years. With the greater movement of people have come increased encounters with a wide variety of diseases: malaria, dengue, cholera, typhoid fever, Ebola virus, and many more. The need for greater scope, consistency, and knowledgeability in pretravel health care to meet these challenges has been met by the emergence of the discipline of travel medicine. Travelers are well advised to become informed of the risks they face and to take steps to minimize those risks. After reviewing a traveler's medical history and a detailed itinerary, a travel medicine practitioner can offer expert advice on behavioral modifications, immunizations, and chemoprophylaxis regimens which will increase the traveler's margin of safety. The issues most frequently addressed in a travel clinic include treatment of traveler's diarrhea, malaria chemoprophylaxis, and immunizations, for hepatitis A, typhoid fever, tetanus/diphtheria, influenza, pneumococcus, hepatitis B, polio, meningococcus, measles, mumps, rubella, varicella, and rabies. Pretravel consultation must consider the age and underlying health problems of the traveler, the nature of the trip (wilderness, jungle, rural, urban, resort, or cruise), the duration of travel, and the latest available information on the site in terms of disease outbreaks, terrorism, and natural calamities. PMID:9336667

Application of a Telecolposcopy Program in Rural Settings.

PubMed

Hitt, Wilbur C; Low, Gordon M; Lynch, Christian E; Gauss, C Heath; Magann, Everett F; Lowery, Curtis L; Eswaran, Hari

2016-10-01

Individuals in rural areas are often restricted by the amount of physicians' availability, thus limiting access to healthcare in those settings. While Pap smear screening has increased across the United States, the rural South still reports high rates of cervical cancer and mortality. One solution to improve patient outcomes related to cervical cancer in rural settings is telecolposcopy. Women with abnormal Pap results or an abnormal visual examination needing an evaluation by colposcopy were referred to a hospital-based telecolposcopy program. Descriptive data are provided that include patients' access to care based on travel time and transportation costs. Over a 15-month time period, 940 unique patients were seen using telecolposcopy. Telecolposcopy was done at eight spoke sites across Arkansas representing patients from 72 of the 75 counties. Data for risk factors that include smoking, first sexual experience, and number of sexual partners in past 12 months and in a lifetime are discussed. Pap results and impression are provided. In addition, avoided transportation costs and travel time have been calculated and included. Cervical cancer is important public health concern especially for women residing in rural areas. We were able to demonstrate that our telecolposcopy program has provided sustainability statewide since its inception and that patients are willing to participate. In addition to providing increased access to care, the program also reduced travel time and costs associated with a face-to-face visit. Telecolposcopy should be further explored and utilized in rural settings as a way to reduce patient costs and improve cervical cancer outcomes.

Travelling for treatment; does distance and deprivation affect travel for intensity-modulated radiotherapy in the rural setting for head and neck cancer?

PubMed

Cosway, B; Douglas, L; Armstrong, N; Robson, A

2017-06-01

NHS England has commissioned intensity-modulated radiotherapy for head and neck cancers from Newcastle hospitals for patients in North Cumbria. This study assessed whether travel distances affected the decision to travel to Newcastle (to receive intensity-modulated radiotherapy) or Carlisle (to receive conformal radiotherapy). All patients for whom the multidisciplinary team recommended intensity-modulated radiotherapy between December 2013 and January 2016 were included. Index of multiple deprivation scores and travel distances were calculated. Patients were also asked why they chose their treating centre. Sixty-nine patients were included in this study. There were no significant differences in travel distance (p = 0.53) or index of multiple deprivation scores (p = 0.47) between patients opting for treatment in Carlisle or Newcastle. However, 29 of the 33 patients gave travel distance as their main reason for not travelling for treatment. Quantitatively, travel distance and deprivation does not impact on whether patients accept intensity-modulated radiotherapy. However, patients say distance is a major barrier for access. Future research should explore how to reduce this.

Interdisciplinary rural immersion week.

PubMed

Deutchman, Mark E; Nearing, Kathryn; Baumgarten, Brenda; Westfall, John M

2012-01-01

Health professions students interested in future rural practice locations spend a week learning about and investigating all aspects of small town personal, professional and community life. This augments the mainly clinical experience provided by clinical rotations they complete as part of their professional academic training program. Students from professional programs in medicine, physician assistant, pharmacy, nursing, public health and psychology travel to a small community, receive an orientation and in small interprofessional groups investigate health care, education, government, law enforcement, public health, economy and natural resources. Participants report that the experience raises their interest in future rural practice, answers questions they have about rural life and enhances their understanding of the issues they must learn more about before making a career location choice. The interdisciplinary rural immersion program provides students with the time, structure and permission to move out of their clinical 'comfort zone' and think about the cultural, economic and environmental aspects of rural life and work.

The reliability of pre-travel history to decide on appropriate counseling and vaccinations: a prospective study.

PubMed

Rossi, Isabelle A; Genton, Blaise

2012-01-01

Although medical and travel plans gathered from pre-travel interviews are used to decide the provision of specific pre-travel health advice and vaccinations, there has been no evaluation of the relevance of this strategy. In a prospective study, we assessed the agreement between pre-travel plans and post-travel history and the effect on advice regarding the administration of vaccines and recommendations for malaria prevention. We included prospectively all consenting adults who had not planned an organized tour. Pre- and post-travel information included questions on destination, itineraries, departure and return dates, access to bottled water, plan of bicycle ride, stays in a rural zone, and close contact with animals. The outcomes measured included: agreement between pre- and post-travel itineraries and activities; and the effect of these differences on pre-travel health recommendations, had the traveler gone to the actual versus intended destinations for actual versus intended duration and activities. Three hundred and sixty-five travelers were included in the survey, where 188 (52%) were males (median age 38 years). In 81(23%) travelers, there was no difference between pre- and post-travel history. Disagreement between pre- and post-travel history were the highest for stays in rural zones or with local people (66% of travelers), close contact with animals (33%), and bicycle riding (21%). According to post-travel history, 125 (35%) travelers would have needed rabies vaccine and 9 (3%) typhoid fever vaccine. Potential overprovision of vaccine was found in <2% of travelers. A change in the malaria prescription would have been recommended in 18 (5%) travelers. Pre-travel history does not adequately reflect what travelers do. However, difference between recommendations for the actual versus intended travel plans was only clinically significant for the need for rabies vaccine. Particular attention during pre-travel health counseling should focus on the risk of rabies

Associations between active travel to work and overweight, hypertension, and diabetes in India: a cross-sectional study.

PubMed

Millett, Christopher; Agrawal, Sutapa; Sullivan, Ruth; Vaz, Mario; Kurpad, Anura; Bharathi, A V; Prabhakaran, Dorairaj; Reddy, Kolli Srinath; Kinra, Sanjay; Smith, George Davey; Ebrahim, Shah

2013-01-01

Increasing active travel (walking, bicycling, and public transport) is promoted as a key strategy to increase physical activity and reduce the growing burden of noncommunicable diseases (NCDs) globally. Little is known about patterns of active travel or associated cardiovascular health benefits in low- and middle-income countries. This study examines mode and duration of travel to work in rural and urban India and associations between active travel and overweight, hypertension, and diabetes. Cross-sectional study of 3,902 participants (1,366 rural, 2,536 urban) in the Indian Migration Study. Associations between mode and duration of active travel and cardiovascular risk factors were assessed using random-effect logistic regression models adjusting for age, sex, caste, standard of living, occupation, factory location, leisure time physical activity, daily fat intake, smoking status, and alcohol use. Rural dwellers were significantly more likely to bicycle (68.3% versus 15.9%; p<0.001) to work than urban dwellers. The prevalence of overweight or obesity was 50.0%, 37.6%, 24.2%, 24.9%; hypertension was 17.7%, 11.8%, 6.5%, 9.8%; and diabetes was 10.8%, 7.4%, 3.8%, 7.3% in participants who travelled to work by private transport, public transport, bicycling, and walking, respectively. In the adjusted analysis, those walking (adjusted risk ratio [ARR] 0.72; 95% CI 0.58-0.88) or bicycling to work (ARR 0.66; 95% CI 0.55-0.77) were significantly less likely to be overweight or obese than those travelling by private transport. Those bicycling to work were significantly less likely to have hypertension (ARR 0.51; 95% CI 0.36-0.71) or diabetes (ARR 0.65; 95% CI 0.44-0.95). There was evidence of a dose-response relationship between duration of bicycling to work and being overweight, having hypertension or diabetes. The main limitation of the study is the cross-sectional design, which limits causal inference for the associations found. Walking and bicycling to work was associated

Access to Cancer Services for Rural Colorectal Cancer Patients

ERIC Educational Resources Information Center

Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary

2008-01-01

Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…

Geographic Access to Health Care for Rural Medicare Beneficiaries

ERIC Educational Resources Information Center

Chan, Leighton; Hart, L. Gary; Goodman, David C.

2006-01-01

Context: Patients in rural areas may use less medical care than those living in urban areas. This could be due to differences in travel distance and time and a utilization of a different mix of generalists and specialists for their care. Purpose: To compare the travel times, distances, and physician specialty mix of all Medicare patients living in…

Distance traveled for Medicaid-covered abortion care in California.

PubMed

Johns, Nicole E; Foster, Diana Greene; Upadhyay, Ushma D

2017-04-19

Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care. We obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization. 11.9% (95% CI: 11.5-12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions. Efforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.

Associations between Active Travel to Work and Overweight, Hypertension, and Diabetes in India: A Cross-Sectional Study

PubMed Central

Millett, Christopher; Agrawal, Sutapa; Sullivan, Ruth; Vaz, Mario; Kurpad, Anura; Bharathi, A. V.; Prabhakaran, Dorairaj; Reddy, Kolli Srinath; Kinra, Sanjay; Smith, George Davey; Ebrahim, Shah

2013-01-01

Background Increasing active travel (walking, bicycling, and public transport) is promoted as a key strategy to increase physical activity and reduce the growing burden of noncommunicable diseases (NCDs) globally. Little is known about patterns of active travel or associated cardiovascular health benefits in low- and middle-income countries. This study examines mode and duration of travel to work in rural and urban India and associations between active travel and overweight, hypertension, and diabetes. Methods and Findings Cross-sectional study of 3,902 participants (1,366 rural, 2,536 urban) in the Indian Migration Study. Associations between mode and duration of active travel and cardiovascular risk factors were assessed using random-effect logistic regression models adjusting for age, sex, caste, standard of living, occupation, factory location, leisure time physical activity, daily fat intake, smoking status, and alcohol use. Rural dwellers were significantly more likely to bicycle (68.3% versus 15.9%; p<0.001) to work than urban dwellers. The prevalence of overweight or obesity was 50.0%, 37.6%, 24.2%, 24.9%; hypertension was 17.7%, 11.8%, 6.5%, 9.8%; and diabetes was 10.8%, 7.4%, 3.8%, 7.3% in participants who travelled to work by private transport, public transport, bicycling, and walking, respectively. In the adjusted analysis, those walking (adjusted risk ratio [ARR] 0.72; 95% CI 0.58–0.88) or bicycling to work (ARR 0.66; 95% CI 0.55–0.77) were significantly less likely to be overweight or obese than those travelling by private transport. Those bicycling to work were significantly less likely to have hypertension (ARR 0.51; 95% CI 0.36–0.71) or diabetes (ARR 0.65; 95% CI 0.44–0.95). There was evidence of a dose-response relationship between duration of bicycling to work and being overweight, having hypertension or diabetes. The main limitation of the study is the cross-sectional design, which limits causal inference for the associations found

Travel Distance and the Use of Inpatient Care among Patients with Schizophrenia

PubMed Central

Hemenway, David; Kawachi, Ichiro; Subramanian, S. V.; Chen, Wei J.

2009-01-01

This study examines the variations in the use of inpatient care that can be explained by travel distance among patients with schizophrenia living in Taiwan. Data were drawn from the Psychiatric Inpatient Medical Claims Database. We used mediation analysis and multilevel analysis to identify associations. Travel distance did not significantly account for lower readmission rates after an index admission, but significantly explained the longer length of stay of an index admission by 9.3 days (P < 0.001, 85% of variation) between remote and non-remote regions. Policies are discussed aimed at reducing the impact of travel distance on rural mental health care through inter-disciplinary collaboration and telepsychiatry. PMID:18512144

Awareness, experiences and perceptions of telehealth in a rural Queensland community.

PubMed

Bradford, Natalie K; Caffery, Liam J; Smith, Anthony C

2015-09-28

Telehealth can offer alternative options for receiving healthcare services in rural locations, improving access and reducing costs associated with traveling for services. However, the full potential of telehealth has not been realised with slow and fragmented uptake. This study describes the awareness, experiences and perceptions of telehealth in an Australian rural community. Semi-structured interviews were undertaken with 47 participants from three rural towns in the Darling Downs region of Queensland. Content analysis was used to abstract themes and core concepts from the interviews. Three participants were healthcare providers who had all previously used telehealth in their clinical practice. Twenty-seven (57 %) participants regularly travelled to access specialist healthcare. While 28 (60 %) participants were aware of telehealth, only six (13 %) had actually used telehealth services; three as patients and three as healthcare providers. Major themes evident included: acceptance of the need to travel; paternalism and empowerment; and trust and misconceptions. For telehealth initiatives to be successful, there needs to be greater public awareness and understanding of the potential benefits of telehealth. Empowering patients as partners in the delivery of healthcare may be an important factor in the growth of telehealth services.

Computing travel time when the exact address is unknown: a comparison of point and polygon ZIP code approximation methods.

PubMed

Berke, Ethan M; Shi, Xun

2009-04-29

Travel time is an important metric of geographic access to health care. We compared strategies of estimating travel times when only subject ZIP code data were available. Using simulated data from New Hampshire and Arizona, we estimated travel times to nearest cancer centers by using: 1) geometric centroid of ZIP code polygons as origins, 2) population centroids as origin, 3) service area rings around each cancer center, assigning subjects to rings by assuming they are evenly distributed within their ZIP code, 4) service area rings around each center, assuming the subjects follow the population distribution within the ZIP code. We used travel times based on street addresses as true values to validate estimates. Population-based methods have smaller errors than geometry-based methods. Within categories (geometry or population), centroid and service area methods have similar errors. Errors are smaller in urban areas than in rural areas. Population-based methods are superior to the geometry-based methods, with the population centroid method appearing to be the best choice for estimating travel time. Estimates in rural areas are less reliable.

Measures to alleviate congestion at rural intersections.

DOT National Transportation Integrated Search

2015-02-01

Many rural highways experience a surge in traffic flow levels on certain high-travel days during national holidays. Due to the : platooned nature of the high volume traffic on the main highway, vehicles on the minor approach attempting to turn ...

The Travelling Telescope

NASA Astrophysics Data System (ADS)

Murabona Oduori, Susan

2015-08-01

The telescope has been around for more than 400 years, and through good use of it scientists have made many astonishing discoveries and begun to understand our place in the universe. Most people, however, have never looked through one. Yet it is a great tool for cool science and observation especially in a continent and country with beautifully dark skies. The Travelling Telescope project aims to invite people outside under the stars to learn about those curious lights in the sky.The Travelling Telescope aims to promote science learning to a wide range of Kenyan schools in various locations exchanging knowledge about the sky through direct observations of celestial bodies using state of the art telescopes. In addition to direct observing we also teach science using various hands-on activities and astronomy software, ideal for explaining concepts which are hard to understand, and for a better grasp of the sights visible through the telescope. We are dedicated to promoting science using astronomy especially in schools, targeting children from as young as 3 years to the youth, teachers, their parents and members of the public. Our presentation focuses on the OAD funded project in rural coastal Kenya.

Rural Rides in Queensland: Travels with Novice Teaching Principals

ERIC Educational Resources Information Center

Clarke, Simon; Stevens, Elizabeth; Wildy, Helen

2006-01-01

This article is concerned with the nature of novice teaching principals' interactions in Queensland rural communities. Stories selected from case accounts are used to provide insights into the teaching principals' interrelationship with the community. The article concludes with a discussion of some implications for practice suggested by these…

The Visiting Specialist Model of Rural Health Care Delivery: A Survey in Massachusetts

ERIC Educational Resources Information Center

Drew, Jacob; Cashman, Suzanne B.; Savageau, Judith A.; Stenger, Joseph

2006-01-01

Context: Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. Purpose: To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of…

Western states one-stop shop for rural traveler information : research on Clarus system data.

DOT National Transportation Integrated Search

2011-09-01

Weather is a primary item of interest to travelers, but generally scattered numerous sources and in varying formats, making it difficult to assemble prior travel. Within this project, a website was developed to display Clarus ESS data, along with oth...

A telegeriatric service in a small rural hospital: A case study and cost analysis.

PubMed

Versleijen, Marloes; Martin-Khan, Melinda G; Whitty, Jennifer A; Smith, Anthony C; Gray, Leonard C

2015-12-01

Small hospitals in rural areas usually have an insufficient caseload of frail old people to justify the regular presence of a geriatrician. This study examined the costs of providing a telegeriatric service by videoconference in a rural hospital, compared to the costs of a visiting geriatrician that travels to undertake in-person consultations. A cost analysis was undertaken to compare the costs of the telegeriatric service model with the costs of a visiting geriatrician service model. A recently established telegeriatric service at Warwick Hospital was used as a case study. In the base case model (assuming four patients per round and a round-trip travel distance of 312 kilometres), an estimated AUD$131 per patient consultation can be saved in favour of the telegeriatric service model. Key drivers of costs are the number of patients per round and the travel distance and time in the visiting geriatrician model. At a workload of four patients per round, it is less expensive to conduct a telegeriatric service than a visiting geriatrician service when the round-trip travel time exceeds 76 minutes. Even under quite conservative assumptions, a telegeriatric service offers an economically feasible approach to the delivery of specialist geriatric assessment in rural and remote settings. © The Author(s) 2015.

Travel distance as factor in follow-up visit compliance in postlaparoscopic adjustable gastric banding population.

PubMed

DeNino, Walter F; Osler, Turner; Evans, Ellen G; Forgione, Patrick M

2010-01-01

Despite the 2008 "American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient," consensus does not exist for postoperative care in laparoscopic adjustable gastric banding (LAGB) patients (grade D evidence). It has been suggested that regular follow-up is related to better outcomes, specifically greater weight loss. The aim of the present study was to investigate the effects of travel distance to the clinic on the adherence to follow-up visits and weight loss in a cohort of LAGB patients in the setting of a rural, university-affiliated teaching hospital in the United States. A retrospective chart review was performed of all consecutive LAGB patients for a 1-year period. Linear regression analysis was used to identify the relationships between appointment compliance and the distance traveled and between the amount of weight loss and the distance traveled. Linear regression analysis was performed to investigate the effect of the travel distance to the clinic on the percentage of follow-up visits postoperatively. This effect was not significant (P = .4). Linear regression analysis was also performed to elucidate the effect of the travel distance to the clinic on the amount of weight loss. This effect was significant (P = .04). The travel distance to the clinic did not seem to be a significant predictor of compliance in a cohort of LAGB patients with ≤ 1 year of follow-up in a rural setting. However, a weak relationship was found between the travel distance to the clinic and weight loss, with patients who traveled further seeming to lose slightly more weight. Copyright © 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

The systemic lupus erythematosus travel burden survey: baseline data among a South Carolina cohort.

PubMed

Williams, Edith M; Ortiz, Kasim; Zhang, Jiajia; Zhou, Jie; Kamen, Diane

2016-04-29

Many studies on the impact of systemic lupus erythematosus or lupus have identified patient travel costs as being problematic. We administered a survey that examined the impact of self-rated travel burden on lupus patients. The systemic lupus erythematosus travel burden survey included 41 patients enrolled in the systemic lupus erythematosus database project at the Medical University of South Carolina. Most participants reported that travel caused medications to be discontinued or appointments to be missed. In unadjusted logistic regressions of the relationship between these outcomes and medical travel burden, both distance to rheumatologists and time to lupus medical care were significant. Our findings suggest that more research is needed to examine the influence of travel burden among this population, but data from this report could help to inform physicians, academic researchers, and other health professionals in South Carolina and other areas with significant rural populations on how travel burden may impact patients receiving care for lupus and provide an opportunity for the development of interventions aimed at assisting lupus patients with management of stressors related to travel burden.

Health risks of travelers in South Africa.

PubMed

Waner, S

1999-09-01

Large numbers of tourists visit South Africa every year. Travelers to urban areas are at little risk of contracting an infectious disease, however the adventure traveler is at increased risk. Yellow fever is not known to occur in South Africa. Malaria is endemic in Mpumalanga and KwaZula-Natal. Schistosomiasis is endemic in large parts of the country. Although rabies is found throughout the country, only a small number of human cases is reported. High risk areas are KwaZulu-Natal, the eastern Cape and Mpumalanga provinces. The incidence of human immunodeficiency virus (HIV) infection is high and counseling regarding sexually transmitted diseases is important. Sanitation of water is excellent in most large cities and towns; however travelers to rural areas should exercise caution. Arbovirus infections do occur but relatively few cases are reported. The hiker is at risk for tick bite fever and should be counseled. Since the abolition of apartheid, South Africa has been seen as an inexpensive, high quality destination by many tourists. In 1997, a total of 5,436,848 travelers from many different countries visited the country. Areas most frequently visited include Johannesburg, Cape Town, Durban, the Garden Route, Kruger National Park, KwaZulu-Natal and Pretoria. The most common reason for visiting the country was holiday (44%), followed by visiting friends and relatives (23%), business travel (27%) other (6%).1 Travelers, to the larger cities such as Johannesburg, Cape Town and Durban are at little risk of acquiring an infectious disease. The adventure traveler however is at greater risk as parts of the country are endemic for malaria, schistosomiasis, rabies, food and waterborne diseases, sexually transmitted diseases and arbovirus infections. Accidental deaths due to motor vehicle accidents and interpersonal violence are important health risks in South Africa. Travelers visiting popular attractions are at significantly lower risk. However this has never been

Starting a General Surgery Program at a Small Rural Critical Access Hospital: A Case Study from Southeastern Oregon

ERIC Educational Resources Information Center

Doty, Brit Cruse; Heneghan, Steven; Zuckerman, Randall

2007-01-01

Context: Surgical services are frequently unavailable in rural American communities. Therefore, rural residents often must travel long distances to receive surgical care. Rural hospitals commonly have difficulty providing surgical services despite potential economic benefits. Purpose: The purpose of this project was to identify the key challenges…

Understanding the 'four directions of travel': qualitative research into the factors affecting recruitment and retention of doctors in rural Vietnam.

PubMed

Witter, Sophie; Thi Thu Ha, Bui; Shengalia, Bakhuti; Vujicic, Marko

2011-08-17

Motivation and retention of health workers, particularly in rural areas, is a question of considerable interest to policy-makers internationally. Many countries, including Vietnam, are debating the right mix of interventions to motivate doctors in particular to work in remote areas. The objective of this study was to understand the dynamics of the health labour market in Vietnam, and what might encourage doctors to accept posts and remain in-post in rural areas. This study forms part of a labour market survey which was conducted in Vietnam in November 2009 to February 2010. The study had three stages. This article describes the findings of the first stage - the qualitative research and literature review, which fed into the design of a structured survey (second stage) and contingent valuation (third stage). For the qualitative research, three tools were used - key informant interviews at national and provincial level (6 respondents); in-depth interviews of doctors at district and commune levels (11 respondents); and focus group discussions with medical students (15 participants). The study reports on the perception of the problem by national level stakeholders; the motivation for joining the profession by doctors; their views on the different factors affecting their willingness to work in rural areas (including different income streams, working conditions, workload, equipment, support and supervision, relationships with colleagues, career development, training, and living conditions). It presents findings on their overall satisfaction, their ranking of different attributes, and willingness to accept different kinds of work. Finally, it discusses recent and possible policy interventions to address the distribution problem. Four typical 'directions of travel' are identified for Vietnamese doctors - from lower to higher levels of the system, from rural to urban areas, from preventive to curative health and from public to private practice. Substantial differences in

Quantifying travel behavior for infectious disease research: a comparison of data from surveys and mobile phones

PubMed Central

Wesolowski, Amy; Stresman, Gillian; Eagle, Nathan; Stevenson, Jennifer; Owaga, Chrispin; Marube, Elizabeth; Bousema, Teun; Drakeley, Christopher; Cox, Jonathan; Buckee, Caroline O.

2014-01-01

Human travel impacts the spread of infectious diseases across spatial and temporal scales, with broad implications for the biological and social sciences. Individual data on travel patterns have been difficult to obtain, particularly in low-income countries. Travel survey data provide detailed demographic information, but sample sizes are often small and travel histories are hard to validate. Mobile phone records can provide vast quantities of spatio-temporal travel data but vary in spatial resolution and explicitly do not include individual information in order to protect the privacy of subscribers. Here we compare and contrast both sources of data over the same time period in a rural area of Kenya. Although both data sets are able to quantify broad travel patterns and distinguish regional differences in travel, each provides different insights that can be combined to form a more detailed picture of travel in low-income settings to understand the spread of infectious diseases. PMID:25022440

Quantifying travel behavior for infectious disease research: a comparison of data from surveys and mobile phones.

PubMed

Wesolowski, Amy; Stresman, Gillian; Eagle, Nathan; Stevenson, Jennifer; Owaga, Chrispin; Marube, Elizabeth; Bousema, Teun; Drakeley, Christopher; Cox, Jonathan; Buckee, Caroline O

2014-07-14

Human travel impacts the spread of infectious diseases across spatial and temporal scales, with broad implications for the biological and social sciences. Individual data on travel patterns have been difficult to obtain, particularly in low-income countries. Travel survey data provide detailed demographic information, but sample sizes are often small and travel histories are hard to validate. Mobile phone records can provide vast quantities of spatio-temporal travel data but vary in spatial resolution and explicitly do not include individual information in order to protect the privacy of subscribers. Here we compare and contrast both sources of data over the same time period in a rural area of Kenya. Although both data sets are able to quantify broad travel patterns and distinguish regional differences in travel, each provides different insights that can be combined to form a more detailed picture of travel in low-income settings to understand the spread of infectious diseases.

Reasons why specialist doctors undertake rural outreach services: an Australian cross-sectional study.

PubMed

O'Sullivan, Belinda G; McGrail, Matthew R; Stoelwinder, Johannes U

2017-01-07

The purpose of the study is to explore the reasons why specialist doctors travel to provide regular rural outreach services, and whether reasons relate to (1) salaried or private fee-for-service practice and (2) providing rural outreach services in more remote locations. A national cross-sectional study of specialist doctors from the Medicine in Australia: Balancing Employment and Life (MABEL) survey in 2014 was implemented. Specialists providing rural outreach services self-reported on a 5-point scale their level of agreement with five reasons for participating. Chi-squared analysis tested association between agreement and variables of interest. Of 567 specialists undertaking rural outreach services, reasons for participating include to grow the practice (54%), maintain a regional connection (26%), provide complex healthcare (18%), healthcare for disadvantaged people (12%) and support rural staff (6%). Salaried specialists more commonly participated to grow the practice compared with specialists in fee-for-service practice (68 vs 49%). This reason was also related to travelling further and providing outreach services in outer regional/remote locations. Private fee-for-service specialists more commonly undertook outreach services to provide complex healthcare (22 vs 14%). Specialist doctors undertake rural outreach services for a range of reasons, mainly to complement the growth and diversity of their main practice or maintain a regional connection. Structuring rural outreach around the specialist's main practice is likely to support participation and improve service distribution.

Familial cluster of exposure to a confirmed rabid dog in travelers to Algeria.

PubMed

Antwi, Sylvie; Parola, Philippe; Sow, Doudou; Sornin, Victoria; Henrion, Maxime; Gautret, Philippe

A 10 person-family originating from Algeria traveled in rural Algeria for the purpose of visiting friends and relatives without seeking pre-travel advice, did not received pre-travel rabies immunization, and were exposed to a confirmed rabid dog including 8 within less than 4 days of arrival. Three received suckling mouse brain rabies vaccine although WHO strongly recommends that its production and administration be discontinued and seven received insufficient doses of equine rabies immune globulin abroad. Rabies treatment was completed on returning to France. This reports underline the fact that travelers visiting friends and relatives in dog rabies endemic country are at high risk of rabies exposure and unaware of such a risk in most instances. Rabies risk warning should be reinforced and rabies pre-exposure vaccination should be considered in all individuals traveling to North Africa (and to sub-Saharan Africa) whatever the duration of stay. Copyright © 2017 Elsevier Ltd. All rights reserved.

Understanding the rural food environment--perspectives of low-income parents.

PubMed

Yousefian, Anush; Leighton, Al; Fox, Kimberly; Hartley, David

2011-01-01

Childhood obesity rates appear to be more pronounced among youth in rural areas of the USA. The availability of retail food outlets in rural communities that sell quality, affordable, nutritious foods may be an important factor for encouraging rural families to select a healthy diet and potentially reduce obesity rates. Researchers use the term 'food desert' to describe communities where access to healthy and affordable food is limited. Understanding the ways in which the food environment and food deserts impact childhood obesity may be a key component to designing interventions that increase the availability of healthy and affordable foods, thus improving the health of rural communities. The food environment was investigated in 6 rural low-income Maine communities to assess how food environments affect eating behaviors and obesity rates of rural children enrolled in Medicaid/State Children's Health Insurance Program in Maine ('MaineCare'). Focus groups were conducted with low-income parents of children enrolled in MaineCare to ask them about their food shopping habits, barriers faced when trying to obtain food, where they get their food, and what they perceive as healthy food. Cost, travel distance, and food quality were all factors that emerged as influential in rural low-income family's efforts to get food. Parents described patterns of thoughtful and creative shopping habits that involve coupons and sales. Grocery shopping is often supplemented with food that is harvested, hunted, and bartered. The use of large freezers for storing bulk items was reported as necessary for survival in 'tough' times. Families often travel up to 128.8 km (80 miles) to purchase good quality, affordable food, recognizing that in rural communities travelling these distances is a reality of rural life. Parents appeared to know what qualities describe 'healthy food'. Rural families may have greater flexibility and opportunity to be methodical in their food shopping than urban families

Improving traveler information on rural corridors in Wyoming through the use of intelligent transportation systems.

DOT National Transportation Integrated Search

2014-03-01

Using intelligent transportation systems to help report traveling conditions has been reserved for urban : areas. The goal of this research was to help develop a new methodology for incorporating travel times : calculated from intelligent transportat...

Rural applications of Advanced Traveler Information Systems : evaluation of satellite communications systems for mayday applications

DOT National Transportation Integrated Search

2001-02-01

This study was conducted to: provide national measures of public satisfaction with the nation's highways, community transportation systems and options, and access to and travel on Federal lands (National Parks and National Forests); describe travel p...

Vaccinations for international travellers travelling from Greece.

PubMed

Pavli, Androula; Spilioti, Athina; Lymperi, Ioanna; Katerelos, Panagiotis; Maltezou, Helena C

2013-01-01

The aim of this prospective, questionnaire-based study is to assess pre-travel vaccinations for international travellers who receive pre-travel advice in Greece. A total of 2494 travellers were studied from January 1, 2009 through December 31, 2010. Travellers sought pre-travel advice at a median of 16 days (range: 0-349 days) before departure. Sub-Saharan Africa was the most common destination (34.7%). Most travellers (60.8%) travelled for <1 month, for recreation purposes (58.9%), stayed in hotels (65.3%), and in urban areas (53.6%). Yellow fever, tetravalent meningococcal, typhoid fever, cholera, and rabies vaccines were administered to 1629 (65.3%), 666 (26.7%), 615 (24.7%), 28 (1.1%), and/or 12 (0.5%) travellers, respectively. Of those who received Yellow fever vaccine, 737 (45.2%) travelled to sub-Saharan Africa, 332 (20.4%) travelled to South America, 949 (58.3%) stayed for short term, and 762 (46.8%) stayed in urban areas. Of the 1629 travellers vaccinated against Yellow fever, 150 (9.2%) and 226 (13.8%) travelled to areas of sub-Saharan Africa and South America respectively, where the vaccine is not or generally not recommended. Of those travellers who received meningococcal vaccine, 327 (49.1%) travelled to the Middle East for the Hajj, 251 (29%) travelled to sub-Saharan Africa, 410 (61.6%) for short term, and 540 (64.4%) stayed in urban areas. Of those travellers who received typhoid vaccine, 241 (39.2%) travelled to sub-Saharan Africa, 78 (12.7%) to the Indian subcontinent, 234 (38%) for short term, and 419 (68.1%) stayed in urban areas. Regarding routine vaccines, tetanus-diphtheria, poliomyelitis, and measles-mumps-rubella vaccines were administered to 707 (28.3%), 639 (25.6%) and/or 149 (6%) travellers, respectively. Of those to whom poliomyelitis vaccine was recommended, 295 (46.2%) and 137 (21.4%) travelled to sub-Saharan Africa and the Middle East, respectively, and 362 (56.7%) travelled for short term. In conclusion, this study revealed that

When travel is a challenge: Travel medicine and the 'dis-abled' traveller.

PubMed

Bauer, Irmgard

Travellers with recognised disabilities or the dis-ability to function as required during a trip have been overlooked in the travel medicine literature. This paper provides a starting point for further discussion and research into this neglected traveller population. In contrast, tourism research has explored travel with a disability for some time in order to understand the travellers' needs and to improve services accordingly. The contemporary bio-psycho-social understanding of disability serves as the framework for exploring motivations to travel as well as barriers, such as inter and intrapersonal, economic, structural and attitudinal obstacles. The demands of complex travel planning are acknowledged. Attention is also drawn to the particular issue of acquired disability. The theoretical discussion is complemented by travellers' own accounts using as examples mobility impairment on aeroplanes, sensory impairments, and obesity. These insights should inform high quality travel health care starting with an exploration of the health professionals' own views on such endeavours. Important are appropriate communication skills, an understanding of the travellers'/carers' views, wishes and judgment of abilities, as well as the appreciation of the reason for the trip, destination and planned activities. Challenging may be the need to accept that the traveller/carer will be more knowledgeable about the disability, needs, potential problems and solutions than the health professional. Finally, medical requirements for destination and activity need to be combined with the medical requirements for the dis-abling condition. Scarce literature and increasing numbers of travellers with disabilities should make this field a research priority in travel medicine. Unless there is an absolute medical contraindication, travel health professionals should encourage and support travellers for whom travel is a challenge. Copyright © 2018 Elsevier Ltd. All rights reserved.

Travel Health Advisory Group: a joint travel industry and travel health Special Interest Group promoting healthy travel in Australia.

PubMed

Leggat, Peter A; Zwar, Nicholas; Hudson, Bernie

2012-09-01

The Travel Health Advisory Group (THAG), established in 1997, is a joint initiative between the travel industry and travel health professionals in Australia that aims to promote healthy travel. THAG seeks to promote cooperation in improving the health of travellers between the travel industry and travel medicine professionals and to raise public awareness of the importance of travel health. From 2011, THAG has been a Special Interest Group of The Australasian College of Tropical Medicine and its membership has been active in several areas, including web-based travel health information, travel health promotion, media releases, research and education in Australia. Information is given on the objectives, membership and an overview of the various activities of the group. Copyright © 2012 Elsevier Ltd. All rights reserved.

Access to Care: Overcoming the Rural Physician Shortage.

ERIC Educational Resources Information Center

Baldwin, Fred D.

1999-01-01

Describes three state-initiated programs that address the challenge of providing access to health care for Appalachia's rural residents: a traveling pediatric diabetes clinic serving eastern Kentucky; a telemedicine program operated out of Knoxville, Tennessee; and a new medical school in Kentucky dedicated to training doctors from Appalachia for…

Travel-related health problems in Japanese travelers.

PubMed

Mizuno, Yasutaka; Kudo, Koichiro

2009-09-01

Although the number of Japanese individuals traveling abroad has increased steadily, reaching approximately 17.3 million in 2007, the incidence of various travel-related health problems in Japan remains unknown. The travel-related health problems of Japanese travelers returning to Japan from abroad are analyzed by assessing the records. Data were collected retrospectively on returning travelers who visited the authors' travel clinic during the period from January 2005 through to December 2006 with any health problem acquired overseas. A total of 345 patients were included in this study (200 male, 145 female; average age, 34+/-12.3 years). Reasons for travel included leisure (45.8%); business (39.1%); visiting friends and relatives or accompanying other travelers (8.7%); volunteering (3.8%); and long stays in order to study or live (2.6%). The most visited destination was Asia (n=260), followed by Africa (n=105). The most commonly reported health problems were gastro-intestinal infections (39.1%), followed by respiratory tract infections (16.2%), animal bites (8.1%), and skin problems (5.8%). Together, malaria and dengue accounted for 10% of diagnoses in 125 febrile patients (36.2%). Although the profile of travel-related health problems in Japanese travelers is similar to that of Western travelers, the characteristics of travel were quite different. Therefore Japanese travel advice should be tailored to suit the Japanese traveler.

Prevention of yellow fever in persons traveling to the tropics.

PubMed

Monath, Thomas P; Cetron, Martin S

2002-05-15

Yellow fever (YF) is a potentially lethal mosquito-borne viral hemorrhagic fever endemic in Africa and South America. Nine million tourists annually arrive in countries where YF is endemic, and fatal cases of YF have occurred recently in travelers. In this article, we review the risk factors for YF during travel and the use of YF 17D vaccine to prevent the disease. Although the vaccine is highly effective and has a long history of safe use, the occurrence of rare, fatal adverse events has raised new concerns. These events should not deter travelers to areas where YF is endemic from being immunized, because the risk of YF infection and illness may be high in rural areas and cannot be easily defined by existing surveillance. To avoid unnecessary vaccination, physicians should vaccinate persons at risk on the basis of knowledge of the epidemiology of the disease, reports of epidemic activity, season, and the likelihood of exposure to vector mosquitoes.

Is Travel Time to Colonoscopy Associated With Late-Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa?

PubMed

Charlton, Mary E; Matthews, Kevin A; Gaglioti, Anne; Bay, Camden; McDowell, Bradley D; Ward, Marcia M; Levy, Barcey T

2016-09-01

Colorectal cancer (CRC) screening has been shown to decrease the incidence of late-stage colorectal cancer, yet a substantial proportion of Americans do not receive screening. Those in rural areas may face barriers to colonoscopy services based on travel time, and previous studies have demonstrated lower screening among rural residents. Our purpose was to assess factors associated with late-stage CRC, and specifically to determine if longer travel time to colonoscopy was associated with late-stage CRC among an insured population in Iowa. SEER-Medicare data were used to identify individuals ages 65 to 84 years old diagnosed with CRC in Iowa from 2002 to 2009. The distance between the centroid of the ZIP code of residence and the ZIP code of colonoscopy was computed for each individual who had continuous Medicare fee-for-service coverage for a 3- to 4-month period prior to diagnosis, and a professional claim for colonoscopy within that time frame. Demographic characteristics and travel times were compared between those diagnosed with early- versus late-stage CRC. Also, demographic differences between those who had colonoscopy claims identified within 3-4 months prior to diagnosis (81%) were compared to patients with no colonoscopy claims identified (19%). A total of 5,792 subjects met inclusion criteria; 31% were diagnosed with early-stage versus 69% with late-stage CRC. Those divorced or widowed (vs married) were more likely to be diagnosed with late-stage CRC (OR: 1.20, 95% CI: 1.06-1.37). Travel time was not associated with diagnosis of late-stage CRC. Among a Medicare-insured population, there was no relationship between travel time to colonoscopy and disease stage at diagnosis. It is likely that factors other than distance to colonoscopy present more pertinent barriers to screening in this insured population. Additional research should be done to determine reasons for nonadherence to screening among those with access to CRC screening services, given that over

Improving mobility and transportation options for Michigan's rural seniors : research spotlight.

DOT National Transportation Integrated Search

2012-12-01

Mobility challenges faced by older adults in : rural Michigan include long travel distances to obtain basic services or medical : care, and the limited availability of public, : private or volunteer transportation providers. Because of these challeng...

The experience of psychiatry training in rural NSW.

PubMed

Nash, Louise; Hickie, Catherine; Clark, Scott; Karageorge, Aspasia; Kelly, Patrick J; Earle, Maree

2014-10-01

To examine the experience of psychiatry training in rural New South Wales. All rural trainees in New South Wales and key psychiatrists involved in their training were invited to complete a survey in May-July 2013. Responses were received from 26 out of 44 rurally placed psychiatry trainees (57% response rate) and 37 out of 55 psychiatrists involved in training in a rural area (67% response rate). Positive and negative aspects of rural training were reported. In general, trainees reported positive experiences regarding supervision, consultant input and their Site Coordinator of training. Their experience of other aspects of training and education in rural areas was often negative with 52% of trainees feeling at a disadvantage due to fewer registrar peers and 60% feeling educationally isolated. Difficulty progressing through training, workforce shortages, difficulty accessing formal aspects of training and limited options for advanced training were reported. Metropolitan trainees on rotation to rural terms receive accommodation, travel and an increase in wage from the rural Local Health District. Rural trainees on rotation to the city for their mandatory subspecialty training receive no such support. There are many challenges for rural trainees. Support from the Royal Australian and New Zealand College of Psychiatrists and state and federal governments to enhance the rural training experience is vital. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Provision of oncology services in remote rural areas: a Scottish perspective.

PubMed

Smith, S M; Campbell, N C

2004-05-01

There is a paucity of research into rural health care services. In particular little is known about the provision of specialist cancer services for patients who live in remote rural areas of the UK. This study set out to investigate current models of medical and clinical oncology care in Scotland. A national survey with key health professionals was conducted to identify rural oncology schemes currently in operation. Detailed quantitative data about the schemes together with qualitative data on how health professionals view current models of care were collected by a computer-assisted telephone survey. Schemes that currently provide outpatient and chemotherapy oncology services for remote rural patients fell into three categories: central clinics (5); shared care outreach clinics with chemotherapy provision (11); and shared care outreach clinics without chemotherapy provision (7). All radiotherapy was conducted at central clinics (5). Widely varying practices in delivery of cancer care were found across the country. The main issues for professionals about current models of care involved expertise, travelling and accessibility (for patients), communication and expansion of the rural service. Nation-wide consistency in cancer care has still to be achieved. Travelling for treatment was seen to take its toll on all patients but particularly for the very remote, elderly and poor. Most professionals believe that an expansion of rural services would be of benefit to these patients. It is clear, however, that the proper infrastructure needs to be in place in terms of local expertise, ensured quality of care, and good communication links with cancer centres before this could happen.

[Travel times of patients to ambulatory care physicians in Germany].

PubMed

Schang, Laura; Kopetsch, Thomas; Sundmacher, Leonie

2017-12-01

The time needed by patients to get to a doctor's office represents an important indicator of realised access to care. In Germany, findings on travel times are only available from surveys or for some regions. For the first time, this study examines nationwide and physician group-specific travel times in the ambulatory care sector in Germany and describes demographic, supply-side and spatial determinants of variations. Using a full review of patient consultations in the statutory health insurance system from 2009/2010 for 14 physician groups (approximately 518 million cases), case-related travel times by car between patients' places of residence and physician's practices were estimated at the municipal level. Physicians were reached in less than 30 min in 90.8% of cases for primary care physicians and up to 63% of cases for radiologists. Patients between 18 and under 30 years of age travel longer to get to the doctor than other age groups. The average travel time at the county level systematically differs between urban and rural planning areas. In the case of gynecologists, dermatologists and ophthalmologists, the average journey time decreases with increasing physician density at the county level, but remains approximately constant from a recognisable point of inflection. There is no association between primary care physician density and travel time at the district level. Spatial analyses show physician group-specific patterns of regional concentrations with an increased proportion of cases with very long travel times. Patients' travel times are influenced by supply- and demand-side determinants. Interactions between influential determinants should be analysed in depth to examine the extent to which the time travelled is an expression of regional under- or over-supply rather than an expression of patient preferences.

Breast cancer stage at diagnosis: is travel time important?

PubMed

Henry, Kevin A; Boscoe, Francis P; Johnson, Christopher J; Goldberg, Daniel W; Sherman, Recinda; Cockburn, Myles

2011-12-01

Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating whether travel time to a patient's diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis. We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility. Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.

Evaluating the benefits of dynamic message signs on Missouri's rural corridors.

DOT National Transportation Integrated Search

2011-12-01

Dynamic message signs (DMSs) are traffic control devices that provide real-time traveler information and are used for traffic warning, regulation, routing and management. DMSs on freeways in rural areas in southeast Missouri were evaluated. First, mo...

The Economics of [Not] Closing Small Rural Schools.

ERIC Educational Resources Information Center

Witham, Mark

This paper presents a preliminary analysis of the comparative costs and benefits of closing small rural schools in South Australia. The cost analysis includes accounting for the use of staff, goods, and services; distance education support; land and buildings; and the opportunity cost of children's bus travel time. The assumption that children's…

The Economic Importance of Air Travel in High-Amenity Rural Areas

ERIC Educational Resources Information Center

Rasker, Ray; Gude, Patricia H.; Gude, Justin A.; van den Noort, Jeff

2009-01-01

The western United States offers a case study on the importance of access to large population centers and their markets, via road and air travel, for economic development. The vast distances between towns and cities in the American West can be a detriment to business, yet they also serve to attract technology and knowledge-based workers seeking to…

Clinical peripherality: development of a peripherality index for rural health services

PubMed Central

Swan, Gillian M; Selvaraj, Sivasubramaniam; Godden, David J

2008-01-01

Background The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. Methods Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. Results Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. Conclusion Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects

Clinical peripherality: development of a peripherality index for rural health services.

PubMed

Swan, Gillian M; Selvaraj, Sivasubramaniam; Godden, David J

2008-01-25

The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects of health policy and planning. It may

Active travel to work in NSW: trends over time and the effect of social advantage.

PubMed

Zander, Alexis; Rissel, Chris; Rogers, Kris; Bauman, Adrian

2014-12-01

Active travel can increase population levels of physical activity, but should be promoted equitably. Socio-economic advantage, housing location and/or car ownership influence walking and cycling (active travel) for transport. We examined active commuting over time in the Sydney Greater Metropolitan Region, and associations between active commuting and socioeconomic advantage, urban/rural location and car ownership at a Local Government Area (LGA) level across New South Wales (NSW). Journey to work data from the 2001, 2006 and 2011 Australian Census were examined. Associations between levels of active commuting in each LGA in NSW and the Socio-Economic Index for Areas (SEIFA), Accessibility/Remoteness Index of Australia (ARIA) and car ownership were examined using negative binomial regression modelling. Between 2001 and 2011, active commuting increased in inner Sydney (relative increase of 24%), decreased slightly in outer Sydney (declined 5.1%) and declined in the Greater Metropolitan Region (down 15%). Overall, active commuting increased slightly (6.8% relative increase). After adjusting for the LGA age and sex profile and all other LGA variables, people living in NSW LGAs with high socioeconomic status, more rural areas and low car ownership were more likely to cycle or walk to work. More needs to be done in NSW to increase levels of active commuting consistently across regions and socio-demographic groups. SO WHAT?: Despite small increases in active travel in the Sydney region, active travel patterns are not evenly distributed across locations or populations.

Rural Student Vocational Program (RSVP) [and] Housing Guide for Parents and Students [and] Work Supervisor's Guide.

ERIC Educational Resources Information Center

Rural Student Vocational Program, Wasilla, AK.

The purpose of the Rural Student Vocational Program (RSVP) is to provide rural high school vocational students with work and other experiences related to their career objective. Students from outlying schools travel to Anchorage, Fairbanks, or Juneau (Alaska) to participate in two weeks of work experience with cooperating agencies and businesses.…

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

PubMed

Gagneux-Brunon, Amandine; Andrillat, Carole; Fouilloux, Pascale; Daoud, Fatiha; Defontaine, Christiane; Charles, Rodolphe; Lucht, Frédéric; Botelho-Nevers, Elisabeth

2016-03-01

Travellers are ageing and frequently report chronic illness. Pre-travel health advice is crucial, particularly in this subgroup, and general practitioners (GPs) are first in line for treatment adjustment before departure. Our aim is to evaluate pre-travel health advice seeking from GPs by travellers with chronic illness seen at a travel clinic. A cross-sectional observational survey using a questionnaire was conducted between August 2013 and July 2014 in travellers attending the travel medicine clinic of a tertiary university hospital in France. During the study, 2019 travellers were included. Mean age was 39.4 years (±18.8). Three hundred and ninety-one (19.4%) travellers reported a history of a chronic illness. Arterial hypertension and diabetes mellitus were the most frequently reported illnesses, affecting, respectively, 168 (8.3%) travellers and 102 (5.1%). Hajj pilgrims were more likely to report a history of chronic illness than other travellers. Only 810 (40.1%) travellers sought pre-travel advice from their GP. Six hundred and fifty-two (40.1%) healthy travellers and 158 (40.5%) travellers reporting chronic illness sought pre-travel advice from their GP (P = 0.96). Travellers with a history of chronic illness do not seek pre-travel health advice from their GP more frequently than healthy travellers. Travel health specialists are generally not the best practitioners to manage the care of underlying medical conditions presenting risks during travel. However, GPs offer continuity and disease management expertise to improve the specificity of pre-travel planning. Thus, ongoing collaboration between the traveller, GP and travel health specialist is likely to yield the best outcomes. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

Travel Schooling: Helping Children Learn through Travel.

ERIC Educational Resources Information Center

Byrnes, Deborah A.

2001-01-01

Provides information for teachers to help parents create rewarding and educational travel experiences for children. Examines the benefits of travel schooling, fundamental elements of a meaningful travel schooling experience, fostering cross cultural sensitivity through travel, and returning to the traditional classroom. (SD)

Pre-Travel Medical Preparation of Business and Occupational Travelers

PubMed Central

Khan, Nomana M.; Jentes, Emily S.; Brown, Clive; Han, Pauline; Rao, Sowmya R.; Kozarsky, Phyllis; Hagmann, Stefan H.F.; LaRocque, Regina C.; Ryan, Edward T.

2016-01-01

Objectives: The aim of the study was to understand more about pre-travel preparations and itineraries of business and occupational travelers. Methods: De-identified data from 18 Global TravEpiNet clinics from January 2009 to December 2012 were analyzed. Results: Of 23,534 travelers, 61% were non-occupational and 39% occupational. Business travelers were more likely to be men, had short times to departure and shorter trip durations, and commonly refused influenza, meningococcal, and hepatitis B vaccines. Most business travelers indicated that employers suggested the pre-travel health consultation, whereas non-occupational travelers sought consultations because of travel health concerns. Conclusions: Sub-groups of occupational travelers have characteristic profiles, with business travelers being particularly distinct. Employers play a role in encouraging business travelers to seek pre-travel consultations. Such consultations, even if scheduled immediately before travel, can identify vaccination gaps and increase coverage. PMID:26479857

Providing Cardiology Care in Rural Areas Through Visiting Consultant Clinics.

PubMed

Gruca, Thomas S; Pyo, Tae-Hyung; Nelson, Gregory C

2016-06-30

Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access. Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic days were provided in 96 predominantly rural cities by 167 cardiologists from Iowa and adjoining states. Forty-five percent of Iowa cardiologists participated in rural outreach. Visiting cardiologists from Iowa and adjoining states drive an estimated 45 000 miles per month. Because of monthly outreach clinics, the average driving time to the nearest cardiologist falls from 42.2±20.0 to 14.7±11.0 minutes for rural Iowans. Cardiology outreach improves geographic access to office-based cardiology care for more than 1 million Iowans out of a total population of 3 million. Direct travel costs and opportunity costs associated with physician travel are estimated to be more than $2.1 million per year. Cardiologists in Iowa and adjoining states have expanded access to office-based cardiology care from 18 to 89 of the 99 counties in Iowa. In these 71 counties without a full-time cardiologist, visiting consultant clinics can accommodate more than 50% of office visits in the patients' home county. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Travel Patterns and Characteristics of Elderly Subpopulation in New York State

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hwang, Ho-Ling; Wilson, Daniel W.; Reuscher, Tim

With the increasing demographic shift towards a larger population of elderly (individuals 65 years and older), it is essential for policy makers and planners to have an understanding of transportation issues that affect the elderly. These issues include livability of the community, factors impacting travel behavior and mobility, transportation safety, etc. In this study, Oak Ridge National Laboratory was tasked by the New York State (NYS) Department of Transportation to conduct a detailed examination of travel behaviors, and identify patterns and trends of the elderly within NYS. The National Household Travel Survey (NHTS) was used as the primary data sourcemore » to analyze subjects and address questions such as: Are there differences in traveler demographics between the elderly population and those of younger age groups who live in various NYS regions; e.g., New York City, other urban areas of NYS, or other parts of the country? How do they compare with the population at large? Are there any regional differences (e.g., urban versus rural)? Gender differences? Do any unique travel characteristics or patterns exist within the elderly group? In addition to analysis of NHTS data, roadway travel safety concerns associated with elderly travelers were also investigated in this study. Specifically, data on accidents involving the elderly (including drivers, passengers, and others) as captured in the Fatal Analysis Reporting System (FARS) database was analyzed to examine elderly driver and elderly pedestrian travel safety issues in NYS. The analyses of these data sets provide a greater understanding of the elderly within NYS and their associated transportation issues. Through this study, various key findings on elderly population size, household characteristics, and travel patterns were produced and are report herein this report.« less

Cross-cutting study of advanced rural transportation system ITS field operational tests

DOT National Transportation Integrated Search

1998-08-01

USDOT has funded seven Advanced Rural Transportation System (ARTS) projects focused on traveler safety under the ITS Field Operational Test Program. Booz-Allen & Hamilton was contracted to oversee the evaluation of these (as well as 50+ other) field ...

Rural maternity care.

PubMed

Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

2012-10-01

To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

Haemodialysis in a rural area: a demanding form of treatment.

PubMed

Brammah, A; Young, G; Allan, A; Robertson, S; Norrie, J; Isles, C

2001-09-01

To determine distances travelled and time spent waiting for transport among hospital haemodialysis patients living in a rural area. Cross sectional survey comparing the subregional dialysis unit in south west Scotland with 12 of the other 13 Scottish Adult Renal Units. Forty three Dumfries and Galloway patients and 935 other Scottish patients receiving hospital haemodialysis in November 1999. At the time of the survey 8/43 (19%) Dumfries patients travelled in excess of 100 miles per dialysis day (15,000 miles per year) solely for the purpose of dialysis, compared to 20/935 (2%) elsewhere in Scotland (p < 0.001). Twenty seven (63%) Dumfries and 594 (64%) patients in other Scottish Units relied on hospital car, Patient Transport Service bus or ambulance for the journey home after treatment. Dumfries patients who travelled by Patient Transport Service or hospital ambulance had to wait twice as long before they left the renal unit as patients using a dedicated hospital car or private car. Haemodialysis in a rural area has every reason to be considered a demanding form of treatment. Greater promotion of home based treatment would improve the quality of life for many of these patients, while dedicated hospital cars would reduce 'car to needle time' for those who remain on hospital haemodialysis.

Travel health knowledge, attitudes and practices among Australasian travelers.

PubMed

Wilder-Smith, Annelies; Khairullah, Nor S; Song, Jae-Hoon; Chen, Ching-Yu; Torresi, Joseph

2004-01-01

Although the Asia Pacific region is the focus of the fastest-growing tourist and travel industry, few data are available on the knowledge, attitudes and practices (KAP) of travelers from this region with regard to travel-related infectious diseases. We conducted a cross-sectional survey among travelers at the departure lounges of five airports in Australasia (Singapore, Kuala Lumpur, Taipeh, Melbourne, Seoul) whose travel destinations were Asia, Africa or South America. Two standardized questionnaires directed towards KAP in travel health, travel immunizations and malaria were administered. Of 2,101 respondents (82% Asian, 17% Western), 31% had sought pretravel health advice and only 4% sought travel health advice from the travel medicine specialist. The risk of vaccine-preventable infectious diseases and malaria at the destination country was perceived to be low. Overall, fewer than 5% of travelers had been vaccinated in preparation for their trip. The most frequent travel vaccinations were for hepatitis A and B. Only 40% of travelers to malaria-endemic areas carried malaria prophylaxis. Compared to Western travelers, those of Asian nationality were significantly less likely to obtain pretravel advice and malaria prophylaxis and to receive travel vaccinations. There is an urgent need for increased awareness about travel-related infectious diseases among Asian travelers, and greater uptake of pretravel health advice, vaccinations and malaria prophylactic measures.

Travel medicine

PubMed Central

Aw, Brian; Boraston, Suni; Botten, David; Cherniwchan, Darin; Fazal, Hyder; Kelton, Timothy; Libman, Michael; Saldanha, Colin; Scappatura, Philip; Stowe, Brian

2014-01-01

Abstract Objective To define the practice of travel medicine, provide the basics of a comprehensive pretravel consultation for international travelers, and assist in identifying patients who might require referral to travel medicine professionals. Sources of information Guidelines and recommendations on travel medicine and travel-related illnesses by national and international travel health authorities were reviewed. MEDLINE and EMBASE searches for related literature were also performed. Main message Travel medicine is a highly dynamic specialty that focuses on pretravel preventive care. A comprehensive risk assessment for each individual traveler is essential in order to accurately evaluate traveler-, itinerary-, and destination-specific risks, and to advise on the most appropriate risk management interventions to promote health and prevent adverse health outcomes during travel. Vaccinations might also be required and should be personalized according to the individual traveler’s immunization history, travel itinerary, and the amount of time available before departure. Conclusion A traveler’s health and safety depends on a practitioner’s level of expertise in providing pretravel counseling and vaccinations, if required. Those who advise travelers are encouraged to be aware of the extent of this responsibility and to refer all high-risk travelers to travel medicine professionals whenever possible. PMID:25500599

International business travel: impact on families and travellers

PubMed Central

Espino, C; Sundstrom, S; Frick, H; Jacobs, M; Peters, M

2002-01-01

Objectives: Spouses and staff of the World Bank Group (WBG) were questioned about the impact of international business travel on families and travellers. Dependent variables were self reported stress, concern about the health of the traveller, and negative impact on the family. We hypothesised that several travel factors (independent variables) would be associated with these impacts. These travel factors had to do with the frequency, duration, and predictability of travel and its interference with family activities. Methods: Survey forms were developed and distributed to all spouses of travelling staff as well as a small sample of operational staff. Kendall's tau b correlation coefficients of response frequencies were computed with the data from scaled items. Written responses to open ended questions were categorised. Results: Response rates for spouses and staff were 24% and 36%, respectively. Half the spouse sample (n=533) and almost 75% of the staff sample (n=102) reported high or very high stress due to business travel. Self reported spouse stress was associated with six out of eight travel factors. Female spouses, those with children, and younger spouses reported greater stress. Self reported staff stress was significantly associated with four out of nine travel factors. Further insight into how business travel affects families and staff (including children's behavioural changes) and how families cope was gained through responses to written questions. Conclusions: The findings support the notion that lengthy and frequent travel and frequent changes in travel dates which affect family plans, all characteristic of WBG missions, negatively affects many spouses and children (particularly young children) and that the strain on families contributes significantly to the stress staff feel about their travel. Policies or management practices that take into consideration family activities and give staff greater leeway in controlling and refusing travel may help relieve

International business travel: impact on families and travellers.

PubMed

Espino, C M; Sundstrom, S M; Frick, H L; Jacobs, M; Peters, M

2002-05-01

Spouses and staff of the World Bank Group (WBG) were questioned about the impact of international business travel on families and travellers. Dependent variables were self reported stress, concern about the health of the traveller, and negative impact on the family. We hypothesised that several travel factors (independent variables) would be associated with these impacts. These travel factors had to do with the frequency, duration, and predictability of travel and its interference with family activities. Survey forms were developed and distributed to all spouses of travelling staff as well as a small sample of operational staff. Kendall's tau b correlation coefficients of response frequencies were computed with the data from scaled items. Written responses to open ended questions were categorised. Response rates for spouses and staff were 24% and 36%, respectively. Half the spouse sample (n=533) and almost 75% of the staff sample (n=102) reported high or very high stress due to business travel. Self reported spouse stress was associated with six out of eight travel factors. Female spouses, those with children, and younger spouses reported greater stress. Self reported staff stress was significantly associated with four out of nine travel factors. Further insight into how business travel affects families and staff (including children's behavioural changes) and how families cope was gained through responses to written questions. The findings support the notion that lengthy and frequent travel and frequent changes in travel dates which affect family plans, all characteristic of WBG missions, negatively affects many spouses and children (particularly young children) and that the strain on families contributes significantly to the stress staff feel about their travel. Policies or management practices that take into consideration family activities and give staff greater leeway in controlling and refusing travel may help relieve stress.

[Pre-travel advice and patient education of Hungarian travellers].

PubMed

Lengyel, Ingrid; Felkai, Péter

2018-03-01

According to international surveys, over half of the travellers face some kind of health issue when travelling. The overwhelming majority of travel-related illnesses can be prevented with pre-travel medical consultations, but the syllabus and content of the consultation have to match the travel habits and culture of the given society. This publication explores the specificities and travel habits of Hungarian travellers. One hundred participants of a travel exhibition completed a survey about their international travel. As the survey was not representative, the data could only be processed through simple statistical methods. However, since the exhibition was presumably attended by those wishing to travel, the conclusions drawn from the results are worth publishing, since no similar survey in Hungary has been published before. Based on the suitable classification of age groups in travel medicine, 11% of the participants were adolescents / young adults (aged 15-24), 81% adults (25-59) and 8% elderly (60-74). Twenty-eight percent of the participants travel multiple times a year, 40% yearly and 32% of them less frequently; 16% of the adults, 8% of the adolescents and 4% of the elderly age group travel multiple times a year. The travel destinations of Hungarian travellers have remained practically unchanged since a study was conducted 13 years ago: the vast majority (95%) travelled within Europe, 2% to the United States, and 11% of them elsewhere. Since Hungarians do not travel to endemic areas, only 5% consulted their general practitioners (GPs) prior to travelling, and 29% did when they had to be vaccinated. Forty-two percent of those wishing to travel never consult their GPs, even though 29% of them are aware of some chronic illness. Instead, 51% gather their health information from the internet and only 6% from their doctors. By the contradiction between the poor health status of the majority of Hungarian travellers and the negligence of seeking pre-travel advice

The economics of potential reduction of the rural road system in Kansas.

DOT National Transportation Integrated Search

2011-11-01

Benefitcost analysis was used to examine the question of road closure in the three counties. The cost of road : closure is the additional travel cost of rural residents due to more circuitous routing to their destinations. The benefit is : the avo...

Technology in rural transportation. Simple solution #6, traveler information on the internet

DOT National Transportation Integrated Search

1997-01-01

This application was identified as a promising rural Intelligent Transportation Systems (ITS) solution under a project sponsored by the Federal Highway Administration (FHWA) and the ENTERPRISE program. This summary describes the solution as well as o...

Technology in rural transportation. Simple solution #5, traveler information using fax machines

DOT National Transportation Integrated Search

1997-01-01

This application was identified as a promising rural Intelligent Transportation Systems (ITS) solution under a project sponsored by the Federal Highway Administration (FHWA) and the ENTERPRISE program. This summary describes the solution as well as o...

An overview: tularemia and travel medicine.

PubMed

Ulu-Kilic, Aysegul; Doganay, Mehmet

2014-01-01

Tularemia is a bacterial zoonotic infection. The disease is endemic in most parts of the world, has been reported through the northern hemisphere between 30 and 71° N latitude. Francisella tularensis causes infection in a wide range of vertebrates (rodents, lagomorphs) and invertebrates (ticks, mosquitoes and other arthropods). Humans can acquire this infection through several routes including; a bite from an infected tick, deerfly or mosquito, contact with an infected animal or its dead body. It can also be spread to human by drinking contaminated water or breathing contaminated dirt or aerosol. Clinical manifestation of this disease varies depending on the biotype, inoculum and port of entry. Infection is potentially life threatening, but can effectively be treated with antibiotics. Travelers visiting rural and agricultural areas in endemic countries may be at greater risk. Appropriate clothing and use of insect repellants is essential to prevent tick borne illness. Travelers also should be aware of food and waterborne disease; avoid consuming potentially contaminated water and uncooked meat. Physicians should be aware of any clinical presentation of tularemia in the patients returning from endemic areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

Influence of socio-demographic factors on distances travelled to access HIV services: enhanced surveillance of HIV patients in north west England

PubMed Central

Cook, Penny A; Downing, Jennifer; Wheater, C Philip; Bellis, Mark A; Tocque, Karen; Syed, Qutub; Phillips-Howard, Penelope A

2009-01-01

Background Patient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV) can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services. Methods We extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983) accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling) and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14). Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1). Results HIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI) 4.6–4.9) per trip and had on average 6 visits (95% CI 5.9–6.2) annually for care. Longer trips were made by males (4.8 km vs 4.5 km), white people (6.2 km), the young (>15 years, 6.8 km) and elderly (60+ years, 6.3 km), those on multiple therapy (5.3 km vs 4.0 km), and the more affluent living in rural areas (16.1 km, P < 0.05). Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05). Of those bypassing local facilities, poorer people were more likely to access a specialist

Travel distances by Wisconsin Medicaid enrollees who visit emergency departments for dental care.

PubMed

Okunseri, Christopher; Vanevenhoven, Rabeea; Chelius, Thomas; Beyer, Kirsten M M; Okunseri, Elaye; Lobb, William K; Szabo, Aniko

2016-06-01

Prior studies document increased numbers of nontraumatic dental condition (NTDC) visits to U.S. emergency departments (EDs). However, the influence of travel distance on ED use for NTDCs, particularly for Medicaid enrollees has hitherto received little attention. The authors examined the effect of travel distance on Wisconsin Medicaid enrollees' NTDC visits to EDs after adjustment for covariates. NTDC-related visits claims data for Wisconsin Medicaid (2001-2009) was analyzed. For each enrollee, travel distance to the nearest of 130 EDs in Wisconsin was determined. The number of NTDC visits per person-year was aggregated by ZIP+4 of residence. Negative binomial regression adjusting for the expected number of visits based on race, sex, age of the residents and calendar year was used to evaluate the effect of travel distance, urbanicity, and dentist-population ratio on rate of visits. Enrollees residing in rural counties, entire dental health professional shortage areas, areas with dentist population ratios >20,000: 1 and non-Hispanic Whites travelled the furthest, compared to nearest mean ED distance of 2.9 miles. Enrollees residing 3 miles away or further had significantly lower rates of NTDC visits to EDs. This study demonstrates that distance is a barrier to making NTDC-related visits to EDs. Rates of NTDC visits decreased as travel distance to the nearest ED increased for Medicaid enrollees. © 2016 American Association of Public Health Dentistry.

Travel patterns and characteristics of low-income subpopulation in New York state

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reuscher, Tim; Hwang, Ho-Ling; Lim, Hyeonsup

Studies have shown that people residing in poverty face more mobility challenges in their daily travels as compared to those living in higher income households. In many cities, the lack of a public transportation systems and investments in low-income areas are making it difficult for those living in poverty to access jobs, goods, and services (schools, groceries, health cares, etc. In this study, Oak Ridge National Laboratory was tasked by the New York State (NYS) Department of Transportation to conduct a detailed examination of the travel behaviors and identify patterns and trends of the low-income residents within NYS. The 2009more » National Household Travel Survey data was used as the primary information source to analyze subjects associated with poverty and mobility, as well as to address questions such as are there differences in traveler demographics between the low-income population and those of others who live in various NYS regions (e.g., New York City, other urban areas of NYS)? How do they compare with the population at large (e.g., rest of the country) or with findings from previous years (i.e., trend)? Are there any regional differences (e.g., urban versus rural)? Do any unique travel characteristics or patterns exist within the low-income group? Through this study, various key findings on low-income population sizes, household characteristics, travel patterns, and mobility limitations were identified and summarized in this report.« less

Travel health attitudes among Turkish business travellers to African countries.

PubMed

Selcuk, Engin Burak; Kayabas, Uner; Binbasioglu, Hulisi; Otlu, Baris; Bayindir, Yasar; Bozdogan, Bulent; Karatas, Mehmet

The number of international travellers is increasing worldwide. Although health risks related to international travel are important and generally well-understood, the perception of these risks was unclear among Turkish travellers. We aimed to evaluate the attitudes and health risk awareness of Turkish travellers travelling to African countries. A survey was performed of Turkish travellers bound for Africa from Istanbul International Ataturk Airport in July 2013. A total of 124 travellers were enrolled in the study. Among them, 62.9% had information about their destination but only 11.3% had looked for information on health problems related to travel and their destination. Of all travellers, 53.2% had at least one vaccination before travelling. The most commonly administered vaccine was for typhoid. Among the travellers, 69.3% and 80.6% had "no idea" about yellow fever vaccination and malaria prophylaxis, respectively. A positive correlation was found between a higher level of travellers' education and receiving the recommended vaccination for the destination. Our study revealed significant gaps in the vaccination and chemoprophylaxis uptake of Turkish travellers departing to Africa. An awareness and training program should be developed for travellers, as well as public health workers, to address health risks related to travel. Copyright © 2016 Elsevier Ltd. All rights reserved.

Characteristics and pre-travel preparation of travelers at a Canadian pediatric tertiary care travel clinic: A retrospective analysis.

PubMed

Ma, Xiao Wei; Pell, Lisa G; Akseer, Nadia; Khan, Sarah; Lam, Ray E; Louch, Debra; Science, Michelle; Morris, Shaun K

2016-01-01

International travelers are susceptible to a wide spectrum of travel related morbidities. Despite rising number of international travelers in Canada, the demographics, risk profiles, and preventative strategies of high-risk traveler groups, including pediatric travelers visiting friends and relatives (VFRs) are not well described. A descriptive analysis was conducted on pre-travel consultations completed between January 2013 and August 2014 at a large pediatric tertiary care center in Toronto, Canada. Data on demographics, travel characteristics, and pre-travel interventions were extracted from 370 pre-travel consultations. Results were compared between all VFR and non-VFR travelers, as well as between children traveling to visit friends and relatives, for vacation, and for education and/or volunteer purposes. Forty-eight percent of consultations were for children <18 years of age (n = 177), of which 31% were for young children (<5 years of age). Young children were more likely to travel to visit friends and/or relatives than for other purposes (29% vs 9%, p < 0.0001). Children VFRs (cVFRs) were more likely to travel for >28 days than children traveling for vacation (43% vs 1%, p < 0.0001), and children traveling for education/volunteer purposes (43% vs 21%, p = 0.03). Around half of cVFRs traveled to destinations in Asia (51%). The majority stayed with locals, friends and/or relatives (85%), and nearly all traveled to urban destinations (98%). The most prescribed interventions for children were azithromycin (84%), Dukoral (66%), and the hepatitis A vaccine (60%). Atovaquone/proguanil was the most commonly prescribed antimalarial for children. Children that travel to visit friends and relatives represent a unique travel group and may require specific considerations during pre-travel preparations. Our findings can help develop targeted pre-travel strategies for children VFRs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Travel Medical Kit.

PubMed

Terry, Anne C; Haulman, N Jean

2016-03-01

"The traveler's medical kit is an essential tool for both the novice and expert traveler. It is designed to treat travel-related illness and injury and to ensure preexisting medical conditions are managed appropriately. Travelers are at increased risk for common gastrointestinal issues during travel. Respiratory illnesses make up approximately 8% of the ailments present in returned international travelers. Approximately 12% of travelers experience a travel-related skin condition. First aid treatment for minor injuries is essential to all travel medical kits. The complexity ranges from a small, simple case for the urban traveler to a larger, extensive case for wilderness travel." Copyright © 2016 Elsevier Inc. All rights reserved.

Travel time and attrition from VHA care among women veterans: how far is too far?

PubMed

Friedman, Sarah A; Frayne, Susan M; Berg, Eric; Hamilton, Alison B; Washington, Donna L; Saechao, Fay; Maisel, Natalya C; Lin, Julia Y; Hoggatt, Katherine J; Phibbs, Ciaran S

2015-04-01

Travel time, an access barrier, may contribute to attrition of women veterans from Veterans Health Administration (VHA) care. We examined whether travel time influences attrition: (a) among women veterans overall, (b) among new versus established patients, and (c) among rural versus urban patients. This retrospective cohort study used logistic regression to estimate the association between drive time and attrition, overall and for new/established and rural/urban patients. In total, 266,301 women veteran VHA outpatients in the Fiscal year 2009. An "attriter" did not return for VHA care during the second through third years after her first 2009 visit (T0). Drive time (log minutes) was between the patient's residence and her regular source of VHA care. "New" patients had no VHA visits within 3 years before T0. Models included age, service-connected disability, health status, and utilization as covariates. Overall, longer drive times were associated with higher odds of attrition: drive time adjusted odds ratio=1.11 (99% confidence interval, 1.09-1.14). The relationship between drive time and attrition was stronger among new patients but was not modified by rurality. Attrition among women veterans is sensitive to longer drive time. Linking new patients to VHA services designed to reduce distance barriers (telemedicine, community-based clinics, mobile clinics) may reduce attrition among women new to VHA.

Demographics, health and travel characteristics of international travellers at a pre-travel clinic in Marseille, France.

PubMed

Aubry, Camille; Gaudart, Jean; Gaillard, Catherine; Delmont, Jean; Parola, Philippe; Brouqui, Philippe; Gautret, Philippe

2012-09-01

With the aim to identify at-risk individuals among a cohort of international travellers, 3442 individuals who sought advice at Marseille travel health centre in 2009 were prospectively included. Demographics, travel characteristics, chronic medical conditions, vaccinations and antimalarial chemoprophylaxis were documented. Chronic medical conditions were reported by 11% of individuals, including hypertension (39%), asthma (20%), thyroid disease (15%) and depression (13%). 4% reported taking a daily medication, and psychotropic and cardiovascular medications were the most commonly used. Older travellers (≥60 years) accounted for 10% of the travellers and the prevalence of chronic medical conditions was 27% in this group. Individuals aged 15 years or less accounted for 13% of the travellers. Age, last minute travel (17%) and neurological and psychiatric diseases were the most frequent factors that influenced Yellow fever vaccination and malaria chemoprophylaxis, with more than one tenth of the travellers reporting at least one risk factor for which adjusted advice may be necessary. Migrants visiting their relatives in their origin country accounted for 14% of travellers and 73% of this group travelled with their family including young children. We demonstrate that a significant proportion of travellers are at-risk (43%) because of their travel conditions (VFR), their age, or their health status, and should be targeted for risk reduction strategies. Copyright © 2012 Elsevier Ltd. All rights reserved.

Subdividing the Digital Divide: Differences in Internet Access and Use among Rural Residents with Medical Limitations

PubMed Central

2011-01-01

Background Access to health care is often contingent upon an individual’s ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs. Objective The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions. Methods We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame. Results Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6% vs 70.3%, P < .001). Similarly, rural residents were less likely to report Internet access and use than urban residents (59.7% vs 69.4%, P < .001). Nationally, 72.8% of white respondents, versus 65.7% of persons of “other” race, 51.5% of African Americans, and 38.0% of Hispanics reported accessing the Internet (P < .001). In adjusted analyses, persons with medical conditions and minority populations were less likely to report Internet use. Rural-urban differences were no longer significant with demographic and ecological characteristics held constant. Conclusions This analysis confirmed previous findings of a digital divide

Travellers' profile, travel patterns and vaccine practices--a 10-year prospective study in a Swiss Travel Clinic.

PubMed

Boubaker, Rim; Meige, Pierrette; Mialet, Catherine; Buffat, Chantal Ngarambe; Uwanyiligira, Mediatrice; Widmer, Francine; Rochat, Jacynthe; Fossati, Annie Hérard; Souvannaraj-Blanchant, Manisinh; Payot, Sylvie; Rochat, Laurence; de Vallière, Serge; Genton, Blaise; D'Acremont, Valérie

2016-01-01

The travel clinic in Lausanne serves a catchment area of 700 000 of inhabitants and provides pre- and post-travel consultations. This study describes the profile of attendees before departure, their travel patterns and the travel clinic practices in terms of vaccination over time. We included all pre-travel first consultation data recorded between November 2002 and December 2012 by a custom-made program DIAMM/G. We analysed client profiles, travel characteristics and vaccinations prescribed over time. Sixty-five thousand and forty-six client-trips were recorded. Fifty-one percent clients were female. Mean age was 32 years. In total, 0.1% were aged <1 year and 0.2% ≥80 years. Forty-six percent of travellers had pre-existing medical conditions. Forty-six percent were travelling to Africa, 35% to Asia, 20% to Latin America and 1% (each) to Oceania and Europe; 19% visited more than one country. India was the most common destination (9.6% of travellers) followed by Thailand (8.6%) and Kenya (6.4%). Seventy-three percent of travellers were planning to travel for ≤ 4 weeks. The main reasons for travel were tourism (75%) and visiting friends and relatives (18%). Sixteen percent were backpackers. Pre-travel advice were sought a median of 29 days before departure. Ninety-nine percent received vaccine(s). The most frequently administered vaccines were hepatitis A (53%), tetanus-diphtheria (46%), yellow fever (39%), poliomyelitis (38%) and typhoid fever (30%). The profile of travel clinic attendees was younger than the general Swiss population. A significant proportion of travellers received vaccinations that are recommended in the routine national programme. These findings highlight the important role of travel clinics to (i) take care of an age group that has little contact with general practitioners and (ii) update vaccination status. The most commonly prescribed travel-related vaccines were for hepatitis A and yellow fever. The question remains to know whether

Plasmodium knowlesi in travellers, update 2014.

PubMed

Müller, Mattia; Schlagenhauf, Patricia

2014-05-01

=3), back pain (n=3), abdominal problems (n=1), anorexia (n=2), fatigue (n=2), malaise (n=1), arthralgia (n=1), sore throat (n=1) vomiting (n=2), and jaundice (n=1). All patients were treated successfully with currently available antimalaria treatments. The identification of the pathogen by microscopy can be problematic due to the morphological similarity of P. knowlesi to Plasmodium malariae. P. knowlesi appears to be a threat not only to the local population in Malaysia, but also to the estimated 25 million annual tourists and occupational travellers to Malaysia, especially those who visit rural, forested areas of the country. The P. knowlesi risk is not limited to Malaysia, and travellers from Southeast Asia presenting with possible malaria should be considered for a diagnostic work-up that includes P. knowlesi. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Towards a Tool for Malaria Supply Chain Management Improvement in Rural Ghana.

PubMed

Carlo, Lorena; Bakken, Suzanne; Mamykina, Lena; Kodie, Richmond; Kanter, Andrew S

2015-01-01

The maintenance of adequate quantities of antimalarial medicines and rapid diagnostic tests (RDTs) at health facilities in rural areas of sub-Saharan Africa is a challenging task because of poor supply chain management. Antimalarial stock-outs in the communities could lead patients (that need to travel long distances to get medications) to remain untreated, develop severe malaria and die. A prototype to improve the management of health commodities in rural Ghana through the visualization of current stock levels and the forecasting of commodities is proposed.

Individual traveller health priorities and the pre-travel health consultation.

PubMed

Flaherty, Gerard T; Chen, Bingling; Avalos, Gloria

2017-09-01

The purpose of this study was to examine the principal travel health priorities of travellers. The most frequently selected travel health concerns were accessing medical care abroad, dying abroad, insect bites, malaria, personal safety and travel security threats. The travel health risks of least concern were culture shock, fear of flying, jet lag and sexually transmitted infections. This study is the first to develop a hierarchy of self-declared travel health risk priorities among travellers. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Public Relations and the Role of the Rural School Psychologist.

ERIC Educational Resources Information Center

Thomas, A. Reese

Although there is no difference between the training provided for school psychologists who practice in rural communities and those who render service in urban areas, there are definite contrasts in the actual work. An elaboration of these comprises the bulk of this paper. Differences covered are: (1) the inordinate amount of travel time required…

Connected Traveler

DOE Office of Scientific and Technical Information (OSTI.GOV)

2016-06-01

The Connected Traveler framework seeks to boost the energy efficiency of personal travel and the overall transportation system by maximizing the accuracy of predicted traveler behavior in response to real-time feedback and incentives. It is anticipated that this approach will establish a feedback loop that 'learns' traveler preferences and customizes incentives to meet or exceed energy efficiency targets by empowering individual travelers with information needed to make energy-efficient choices and reducing the complexity required to validate transportation system energy savings. This handout provides an overview of NREL's Connected Traveler project, including graphics, milestones, and contact information.

Epidemiologic and biogeographic analysis of 542 VFR traveling children in Catalonia (Spain). A rising new population with specific needs.

PubMed

Valerio, Lluís; Roure, Sílvia; Sabrià, Miquel; de Balanzó, Xavier; Moreno, Nemesio; Martinez-Cuevas, Octavio; Peguero, Carme

2011-01-01

Imported diseases recorded in the European Union (EU) increasingly involve traveling immigrants returning from visits to their relatives and friends (VFR). Children of these immigrant families can represent a population of extreme vulnerability. A randomized cross-sectional study of 698 traveling children under the age of 15 was performed. VFR traveling children and non-VFR (or tourist) children groups were compared. A total of 698 individuals were analyzed: 354 males (50.7%) and 344 females (49.3%), with a median age (interquartile range) of 4 (2-9) years. Of these, 578 (82.8%) had been born in the EU with 542 (77.7%) being considered as VFR, whereas 156 (22.3%) were considered tourists. VFR children were younger (4.7 vs 8.2 yr; p < 0.001), they had more frequently been born in the EU (62.8% vs 20.1%; p < 0.01) and were more frequently lodged in private homes (76.6% vs 3.2%: p < 0.001) and rural areas (23.2% vs 1.6%; p < 0.001). Furthermore, VFR remained abroad longer (51.6 vs 16.6 d; p < 0.001), the visit/travel time interval was shorter (21.8 vs 32.2 d; p < 0.001) than tourists, and consultation was within 10 days prior to the departure (26.4% vs 2.7%; p < 0.001). The risk factor most differentiating VFR children from tourists was accommodation in a rural setting [odds ratio(OR) = 5.26;95%CI = 2.704-10.262;p < 0.001]. VFR traveling children showed a greater risk of exposure to infectious diseases compared with tourists. Immigrant families may represent a target group to prioritize international preventive activities. © 2011 International Society of Travel Medicine.

Using "Moodle[TM]": How Rural School Librarians Stay Connected

ERIC Educational Resources Information Center

Appleton, Karen; DeGroot, Dorothy; Lampe, Karen; Carruthers, Cheryl

2009-01-01

So, what if one lives in a remote, rural area, but still has important knowledge and insights that others might benefit from learning? What if one is the only school librarian for multiple districts, and one just cannot justify the time to travel to a regular, traditional class meeting These are questions that school librarians in Iowa, as well as…

Understanding the Business Case for Telemental Health in Rural Communities.

PubMed

Lambert, David; Gale, John; Hartley, David; Croll, Zachariah; Hansen, Anush

2016-07-01

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment.

Travel and transplantation: travel-related diseases in transplant recipients.

PubMed

Kotton, Camille N

2012-12-01

Travel-related diseases may be seen in transplant recipients after travel, after transplant tourism, and via transmission from blood and organ donors, augmented by recent increases in travel, migration, and globalization. Such infections include tuberculosis, Plasmodium (malaria), Babesia, Trypanosoma cruzi (Chagas disease), Strongyloides, Coccidioides, Histoplasma, Leishmania, Brucella, HTLV, dengue, among numerous others. Review of cohorts of transplant recipients show that they tend to have minimal or suboptimal preparation prior to travel, with limited pretravel vaccination, medications, and education, which poses a greatly increased risk of travel-related infections and complications. The epidemiology of such travel-related infections in transplant recipients, along with methods for prevention, including vaccines, chemoprophylaxis, and education may help SOT recipients avoid travel-related infections, and are discussed in this review. Optimizing the understanding of the risk of tropical, geographically restricted, and other unusual or unexpected, travel-related infections will enhance the safety of vulnerable transplant recipients from potentially life-threatening infections.

Rural maternity care: can we learn from Wal-Mart?

PubMed

van Teijlingen, E R; Pitchforth, E

2010-03-01

In many countries rural maternity care is under threat. Consequently rural pregnant women will have to travel further to attend larger maternity units to receive care and deliver their babies. This trend is not dissimilar from the disappearance of other rural services, such as village shops, banks, post offices and bus services. We use a comparative approach to draw an analogy with large-scale supermarkets, such as the Wal-Mart and Tesco and their effect on the viability of smaller rural shops, depersonalisation of service and the wider community. The closure of a community-maternity unit leads to women attending a different type of hospital with a different approach to maternity care. Thus small community-midwifery units are being replaced, not by a very similar unit that happens to be further away, but by a larger obstetric unit that operates on different models, philosophy and notions of risk. Comparative analysis allows a fresh perspective on the provision of rural maternity services. We argue that previous discussions focusing on medicalisation and change in maternity services can be enhanced by drawing on experience in other sectors and taking a wider societal lens. Copyright 2009 Elsevier Ltd. All rights reserved.

Travel health preparation and travel-related morbidity of splenectomised individuals.

PubMed

Boeddha, Christien; de Graaf, Wilmar; Overbosch, David; van Genderen, Perry J J

2012-07-01

Asplenic or hyposplenic patients are at an increased risk of encapsulated bacterial and intraerythrocytic parasitic infections, which are endemic at many travel destinations. With proper travel health advice and preparation splenectomised individuals could have comparable travel-related morbidity as healthy control subjects. We conducted a prospective case-control study with 21 travel pairs. Each pair consisted of a splenectomised patient (case) and a healthy, non-splenectomised travel companion (control) in order to match for travel destination, duration and potential exposures to travel-related health risks. All participants filled out a questionnaire detailing travel health preparation including vaccination and malaria prophylaxis as well as travel-related morbidity. Cases and controls were comparable for age and gender. Cases received significantly more information about on demand use of antibiotics in case of fever. Immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal. There were no significant differences in the occurrence of travel-related ailments nor differences in severity of ailments. The immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal in some splenectomised patients and should be improved. Strict adherence to national travel health advice guidelines and specific guidelines for asplenic patients is advisable. However, with regard to travel-related morbidity there are no significant differences in morbidity between splenectomised patients and healthy controls, at least in the setting of short-term travel. Copyright © 2012 Elsevier Ltd. All rights reserved.

Paediatric international travellers from Greece: characteristics and pre-travel recommendations.

PubMed

Maltezou, Helena C; Pavli, Androula; Spilioti, Athina; Katerelos, Panos; Theodoridou, Maria

2012-05-01

The aim of this study was to describe the children who seek pre-travel advice in Greece. During 2008-2010, 4065 persons sought pre-travel services in the 57 Prefectures, including 128 (3.15%) children <15 years. Main travel destinations were sub-Saharan Africa (54 children; 42.2%), South America (18; 14.1%), the Middle East (16; 12.5%), the Indian subcontinent (12; 9.4%), and South East Asia (7; 5.5%). Seventy-six children (59.4%) stayed for <1 month, 34 (26.6%) for 1-6 months, and 10 (7.8%) for >6 months. Recreation was the main purpose of travel (81 children; 63.3%), followed by work (24; 18.8%), and to visit friends and relatives (VFRs) (14; 10.9%). Paediatric travellers VFRs stayed more frequently in local residences compared to non-VFR paediatric travellers (85.7% and 20.2%). Children stayed more frequently in local residences and travelled more frequently for recreational purposes or to VFRs (27.3%, 63.3%, and 10.9%, respectively), compared to older travellers (11.9%, 58.8%, and 4%, respectively). Malaria chemoprophylaxis was prescribed for 64.8% of children travelling to sub-Saharan Africa. This study demonstrated clearly that only a very small number of international paediatric travellers seek pre-travel services in Greece. Communication strategies to access paediatric travellers should be developed in order to improve travel medicine services for children in Greece. Copyright © 2012 Elsevier Ltd. All rights reserved.

25 CFR 700.533 - Restrictions affecting travel and travel expense reimbursement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 2 2012-04-01 2012-04-01 false Restrictions affecting travel and travel expense... travel and travel expense reimbursement. (a) When an employee is on officially authorized travel his or... in cash or kind for travel expenses from any other source, even when the employee's expenses exceed...

25 CFR 700.533 - Restrictions affecting travel and travel expense reimbursement.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false Restrictions affecting travel and travel expense... travel and travel expense reimbursement. (a) When an employee is on officially authorized travel his or... in cash or kind for travel expenses from any other source, even when the employee's expenses exceed...

25 CFR 700.533 - Restrictions affecting travel and travel expense reimbursement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Restrictions affecting travel and travel expense... travel and travel expense reimbursement. (a) When an employee is on officially authorized travel his or... in cash or kind for travel expenses from any other source, even when the employee's expenses exceed...

25 CFR 700.533 - Restrictions affecting travel and travel expense reimbursement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 2 2011-04-01 2011-04-01 false Restrictions affecting travel and travel expense... travel and travel expense reimbursement. (a) When an employee is on officially authorized travel his or... in cash or kind for travel expenses from any other source, even when the employee's expenses exceed...

25 CFR 700.533 - Restrictions affecting travel and travel expense reimbursement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false Restrictions affecting travel and travel expense... travel and travel expense reimbursement. (a) When an employee is on officially authorized travel his or... in cash or kind for travel expenses from any other source, even when the employee's expenses exceed...

Travelers' Diarrhea and Other Gastrointestinal Symptoms Among Boston-Area International Travelers

PubMed Central

Stoney, Rhett J.; Han, Pauline V.; Barnett, Elizabeth D.; Wilson, Mary E.; Jentes, Emily S.; Benoit, Christine M.; MacLeod, William B.; Hamer, Davidson H.; Chen, Lin H.

2017-01-01

This prospective cohort study describes travelers' diarrhea (TD) and non-TD gastrointestinal (GI) symptoms among international travelers from the Boston area, the association of TD with traveler characteristics and dietary practices, use of prescribed antidiarrheal medications, and the impact of TD and non-TD GI symptoms on planned activities during and after travel. We included adults who received a pre-travel consultation at three Boston-area travel clinics and who completed a three-part survey: pre-travel, during travel, and post-travel (2–4 weeks after return). TD was defined as self-reported diarrhea with or without nausea/vomiting, abdominal pain, or fever. Demographic and travel characteristics were evaluated by χ2 test for categorical and Wilcoxon rank-sum test for continuous variables. Analysis of dietary practices used logistic generalized estimating equation models or logistic regression models. Of 628 travelers, 208 (33%) experienced TD and 45 (7%) experienced non-TD GI symptoms. Of 208 with TD, 128 (64%), 71 (36%), and 123 (62%) were prescribed ciprofloxacin, azithromycin, and/or loperamide before travel, respectively. Thirty-nine (36%) of 108 took ciprofloxacin, 20 (38%) of 55 took azithromycin, and 28 (28%) of 99 took loperamide during travel. Of 172 with TD during travel, 24% stopped planned activities, and 2% were hospitalized. Of 31 with non-TD GI symptoms during travel, six (13%) stopped planned activities. International travelers continue to experience diarrhea and other GI symptoms, resulting in disruption of planned activities and healthcare visits for some. Although these illnesses resulted in interruption of travel plans, a relatively small proportion took prescribed antibiotics. PMID:28719282

Travelers' Diarrhea and Other Gastrointestinal Symptoms Among Boston-Area International Travelers.

PubMed

Stoney, Rhett J; Han, Pauline V; Barnett, Elizabeth D; Wilson, Mary E; Jentes, Emily S; Benoit, Christine M; MacLeod, William B; Hamer, Davidson H; Chen, Lin H

2017-06-01

AbstractThis prospective cohort study describes travelers' diarrhea (TD) and non-TD gastrointestinal (GI) symptoms among international travelers from the Boston area, the association of TD with traveler characteristics and dietary practices, use of prescribed antidiarrheal medications, and the impact of TD and non-TD GI symptoms on planned activities during and after travel. We included adults who received a pre-travel consultation at three Boston-area travel clinics and who completed a three-part survey: pre-travel, during travel, and post-travel (2-4 weeks after return). TD was defined as self-reported diarrhea with or without nausea/vomiting, abdominal pain, or fever. Demographic and travel characteristics were evaluated by χ 2 test for categorical and Wilcoxon rank-sum test for continuous variables. Analysis of dietary practices used logistic generalized estimating equation models or logistic regression models. Of 628 travelers, 208 (33%) experienced TD and 45 (7%) experienced non-TD GI symptoms. Of 208 with TD, 128 (64%), 71 (36%), and 123 (62%) were prescribed ciprofloxacin, azithromycin, and/or loperamide before travel, respectively. Thirty-nine (36%) of 108 took ciprofloxacin, 20 (38%) of 55 took azithromycin, and 28 (28%) of 99 took loperamide during travel. Of 172 with TD during travel, 24% stopped planned activities, and 2% were hospitalized. Of 31 with non-TD GI symptoms during travel, six (13%) stopped planned activities. International travelers continue to experience diarrhea and other GI symptoms, resulting in disruption of planned activities and healthcare visits for some. Although these illnesses resulted in interruption of travel plans, a relatively small proportion took prescribed antibiotics.

Skin diseases in rural Yucatan, Mexico.

PubMed

Paek, So Yeon; Koriakos, Angie; Saxton-Daniels, Stephanie; Pandya, Amit G

2012-07-01

There are no known reports of the frequency of skin diseases endemic to rural Yucatan, Mexico. The aim of this study was to report the prevalence of dermatologic conditions in rural villages in that region. We conducted a retrospective descriptive study of all cases of skin disease diagnosed by a team of American board-certified dermatologists during consultations in January 2009, August 2009, and June 2010, in the state of Yucatan, Mexico. Traveling clinics were held in eight different rural locations. Age, sex, and diagnosis, according to history and physical examination, were recorded for each patient. A total of 1071 cases of skin disease were seen in 858 patients. The frequency of parasitic, viral, and fungal infections was 34.5%. Dermatitis and eczema (24.6%) were the next most prevalent conditions, followed by disorders of skin appendages (12.2%), photosensitivity disorders (5.4%), papulosquamous disorders (3.2%), urticaria and erythema (1.5%), bacterial infections of the skin and subcutaneous tissue (1.2%), and neoplastic disorders (2.1%). The most frequently seen single diagnoses were viral warts (12.2%), scabies (8.7%), acne (7.4%), dermatophytosis (6.8%), contact dermatitis (3.5%), and nummular eczema (3.5%). Infectious diseases, acne, and eczemas are the most common skin disorders seen in dermatology clinics in rural Yucatan, Mexico. Our findings may be useful in the development of public health initiatives targeting rural communities in this region. © 2012 The International Society of Dermatology.

Vaccination knowledge, attitude and practice among Chinese travelers who visit travel clinics in Preparation for international travel.

PubMed

Zhang, Min; Zhang, Jianming; Hao, Yutong; Fan, ZhengXing; Li, Lei; Li, Yiguang; Ju, Wendong; Zhang, Hong; Liu, Wei; Zhang, Mengzhang; Wu, Di; He, Hongtao

2016-06-01

Although international travel has become increasingly more common in main land China, few data are available on vaccination knowledge, attitude and practice (KAP) among Chinese travelers. In each of 14 International Travel Healthcare Centers (ITHCs) situated in mainland China 200 volunteers were recruited for a cross-sectional investigation by questionnaire on KAP related to travel vaccinations. For the evaluation the study subjects were grouped by demographic data, past travel experience, travel destination, duration of stay abroad, purpose of travel. Among the 2,800 Chinese travelers who participated in the study, 67.1% were aware of national and travel vaccination recommendations. The knowledge about vaccine preventable diseases was low. The most common sources (73.4%) of information were requirements by destination countries obtained in connection with the visa application, Chinese companies employing workers/laborers for assignments overseas, and foreign schools. The overall acceptance rate of recommended vaccines was 68.7%, but yellow fever was accepted by 99.8% of the participants when recommended. Among 81.1% respondents who recalled to have received vaccinations in the past, only 25.9% of them brought the old vaccination records with them to their ITHC consultations. The results indicate that increased awareness of the importance of pre-travel vaccination is needed among the travellers in order to improve their KAP. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

77 FR 5252 - Federal Travel Regulation; GSA E-Gov Travel Service (ETS) Transition to E-Gov Travel Service 2...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... Travel Regulation; GSA E-Gov Travel Service (ETS) Transition to E-Gov Travel Service 2 (ETS2) AGENCY... (QMC), at [email protected]gov or (703) 605-2151. SUPPLEMENTARY INFORMATION: The Federal Travel...-GOV TRAVEL SERVICE GSA Bulletin ETS 12-01 TO: Heads of Federal Agencies SUBJECT: GSA E-Gov Travel...

Travelers' thrombosis.

PubMed

Johnston, Raymond V; Hudson, Martin F

2014-02-01

The suggestion that venous thromboembolism (VTE) is associated with air travel has for several decades been the subject of both "media hype" and extensive debate in the medical literature. As emotion and anecdote is often a feature in this debate, it is therefore necessary to separate evidence from anecdote. "Travelers' thrombosis" is a more appropriate term because the evidence suggests that any form of travel involving immobility lasting more than 4 h can predispose to thrombosis. There is no unique factor in the air travel cabin environment that has been shown to have any effect on the coagulation cascade. Prevention of thrombosis in any form of travel, including air travel, requires being aware of the issue and making an adequate risk assessment together with appropriate prophylactic measures.

Impact of Local Resources on Hospitalization Patterns of Medicare Beneficiaries and Propensity to Travel outside Local Markets

ERIC Educational Resources Information Center

Basu, Jayasree; Mobley, Lee R.

2010-01-01

Purpose: To examine how local health care resources impact travel patterns of patients age 65 and older across the rural urban continuum. Methods: Information on inpatient hospital discharges was drawn from complete 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for New York,…

Travelers' Health

MedlinePlus

... Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers Road Safety Senior Citizens Sex Tourism STDs Sun Exposure Swimming and Diving Study Abroad ...

Travelers' Diarrhea

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Technology in rural transportation. Simple solution #1, traveler warnings for spot hazardous conditions

DOT National Transportation Integrated Search

1997-01-01

This application was identified as a promising rural Intelligent Transportation Systems (ITS) solution under a project sponsored by the Federal Highway Administration (FHWA) and the ENTERPRISE program. This summary describes the solution as well as o...

International travel patterns and travel risks for stem cell transplant recipients.

PubMed

Mikati, Tarek; Griffin, Kenneth; Lane, Dakotah; Matasar, Matthew; Shah, Monika K

2015-01-01

Stem cell transplantation (SCT) is being increasingly utilized for multiple medical illnesses. However, there is limited knowledge about international travel patterns and travel-related illnesses of stem cell transplant recipients (SCTRs). An observational cross-sectional study was conducted among 979 SCTRs at Memorial Sloan Kettering Cancer Center using a previously standardized and validated questionnaire. International travel post SCT, pre-travel health advice, exposure risks, and travel-related illnesses were queried. A total of 516 SCTRs completed the survey (55% response rate); of these, 40% were allogeneic SCTRs. A total of 229 (44.3%) respondents reported international travel outside the United States and Canada post SCT. The international travel incidence was 32% [95% confidence interval CI 28-36] within 2 years after SCT. Using multivariable Cox regression analysis, variables significantly associated with international travel within first 2 years after SCT were history of international travel prior to SCT [hazard ratio (HR) = 5.3, 95% CI 2.3-12.0], autologous SCT (HR = 2.6, 95% CI 1.6-2.8), foreign birth (HR = 2.3, 95% CI 1.5-3.3), and high income (HR = 2.0, 95% CI 1.8-3.7). During their first trip, 64 travelers (28%) had traveled to destinations that may have required vaccination or malaria chemoprophylaxis. Only 56% reported seeking pre-travel health advice. Of those who traveled, 16 travelers (7%) became ill enough to require medical attention during their first trip after SCT. Ill travelers were more likely to have visited high-risk areas (60 vs 26%, p = 0.005), to have had a longer mean trip duration (24 vs 12 days, p = 0.0002), and to have visited friends and relatives (69 vs 21%, p < 0.0001). International travel was common among SCTRs within 2 years after SCT and was mainly to low-risk destinations. Although the overall incidence of travel-related illnesses was low, certain subgroups of travelers were at a

Risk factors and pre-travel healthcare of international travellers attending a Dutch travel clinic: a cross-sectional analysis.

PubMed

Wieten, Rosanne W; van der Schalie, Maurice; Visser, Benjamin J; Grobusch, Martin P; van Vugt, Michèle

2014-01-01

The number of international travellers is currently estimated to exceed one billion annually. To address travel related health risks and facilitate risk reduction strategies, detailed knowledge of travellers' characteristics is important. In this cross-sectional study, data of a 20% sample of travellers visiting the Academic Medical Center (AMC) travel clinic Amsterdam from July 2011 to July 2012 was collected. Itineraries and protection versus exposure rates of preventable infectious diseases were mapped and reported according to STROBE guidelines. 1749 travellers were included. South-Eastern Asia, South-America and West-Africa were most frequently visited. 26.2% of the population had pre-existing medical conditions (often cardiovascular). Young and VFR travellers had a longer median travel time (28 and 30 days) compared to the overall population (21 days). Young adult travellers were relatively often vaccinated against hepatitis B (43.9% vs. 20.5%, p < .001) and rabies (16.6% vs. 4.3%, p < .001). VFRs were less often vaccinated against hepatitis B (11.6% vs. 30.6%, p < .001) and rabies (1.3% vs. 9.0%, p .012) compared to non-VFR travellers. Pre-travel guidelines were well adhered to. Young adult travellers had high-risk itineraries but were adequately protected. Improvement of hepatitis B and rabies protection would be desirable, specifically for VFRs. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

PubMed

Flaherty, Gerard; Md Nor, Muhammad Najmi

2016-01-01

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. © The Author 2016. Published by Oxford University Press on behalf of International society of travel medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Increasing referral of at-risk travelers to travel health clinics: evaluation of a health promotion intervention targeted to travel agents.

PubMed

MacDougall, L A; Gyorkos, T W; Leffondré, K; Abrahamowicz, M; Tessier, D; Ward, B J; MacLean, J D

2001-01-01

Increases in travel-related illness require new partnerships to ensure travelers are prepared for health risks abroad. The travel agent is one such partner and efforts to encourage travel agents to refer at-risk travelers to travel health clinics may help in reducing travel-attributable morbidity. A health promotion intervention encouraging travel agents to refer at-risk travelers to travel health clinics was evaluated. Information on the knowledge, attitudes, and behaviors of travel agents before and after the intervention was compared using two self-administered questionnaires. The Wilcoxon signed rank test was used to compare the mean difference in overall scores to evaluate the overall impact of the intervention and also subscores for each of the behavioral construct groupings (attitudes, barriers, intent, and subjective norms). Multiple regression techniques were used to evaluate which travel agent characteristics were independently associated with a stronger effect of the intervention. A small improvement in travel agents overall attitudes and beliefs (p =.03) was found, in particular their intention to refer (p =.01). Sixty-five percent of travel agents self-reported an increase in referral behavior; owners or managers of the agency were significantly more likely to do so than other travel agents (OR = 7.25; 95% CI: 1.64 32.06). Older travel agents, those that worked longer hours and those with some past referral experience, had significantly higher post-intervention scores. Travel agents can be willing partners in referral, and agencies should be encouraged to develop specific referral policies. Future research may be directed toward investigating the role of health education in certification curricula, the effectiveness of different types of health promotion interventions, including Internet-facilitated interventions, and the direct impact that such interventions would have on travelers attending travel health clinics.

Culinary delights and travel? A review of zoonotic cestodiases and metacestodiases.

PubMed

Ito, Akira; Budke, Christine M

2014-01-01

Due to increased globalization, food-borne parasitic infections are becoming more prevalent worldwide, including in countries where these parasites and parasitic diseases had previously been well controlled or eradicated. Improved sanitation, health education, and establishment of appropriate food safety mechanisms can go a long way towards the control of many these infections. However, food-borne parasitic infections are still common diseases in developing countries, especially in rural areas. As many of today's travelers are looking to explore more distant locations and partake in the local cuisine, they may be at greater risk of acquiring a food-borne parasitic infection, including those caused by a number of adult and larval tapeworms. This review discusses fish and meat-borne tapeworms and zoonotic metacestodiases of public health importance to both developing and developed countries, with a focus on infection prevention in travelers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Human travel and traveling bedbugs.

PubMed

Delaunay, Pascal

2012-12-01

A dramatic increase of reported bedbug (Cimex lectularius and Cimex hemipterus) infestations has been observed worldwide over the past decade. Bedbug infestations have also been detected across a wide range of travel accommodations, regardless of their comfort and hygiene levels. Travelers are increasingly exposed to the risks of bedbug bites, infestation of personal belongings, and subsequent contamination of newly visited accommodations and their homes. We searched Medline publications via the PubMed database. National bedbug recommendations, textbooks, newspapers, and Centers for Disease Control websites were also searched manually. To detect infested sites, avoid or limit bedbug bites, and reduce the risk of contaminating one's belongings and home, bedbug biology and ecology must be understood. A detailed search of their most classic hiding niches is a key to finding adult bedbugs, nymphs, eggs, and feces or traces of blood from crushed bedbugs. Locally, bedbugs move by active displacement to feed (bite) during the night. Bed, mattress, sofa, and/or curtains are the most frequently infested places. If you find bedbugs, change your room or, even better, the hotel. Otherwise, travelers should follow recommendations for avoiding bedbugs and their bites during the night and apply certain simple rules to avoid infesting other sites or their home. Travelers exposed to bedbugs can minimize the risks of bites and infestation of their belongings, and must also do their civic duty to avoid contributing to the subsequent contamination of other hotels and, finally, home. © 2012 International Society of Travel Medicine.

TRAVEL FORECASTER

NASA Technical Reports Server (NTRS)

Mauldin, L. E.

1994-01-01

Business travel planning within an organization is often a time-consuming task. Travel Forecaster is a menu-driven, easy-to-use program which plans, forecasts cost, and tracks actual vs. planned cost for business-related travel of a division or branch of an organization and compiles this information into a database to aid the travel planner. The program's ability to handle multiple trip entries makes it a valuable time-saving device. Travel Forecaster takes full advantage of relational data base properties so that information that remains constant, such as per diem rates and airline fares (which are unique for each city), needs entering only once. A typical entry would include selection with the mouse of the traveler's name and destination city from pop-up lists, and typed entries for number of travel days and purpose of the trip. Multiple persons can be selected from the pop-up lists and multiple trips are accommodated by entering the number of days by each appropriate month on the entry form. An estimated travel cost is not required of the user as it is calculated by a Fourth Dimension formula. With this information, the program can produce output of trips by month with subtotal and total cost for either organization or sub-entity of an organization; or produce outputs of trips by month with subtotal and total cost for international-only travel. It will also provide monthly and cumulative formats of planned vs. actual outputs in data or graph form. Travel Forecaster users can do custom queries to search and sort information in the database, and it can create custom reports with the user-friendly report generator. Travel Forecaster 1.1 is a database program for use with Fourth Dimension Runtime 2.1.1. It requires a Macintosh Plus running System 6.0.3 or later, 2Mb of RAM and a hard disk. The standard distribution medium for this package is one 3.5 inch 800K Macintosh format diskette. Travel Forecaster was developed in 1991. Macintosh is a registered trademark of

HIV and travel.

PubMed

Schuhwerk, M A; Richens, J; Zuckerman, Jane N

2006-01-01

There is a high demand for travel among HIV-positive individual. This demand arises partly from those who have benefited from advances in antiretroviral therapy as well as those with disease progression. The key to a successful and uneventful holiday lies in careful pre-trip planning, yet many patients fail to obtain advice before travelling. Travel advice for HIV patients is becoming increasingly specialized. In addition to advice on common travel-related infectious diseases, HIV-positive travellers are strongly advised to carry information with them and they need specific advice regarding country entry restrictions, HIV inclusive travel insurance, safety of travel vaccinations and highly active antiretroviral therapy-related issues. A wide range of relevant issues for the HIV-positive traveller are discussed in this review and useful websites can be found at the end.

A profile of travelers--an analysis from a large swiss travel clinic.

PubMed

Bühler, Silja; Rüegg, Rolanda; Steffen, Robert; Hatz, Christoph; Jaeger, Veronika K

2014-01-01

Globally, the Swiss have one of the highest proportions of the population traveling to tropical and subtropical countries. Large travel clinics serve an increasing number of customers with specific pre-travel needs including uncommon destinations and preexisting medical conditions. This study aims to identify health characteristics and travel patterns of travelers seeking advice in the largest Swiss travel clinic so that tailored advice can be delivered. A descriptive analysis was performed on pre-travel visits between July 2010 and August 2012 at the Travel Clinic of the Institute of Social and Preventive Medicine, University of Zurich, Switzerland. A total of 22,584 travelers sought pre-travel advice. Tourism was the main reason for travel (17,875, 81.5%), followed by visiting friends and relatives (VFRs; 1,715, 7.8%), traveling for business (1,223, 5.6%), and "other reasons" (ie, volunteer work, pilgrimage, study abroad, and emigration; 1,112, 5.1%). The main travel destination was Thailand. In the VFR group, the highest proportions of traveling children (258, 15.1%) and of pregnant or breastfeeding women (23, 3.9%) were observed. Mental disorders were more prominent in VFRs (93, 5.4%) and in travel for "other reasons" (63, 5.7%). The latter stayed for the longest periods abroad; 272 (24.9%) stayed longer than 6 months. VFR travelers received the highest percentage of yellow fever vaccinations (523, 30.5%); in contrast, rabies (269, 24.2%) and typhoid vaccinations (279, 25.1%) were given more often to the "other travel reasons" group. New insights into the characteristics of a selected and large population of Swiss international travelers results in improved understanding of the special needs of an increasingly diverse population and, thus, in targeted preventive advice and interventions. © 2014 International Society of Travel Medicine.

Travel health: sun protection and skin cancer prevention for travellers.

PubMed

Wood, Cate

The UK population likes to travel to sunny parts of the world, where the risk of sunburn is greater than it is at home. Sunburn and the cultural desire for a tan is one of the risk factors for the increase in skin cancer. The rise in foreign travel has resulted in an increased demand for pre-travel health services, with nurses in primary care acting as the main providers.Within these consultations, the traveller and their travel plans are risk assessed.Travel health consultations give an ideal opportunity to discuss and advise the public regarding sun burn and skin cancer protection. However, there are also other ways to impart safety in the sun message to travellers. Skin protection is a health promoting activity provided as a part of public health provision and all nurses can play a role in prevention.

The New England travel market: changes in generational travel patterns

Treesearch

Rodney B. Warnick

1995-01-01

The purpose of this study was to examine and explore the New England domestic travel market trends, from 1979 through 1991 within the context of generations. The existing travel markets, who travel to New England, are changing by age cohorts and specifically within different generations. The New England changes in generational travel patterns do not reflect national...

Travel Time Influences Readmission Risk: Geospatial Mapping of Surgical Readmissions.

PubMed

Turrentine, Florence E; Buckley, Patrick J; Sohn, Min-Woong; Williams, Michael D

2017-06-01

The University of Virginia (UVA) has recently become an Accountable Care Organization (ACO), intensifying efforts to provide better care for individuals. UVA's ACO population resides across the entire Commonwealth, with a large percentage of patients living in rural areas. To provide better health for this population, the central tenet of the ACO mission, we identified geographic risk factors influencing hospital readmission. We analyzed the relationship between the distance of patients' residence to the nearest hospital and 30-day readmission in general surgery patients. A retrospective chart review using January 1, 2011 through October 31, 2013 American College of Surgeons National Surgical Quality Improvement Program data for general surgery procedures was conducted. ArcGIS mapped street addresses provided graphical representation of distance between surgical population and the nearest hospital. We analyzed the impact on readmission, of time traveled, insurance status, and median household income. Each increase of 10 minutes in travel time from the patient's residence to the nearest hospital, not just UVA, was associated with a 9 per cent increase in the probability of readmission after adjusting for patient characteristics, preoperative comorbidities, laboratory values, and postoperative complications before or after discharge (odds ratio = 1.09; 95% confidence interval = 1.01-1.17; P = 0.019). Unlike urban hospitals, those serving rural populations may be at particular risk of postsurgical readmissions. Patients living furthest from a hospital facility are most at risk for readmission after a general surgery procedure. This vulnerable population may benefit most from comprehensive discharge planning.

[The profile of Israeli travelers to developing countries: perspectives of a travel clinic].

PubMed

Stienlauf, Shmuel; Meltzer, Eyal; Leshem, Eyal; Rendi-Wagner, Pamela; Schwartz, Eli

2010-09-01

The number of Israeli travelers is increasing, including the number of travelers to developing countries. This study aimed to characterize the profile of Israeli travelers to developing countries. Data regarding demographics, travel destinations, trip duration and the purpose of travel were collected on travelers attending the pre-travel clinic at the Sheba Medical Center during a period of 9 years. Between the dates 1/1/1999 and 31/12/2007, 42,771 travelers presented for consultation at the Sheba Medical Center pre-travel clinic. The average age was 30.8 +/- 13.4 years and 54% of the travelers were males. The female proportion increased from 42% in 1999 to 49% in 2006. There was a steady increase in the number of travelers attending our clinic, except in 2003 (coinciding with the SARS epidemic). Post-army backpackers (20-25 year-old age group) were only 43% of the travelers. Children (<18 years), and elderly (>60 years) comprised 4.4% and 4.6% of the travelers, respectively. The favorite destinations were Asia (55%), followed by Latin America (27%) and Africa (13%). The distribution of travel destinations varied significantly during the study period. Of note is the sharp decline in travel to Africa following the terrorist attack in Mombassa, Kenya (November 2002). The median trip duration changed during the study period, from 30 to 45 days, between 1999-2004 and 2005-2007 respectively. The majority (87%) of voyagers traveled for pleasure, 6% went for business, and 7% were representatives of governmental organizations. This study found an increasing diversity in the traveler population (more women, more children and older travelers) and more diversity in travel destinations. Disease outbreaks and terrorist attacks had transient negative impacts on the number of travelers.

The impact of injection anxiety on education of travelers about common travel risks.

PubMed

Noble, Lorraine M; Farquharson, Lorna; O'Dwyer, Niamh A; Behrens, Ron H

2014-01-01

Despite many travelers receiving at least one vaccination during the pre-travel consultation, little is known about travelers' fear of injections and the impact this may have on educating travelers about health risks associated with their trip. This study aimed to investigate: (1) the prevalence of injection anxiety in travelers attending a pre-travel consultation, (2) whether anxiety due to anticipating a vaccination adversely affects recall of information and advice, and (3) whether clinicians can recognize travelers' anxiety, and how they respond to anxious travelers. Consecutive adult travelers (N = 105) attending one of two inner-city travel clinics completed self-report measures of state anxiety, injection anxiety, and symptoms of needle phobia immediately before and after their pre-travel consultation. Clinicians were also asked to rate travelers' anxiety and report any anxiety management strategies. Standardized information was presented during the consultation and recall of information and advice was assessed immediately post-consultation. Delayed recall (24 hours) was assessed for a subsample (20%) of participants. More than one third of travelers reported feeling nervous or afraid when having an injection (39%). Travelers' state anxiety was related to their psychological and physiological reactions to needles, and reduced significantly post-consultation. Recall of information and advice varied, with failure of recall ranging from 2 to 70% across 15 items, and delayed recall being significantly lower. No relationship was found between recall and anxiety. Clinician-rated anxiety moderately correlated with travelers' self-reported anxiety. A significant proportion of travelers experienced injection anxiety when attending the pre-travel consultation, with some travelers reporting symptoms consistent with criteria for Blood Injection Injury phobia. There were important gaps in recall of information and advice about common travel risks. Although no

The provision of neuropsychological services in rural/regional settings: professional and ethical issues.

PubMed

Allott, Kelly; Lloyd, Susan

2009-07-01

Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.

Pre-travel counselling in Greece for travellers visiting friends and relatives.

PubMed

Pavli, Androula; Katerelos, Panagiotis; Pierroutsakos, Ioannis N; Maltezou, Helen C

2009-09-01

Pre-travel services are underused by travellers visiting friends and relatives (VFRs). The objective of this study was to define the proportion and the profile of VFRs who seek pre-travel counselling in Greece. The study was conducted prospectively, from July, 2005 to December, 2007, in seven Health Departments of the Prefectures in Athens and Attica, where 35.6% of the Greek population resides; migrants account for 17% and 8% of the population in these areas, respectively. 2548 travellers seeking pre-travel advice were studied; 23 (0.9%) were identified as VFRs. Children younger than 15 years accounted for 30.4% of VFRs, compared to 2.3% among non-VFRs. VFRs were younger than non-VFRs (mean ages: 29.9 versus 40.4 years, respectively). A comparison of VFRs with non-VFRs revealed that VFRs travelled for longer periods of time, stayed at local people's home more frequently (87% versus 15.5%), and travelled on an organized trip less frequently (4.3% versus 54.6%). Considering the fact that 36,056 VFRs travelled from Greece to Africa and Asia during 2005-2007, and that only 1 out of 700 VFRs to these destinations pre-travel advice in Greece, communication strategies to access efficiently this group of travellers should be explored urgently.

Challenges to providing pre-travel care for travellers visiting friends and relatives: an audit of a specialist travel medicine clinic.

PubMed

Rowe, Kate; Chaves, Nadia; Leder, Karin

2017-09-01

Travellers visiting friends and relatives (VFRs) often have complex pre-travel needs. We identified the characteristics, destinations, vaccinations and pre-travel advice provided to VFRs and compared these with non-VFR travellers. The significant differences we found suggest that future research should focus on improving the uptake of recommended interventions in VFR travellers. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Simple cost analysis of a rural dental training facility in Australia.

PubMed

Lalloo, Ratilal; Massey, Ward

2013-06-01

Student clinical placements away from the university dental school clinics are an integral component of dental training programs. In 2009, the School of Dentistry and Oral Health, Griffith University, commenced a clinical placement in a remote rural community in Australia. This paper presents a simple cost analysis of the project from mid-2008 to mid-2011. All expenditures of the project are audited by the Financial and Planning Services unit of the university. The budget was divided into capital and operational costs, and the latter were further subdivided into salary and non-salary costs, and these were further analysed for the various types of expenditures incurred. The value of the treatments provided and income generated is also presented. Remote rural placements have additional (to the usual university dental clinic) costs in terms of salary incentives, travel, accommodation and subsistence support. However, the benefits of the placement to both the students and the local community might outweigh the additional costs of the placement. Because of high costs of rural student clinical placements, the financial support of partners, including the local Shire Council, state/territory and Commonwealth governments, is crucial in the establishment and ongoing sustainability of rural dental student clinical placements. © 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Travel characteristics and risk-taking attitudes in youths traveling to nonindustrialized countries.

PubMed

Han, Pauline; Balaban, Victor; Marano, Cinzia

2010-01-01

International travel to developing countries is increasing with rising levels of disposable income; this trend is seen in both adults and children. Risk-taking attitude is fundamental to research on the prevention of risky health behaviors, which can be an indicator of the likelihood of experiencing illness or injury during travel. The aim of this study is to investigate whether risk-taking attitudes of youths are associated with travel characteristics and likelihood of experiencing illness or injury while traveling to nonindustrialized countries. Data were analyzed from the 2008 YouthStyles survey, an annual mail survey gathering demographics and health knowledge, attitudes, and practices of individuals from 9 through 18 years of age. Travelers were defined as respondents who reported traveling in the last 12 months to a destination other than the United States, Canada, Europe, Japan, Australia, or New Zealand. Risk-taking attitude was measured by using a four-item Brief Sensation-Seeking Scale. All p values ≤ 0.05 were considered significant. Of 1,704 respondents, 131 (7.7%) traveled in the last 12 months. Females and those with higher household income were more likely to travel (odds ratio = 1.6,1.1). Of those who traveled, 16.7% reported seeking pretravel medical care, with most visiting a family doctor for that care (84.0%). However, one-fifth of respondents reported illness and injury during travel; of these, 83.3% traveled with their parents. Males and older youths had higher mean sensation-seeking scores. Further, travelers had a higher mean sensation-seeking score than nontravelers. Those who did not seek pretravel medical care also had higher mean sensation-seeking scores (p = 0.1, not significant). Our results show an association between risk-taking attitudes and youth travel behavior. However, adult supervision during travel and parental directives prior to travel should be taken into consideration. Communication messages should emphasize the

The Fly-in Fly-out and Drive-in Drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages.

PubMed

Hussain, Rafat; Maple, Myfanwy; Hunter, Sally V; Mapedzahama, Virginia; Reddy, Prasuna

2015-01-01

Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners. FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities. Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.

Fellow travellers: Working memory and mental time travel in rodents.

PubMed

Dere, Ekrem; Dere, Dorothea; de Souza Silva, Maria Angelica; Huston, Joseph P; Zlomuzica, Armin

2017-03-19

The impairment of mental time travel is a severe cognitive symptom in patients with brain lesions and a number of neuropsychiatric disorders. Whether animals are also able to mentally travel in time both forward and backward is still a matter of debate. In this regard, we have proposed a continuum of mental time travel abilities across different animal species, with humans being the species with the ability to perform most sophisticated forms of mental time travel. In this review and perspective article, we delineate a novel approach to understand the evolution, characteristics and function of human and animal mental time travel. Furthermore, we propose a novel approach to measure mental time travel in rodents in a comprehensive manner using a test battery composed of well-validated and easy applicable tests. Copyright © 2017. Published by Elsevier B.V.

The Concept of Travel Medicine and the Actual Situation of Travel-Related Illnesses.

PubMed

Tunalı, Varol; Turgay, Nevin

2017-06-01

Travel medicine defines all diseases and medical situations that are related to travel. Travel medicine comprises infectious diseases, traumas, altitude sickness, sun burns, embolisms, jet lag, and many more travel-related situations. With the increasing possibility and ease of travel, the number of people who have travelled internationally has exceeded 1.13 billion in 2014, and the revenues of international travel have exceeded 1.25 trillion dollars. With every passing day, international travels are shifting toward the developing countries and to more exotic regions of the world, and travelers tend to be more adventurous and daring, thereby increasing risky behaviors during travels. Traveling plays an important role in transmitting infections such as Zika virus infection, Ebola, avian flu, severe acute respiratory syndrome, Chikungunya, and dengue fever and is the principal reason for the epidemics of these types of infections on a global scale. With this background, we suggest that travel medicine is an important but "neglected" medical discipline as the discipline of Parasitology itself like most parasitic diseases.

Serious altitude illness in travelers who visited a pre-travel clinic.

PubMed

Croughs, Mieke; Van Gompel, Alfons; Rameckers, Sarah; Van den Ende, Jef

2014-01-01

Few data are available on the incidence and predictors of serious altitude illness in travelers who visit pre-travel clinics. Travel health consultants advise on measures to be taken in case of serious altitude illness but it is not clear if travelers adhere to these recommendations. Visitors to six travel clinics who planned to travel to an altitude of ≥3,000 m were asked to complete a diary from the first day at 2,000 m until 3 days after reaching the maximum sleeping altitude. Serious altitude illness was defined as having symptoms of serious acute mountain sickness (AMS score ≥ 6) and/or cerebral edema and/or pulmonary edema. The incidence of serious altitude illness in the 401 included participants of whom 90% reached ≥4,000 m, was 35%; 23% had symptoms of serious AMS, 25% symptoms of cerebral edema, and 13% symptoms of pulmonary edema. Independent predictors were young age, the occurrence of dark urine, travel in South America or Africa, and lack of acclimatization between 1,000 and 2,500 m. Acetazolamide was brought along by 77% of the responders of whom 41% took at least one dose. Of those with serious altitude illness, 57% had taken at least one dose of acetazolamide, 20% descended below 2,500 m on the same day or the next, and 11% consulted a physician. Serious altitude illness was a very frequent problem in travelers who visited pre-travel clinics. Young age, dark urine, travel in South America or Africa, and lack of acclimatization nights at moderate altitude were independent predictors. Furthermore, we found that seriously ill travelers seldom followed the advice to descend and to visit a physician. © 2014 International Society of Travel Medicine.

Traveler Information Services in Rural Tourism Areas. Appendix C: Observations at Tourist Interactions with Kiosks

DOT National Transportation Integrated Search

2000-06-30

In originally designing the qualitative research, the researchers had expected to find well-utilized kiosks in highly visible locations. They expected that travelers would understand the uses of the kiosks and would be using them for practical trip p...

Tuberculosis and the traveller: evaluating and reducing risk through travel consultation.

PubMed

Denholm, Justin T; Thevarajan, Irani

2016-03-01

Although the last 10 years have seen a slow decline in global tuberculosis (TB) incidence, it remains one of the most significant infectious diseases worldwide, with an estimated 9.6 million new cases and 1.5 million deaths in 2014. The consequences of contracting TB can be significant for the individual, with extended treatment requirements, risk of long-term health consequences and the possibility of transmitting infection to others among the complications of disease. This review article discusses the risk of TB infection as a result of international travel including evaluation of risk, risk reduction and a proposed testing strategy for travel-related TB infection. A review of the relevant literature combined with expert opinion was used to formulate this article. The global TB epidemic is varied and dynamic, including changing patterns of both drug sensitive and drug resistant disease. The annual incidence of TB in individual countries such as South Africa may be greater than 800/100,000, while multidrug resistance is found in up to 19% of new cases in the Russian Federation. Recent surveys of traveller risk are presented for short and long-term travellers to various countries and settings. Overall, risk to travelers is low, with rates of acquiring latent TB less than 1% per travel year for most settings. However, detailed travel evaluation is necessary to evaluate individual risk. Travellers with immunosuppressive conditions are at high risk for progression to active disease if infected, and should have special consideration in travel consultation. It is important for practitioners giving advice regarding tuberculosis risk and travel to access up-to-date information regarding local conditions. This article provides an approach to assessment and management of TB in travellers, including a guide to pre- and post-travel evaluation, testing and vaccination. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press

President's Address: Travel Medicine and Principles of Safe Travel

PubMed Central

DuPont, Herbert L.

2008-01-01

Persons crossing international boundaries away from their medical support systems are put at risk for illness and injury. Travel medicine is a new medical discipline that quantifies these health risks and develops strategies for reducing them. Obtaining health and evacuation insurance for a future trip is important for persons with medical conditions, those planning trips to developing tropical or semi-tropical regions of the world or when an international stay anywhere will be as long as a month. Pre-travel medical evaluation, vaccines against endemic infectious diseases and medications to reduce the occurrence of diarrhea and malaria during trips to endemic areas, and medications for self-treatment of common illnesses such as diarrhea are fundamental to travel medicine. There are a number of miscellaneous areas to consider in travel medicine including preventing deep vein thrombosis and minimizing jet lag during long haul air travel and reducing the occurrence of accidents and water- and altitude-related illnesses. An important recently defined challenge to the field is the growing number of ill-prepared persons put at great risk for illness while visiting friends and relatives living in areas of reduced hygiene. All persons need to have an idea of how and where they may find medical care if they develop illness while abroad. This article summarizes essential elements in travel medicine and offers 10 recommendations for safe travel. PMID:18596858

Do British travel agents provide adequate health advice for travellers?

PubMed Central

Lawlor, D A; Burke, J; Bouskill, E; Conn, G; Edwards, P; Gillespie, D

2000-01-01

Travel-related illness is a burden for primary care, with more than two million travellers consulting a general practitioner each year. The annual cost of travel-related illness in the United Kingdom is 11 million Pounds. Travel agents are in a unique position to influence this burden as the most common and most serious problems are preventable with simple advice and/or immunisation. This study, using covert researchers, suggests this potential is not being fully utilised. PMID:10954940

Hypothermia in a Rural Setting: An Emergency Medicine Simulation Scenario

PubMed Central

Jong, Robert; Heroux, Aron; Dubrowski, Adam

2017-01-01

Patients presenting with hypothermia in a rural emergency department can be quite challenging to manage without significant mortality and morbidity. Standard medical school curricula do not fully prepare trainees for the unique aspects of practice in northern rural and remote communities. Training opportunities on site may provide a solution to this lack of experience. However, these communities often have limited simulation-based resources and expertise for conducting and developing simulation scenarios. In this technical report, we outline a hypothermia simulation that utilizes only basic resources and is, thus, practical for rural and remote facilities. The aim of this report is to better equip trainees, clinicians, and emergency department staff who may encounter such a scenario in their practice. While the simulation is specifically designed for medical students, resident doctors, and emergency department staff, it could also be applicable in other low-resource settings, such as military bases, search and rescue stations, and arctic travel and tourism infirmaries. PMID:29511605

Travelers' Health: Scabies

MedlinePlus

... Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers Road Safety Senior Citizens Sex Tourism STDs Sun Exposure Swimming and Diving Study Abroad ...

Travelers' Health: Diphtheria

MedlinePlus

... Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers Road Safety Senior Citizens Sex Tourism STDs Sun Exposure Swimming and Diving Study Abroad ...

International Travelers' Sociodemographic, Health, and Travel Characteristics: An Italian Study.

PubMed

Troiano, Gianmarco; Mercone, Astrid; Bagnoli, Alessandra; Nante, Nicola

Approximately the 8% of travelers requires medical care, with the diagnosis of a vaccine-preventable disease. The aim of our study was to analyze the socio-demographic, health and travel characteristics of the Italian international travelers. We conducted a cross sectional study from January 2015 to June 2016, at the Travel Medicine Clinic of Siena, asking the doctor to interview patients who attended the Clinic, recording socio-demographic and travel information, malaria prophylaxis, vaccinations. The data were organized in a database and processed by software Stata®. We collected 419 questionnaires. Patients chose 71 countries for their travels; the favorite destinations were: India (6.31%), Thailand (6.31%), and Brazil (5.10%). The mean length of stay was 36.17 days. Italians, students, and freelancers tended to stay abroad for a longer time (mean: 36.4 days, 59.87 days and 64.16 days respectively). 33.17% of our sample used drugs for malaria chemoprophylaxis: 71.9% of them used Atovaquone/Proguanil (Malarone®), 26.6% used Mefloquine (Lariam®), 1.5% other drugs. The vaccinations that travelers mostly got in our study were to prevent hepatitis A (n = 264), the typhoid fever (n = 187), the Tetanus + Diphtheria + Pertussis (n = 165), the Yellow fever (n = 118) and the cholera (n = 78). Twenty-eight (6.68%) refused some recommended vaccinations. The vaccines mostly refused were for Typhoid fever (n = 20), hepatitis a (n = 9), and cholera (n = 9). Our results demonstrated that Italian international travelers are at-risk because of their poor vaccinations adherence. This implies that pre-travel counseling is fundamental to increase the knowledge of the risks and the compliance of future travelers. Copyright © 2016 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Acquisition of traveler information and its effects on travel choices : evidence from a Seattle-area travel diary survey

DOT National Transportation Integrated Search

2003-04-07

Advanced Traveler Information Systems offer the promise of better informed travel decisions and more efficient use of transportation infrastructure. However, no firm consensus has emerged as to how travelers decide to access information, or how they ...

Travelers' Health: Rabies

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Poliomyelitis

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Rubella

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Cryptosporidiosis

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travellers' diarrhoea.

PubMed

Ericsson, Charles D

2003-02-01

Risk of travellers' diarrhoea is about 7% in developed countries and 20-50% in the developing world. Options for prevention include education and chemoprophylaxis. Vaccination is a promising but incomplete option. Achieving behaviour modification of food and water choices among tourists is difficult. Bismuth subsalicylate (BSS)-containing compounds are about 62% effective in the prevention of travellers' diarrhoea. Antibiotics are about 84% effective in preventing travellers' diarrhoea. Routine prophylaxis of travellers' diarrhoea, especially with antibiotics, should be discouraged. Oral rehydration is generally important in the treatment of diarrhoea, but travellers' diarrhoea is only infrequently dehydrating in adults. The addition of oral rehydration solutions confers no additional benefit to loperamide in the treatment of travellers' diarrhoea in adults. Presently, the most active of the antibiotics routinely available for treatment are members of the fluoroquinolone group. Antibiotics that are not absorbed such as aztreonam and a rifampicin-like agent, rifaximin, are both effective. The latter might become a therapy of choice once it is routinely available, due to predictably less adverse reactions with a non-absorbed antibiotic. Preliminary results with azithromycin look very promising. Less severe disease can be treated with a variety of non-antibiotic agents (e.g. BSS-containing compounds, loperamide and a calmodulin inhibitor, zaldaride). The combination of an antibiotic and loperamide is superior to treatment with either agent alone in a several studies and is arguably the treatment of choice for distressing travellers' diarrhoea.

Travel Times for Screening Mammography: Impact of Geographic Expansion by a Large Academic Health System.

PubMed

Rosenkrantz, Andrew B; Liang, Yu; Duszak, Richard; Recht, Michael P

2017-09-01

This study aims to assess the impact of off-campus facility expansion by a large academic health system on patient travel times for screening mammography. Screening mammograms performed from 2013 to 2015 and associated patient demographics were identified using the NYU Langone Medical Center Enterprise Data Warehouse. During this time, the system's number of mammography facilities increased from 6 to 19, reflecting expansion beyond Manhattan throughout the New York metropolitan region. Geocoding software was used to estimate driving times from patients' homes to imaging facilities. For 147,566 screening mammograms, the mean estimated patient travel time was 19.9 ± 15.2 minutes. With facility expansion, travel times declined significantly (P < 0.001) from 26.8 ± 18.9 to 18.5 ± 13.3 minutes (non-Manhattan residents: from 31.4 ± 20.3 to 18.7 ± 13.6). This decline occurred consistently across subgroups of patient age, race, ethnicity, payer status, and rurality, leading to decreased variation in travel times between such subgroups. However, travel times to pre-expansion facilities remained stable (initial: 26.8 ± 18.9 minutes, final: 26.7 ± 18.6 minutes). Among women undergoing mammography before and after expansion, travel times were shorter for the postexpansion mammogram in only 6.3%, but this rate varied significantly (all P < 0.05) by certain demographic factors (higher in younger and non-Hispanic patients) and was as high as 18.2%-18.9% of patients residing in regions with the most active expansion. Health system mammography facility geographic expansion can improve average patient travel burden and reduce travel time variation among sociodemographic populations. Nonetheless, existing patients strongly tend to return to established facilities despite potentially shorter travel time locations, suggesting strong site loyalty. Variation in travel times likely relates to various factors other than facility proximity

Trends and characteristics among HIV-infected and diabetic travelers seeking pre-travel advice.

PubMed

Elfrink, Floor; van den Hoek, Anneke; Sonder, Gerard J B

2014-01-01

The number of individuals with a chronic disease increases. Better treatment options have improved chronic patients' quality of life, likely increasing their motivation for travel. This may have resulted in a change in the number of HIV-infected travelers and/or travelers with Diabetes Mellitus (DM) visiting our travel clinic. We retrospectively analyzed the database of the travel clinic of the Public Health Service Amsterdam, between January 2001 and December 2011 and examined the records for patients with these conditions. Of the 25,000 travelers who consult our clinic annually, the proportion of travelers with HIV or DM has increased significantly. A total of 564 HIV-infected travelers visited our clinic. The mean age was 41 years, 86% were male, 43% visited a yellow fever endemic country and 46.5% had a CD4 count <500 cells/mm(3). Travelers with low CD4 counts traveled significantly more often to visit friends or relatives. A total of 3704 diabetics visited our clinic. The mean age was 55 years, 52% were male, 27% visited a yellow fever endemic country and 36% were insulin-dependent. Insulin-dependent diabetics traveled more often for work than non-insulin-dependent diabetics. Adequately trained and qualified travel health professionals and up-to-date guidelines for travelers with chronic diseases are of increasing importance. Copyright © 2013 Elsevier Ltd. All rights reserved.

Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study.

PubMed

O'Sullivan, Belinda G; McGrail, Matthew R; Joyce, Catherine M; Stoelwinder, Johannes

2016-06-01

Objective This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21-0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32-7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. What is known about this topic? There are numerous case studies describing outreach by specialist doctors. However, there is no systematic evidence describing the distribution of rural outreach services and models of outreach by specialists living in different locations and the broad-level factors that affect this. What does this paper add? The present study provides the first description of outreach service distribution and models of rural outreach by specialist doctors living in rural versus metropolitan areas. It shows

Travelers' health problems and behavior: prospective study with post-travel follow-up.

PubMed

Vilkman, Katri; Pakkanen, Sari H; Lääveri, Tinja; Siikamäki, Heli; Kantele, Anu

2016-07-13

The annual number of international tourist arrivals has recently exceeded one billion, yet surprisingly few studies have characterized travelers' behavior, illness, and risk factors in a prospective setting. Particularly scarce are surveys of data spanning travel, return, and follow-up of the same cohort. This study examines behavior and illness among travelers while abroad, after return home, and at follow-up. Patterns of behavior connected to type of travel and illness are characterized so as to identify risk factors and provide background data for pre-travel advice. Volunteers to this prospective cohort study were recruited at visits to a travel clinic prior to departure. Data on the subjects' health and behavior were collected by questionnaires before and after journeys and over a three-week follow-up. In addition, the subjects were asked to fill in health diaries while traveling. The final study population consisted of 460 subjects, 79 % of whom reported illness during travel or on arrival: 69 % had travelers' diarrhea (TD), 17 % skin problems, 17 % fever, 12 % vomiting, 8 % respiratory tract infection, 4 % urinary tract infection, 2 % ear infection, 4 % gastrointestinal complaints other than TD or vomiting, and 4 % other symptoms. Of all subjects, 10 % consulted a doctor and 0.7 % were hospitalized; 18 % took antimicrobials, with TD as the most common indication (64 %). Ongoing symptoms were reported by 25 % of all travelers upon return home. During the three-week follow-up (return rate 51 %), 32 % of respondents developed new-onset symptoms, 20 % visited a doctor and 1.7 % were hospitalized. Factors predisposing to health problems were identified by multivariable analysis: certain regions (Southern Asia, South-Eastern Asia, and Eastern Africa), female gender, young age, and long travel duration. Despite proper preventive measures like vaccinations, malaria prophylaxis, and travel advice, the majority of our subjects fell ill during or

Australian senior adventure travellers to Peru: Maximising older tourists' travel health experience.

PubMed

Bauer, Irmgard

2012-03-01

Financially comfortable, with ample spare time and much better health, older people travel more than ever and to more adventurous destinations. Taking Australian senior adventure travellers to Peru as an example, travel health preparations need to take into account the phenomenon 'senior traveller', the destination with its attractions and challenges, and age-related changes and restrictions. The need for routine travel health advice, vaccinations and prophylaxis remains unchanged. However, more emphasis should be placed on locality-specific issues so that age-appropriate advice and preparations maximize the chances for a safe and memorable travel experience. Copyright © 2012 Elsevier Ltd. All rights reserved.

Major variations in malaria exposure of travellers in rural areas: an entomological cohort study in western Côte d'Ivoire.

PubMed

Orlandi-Pradines, Eve; Rogier, Christophe; Koffi, Bernard; Jarjaval, Fanny; Bell, Melissa; Machault, Vanessa; Pons, Christophe; Girod, Romain; Boutin, Jean-Paul; Pagès, Frédéric

2009-07-28

Malaria remains a major threat, to both travellers and military personnel deployed to endemic areas. The recommendations for travellers given by the World Health Organization is based on the incidence of malaria in an area and do not take the degree of exposure into account. The aim of this article is to evaluate the exposure of travellers by entomologic methods, which are the commonly used measures of the intensity of malaria transmission. From February 2004 to June 2004, five groups of 30 military personnel were stationed in up to 10 sites in western Côte d'Ivoire, from one week to several months. Adult mosquitoes were collected by human landing catches at each site during the five months and the level of exposure to malaria transmission of each group was estimated. The level of transmission varied from one site to another one from less than one to approximately more than 100 infective bites per month. In the majority of sites, at least two anopheline species were involved in transmission. The cumulative EIR over the study period varied according to the groups from 29 infected bites per person/per mission to 324. The level of malaria transmission and malaria risk varies widely (varying by a factor of eleven) between groups of travellers travelling in the same region and at the same time. Physicians involved in travel medicine or supporting expatriated populations or refugees should consider this heterogeneity and emphasize the importance of combining appropriate measures, such as chemoprophylaxis and protective measures against mosquitoes.

Major variations in malaria exposure of travellers in rural areas: an entomological cohort study in western Côte d'Ivoire

PubMed Central

Orlandi-Pradines, Eve; Rogier, Christophe; Koffi, Bernard; Jarjaval, Fanny; Bell, Melissa; Machault, Vanessa; Pons, Christophe; Girod, Romain; Boutin, Jean-Paul; Pagès, Frédéric

2009-01-01

Background Malaria remains a major threat, to both travellers and military personnel deployed to endemic areas. The recommendations for travellers given by the World Health Organization is based on the incidence of malaria in an area and do not take the degree of exposure into account. The aim of this article is to evaluate the exposure of travellers by entomologic methods, which are the commonly used measures of the intensity of malaria transmission. Methods From February 2004 to June 2004, five groups of 30 military personnel were stationed in up to 10 sites in western Côte d'Ivoire, from one week to several months. Adult mosquitoes were collected by human landing catches at each site during the five months and the level of exposure to malaria transmission of each group was estimated. Results The level of transmission varied from one site to another one from less than one to approximately more than 100 infective bites per month. In the majority of sites, at least two anopheline species were involved in transmission. The cumulative EIR over the study period varied according to the groups from 29 infected bites per person/per mission to 324. Conclusion The level of malaria transmission and malaria risk varies widely (varying by a factor of eleven) between groups of travellers travelling in the same region and at the same time. Physicians involved in travel medicine or supporting expatriated populations or refugees should consider this heterogeneity and emphasize the importance of combining appropriate measures, such as chemoprophylaxis and protective measures against mosquitoes. PMID:19638219

Travel agents and the prevention of health problems among travelers in Québec.

PubMed

Provost, Sylvie; Gaulin, Colette; Piquet-Gauthier, Blandine; Emmanuelli, Julien; Venne, Sylvie; Dion, Réjean; Grenier, Jean-Luc; Dessau, Jean-Claude; Dubuc, Martine

2002-01-01

Among the factors influencing travelers to seek preventive health advice before departure, the travel agent's recommendation plays an important role. The objective of our study was to document the practices and needs of travel agents in Québec (Canada) in relation to the prevention of health problems among travelers. In June 2000, a cross-sectional descriptive survey was carried out among travel agents from all travel agencies in Québec. One agent per agency was asked to answer our questions. Data were collected using a 32-item telephone questionnaire. Altogether, 708 travel agents from the 948 agencies contacted answered our questionnaire (participation rate: 75%). Most respondents (81%) believed that the travel agent has a role to play in the prevention of health problems among travelers, especially to recommend that travelers consult a travel clinic before departure. Although over 80% of the agents interviewed mentioned recommending a visit to a travel clinic before an organized tour to Thailand or a backpacking trip in Mexico, less than half said they make the same recommendation for a stay in a seaside resort in Mexico. The majority of respondents were acquainted with the services offered in travel health clinics, and these clinics were the source of travel health information most often mentioned by travel agents. However, nearly 60% of the agents questioned had never personally consulted a travel clinic. When asked about the best way to receive information about travelers' health, more than 40% of respondents favoured receiving information newsletters from public health departments regularly whereas 28% preferred the Internet. Despite the limits of this study, our results should help the public health network better target its interventions aimed to inform travel agents on prevention of health problems among travelers.

Changing retail business models and the impact on CO2 emissions from transport : e-commerce deliveries in urban and rural areas.

DOT National Transportation Integrated Search

2014-10-01

While researchers have found relationships between passenger vehicle travel and smart growth development patterns, : similar relationships have not been extensively studied between urban form and goods movement trip making patterns. In : rural areas,...

German travelers' preferences for travel vaccines assessed by a discrete choice experiment.

PubMed

Poulos, Christine; Curran, Desmond; Anastassopoulou, Anastassia; De Moerlooze, Laurence

2018-02-08

Many travelers to regions with endemic infectious diseases do not follow health authorities' recommendations regarding vaccination against vaccine-preventable infectious diseases, before traveling. The determinants of individual travelers' decisions to vaccinate before traveling are largely unknown. This study aimed to provide this information using a discrete choice experiment (DCE) administered to four types of German travelers: (1) business travelers; (2) travelers visiting friends and relatives (VFR); (3) leisure travelers; and (4) backpackers. A DCE survey was developed, pretested and administered online. It included a series of choice questions in which respondents chose between two hypothetical vaccines, each characterized by four disease attributes with varying levels describing the of risk, health impact, curability and transmissibility of the disease they would prevent (described with four disease attributes with varying levels of risk, health impact, curability and transmissibility), and varying levels of four vaccine attributes (duration of protection, number of doses required, time required for vaccination, and vaccine cost). A random-parameters logit model was used to estimate the importance weights each traveler type placed on the various attribute levels. These weights were used to calculate mean monetary equivalents (MMEs) of changes in each attribute (holding all others constant) and of hypothetical disease-vaccine combinations. All traveler types' choices indicated that they attached the greatest importance to the risk and health impact of disease and to the vaccine cost whereas the other disease and vaccine attributes were less important for their decisions about travel vaccines. An option of not choosing any of the vaccine-pairs presented was rarely selected indicating that travelers' generally prefer to be vaccinated rather than not. The MMEs of changes in vaccine attributes indicated a very high variability between the individual travelers

Calming the Spirit and Ensuring Super-Vivencia: Rural Mexican Women-Centred Teaching and Learning Spaces

ERIC Educational Resources Information Center

Galvan, Ruth Trinidad

2010-01-01

The changing social, cultural and economic conditions of transmigrant communities in rural Mexico require that women who stay behind, while their loved ones travel back and forth to the USA, create social relations that ensure their survival. From over five years of ethnographic research, this article explores the healing potential of…

An Individual-based Rurality Measure and Its Health Application: A Case Study of Latino Immigrants in North Florida, USA

PubMed Central

Mao, Liang; Stacciarini, Jeanne-Marie R.; Smith, Rebekah; Wiens, Brenda

2015-01-01

Rurality has been frequently noted by researchers as pathways to understand human health in rural and remote areas. Current measures of rurality are mostly oriented to places, not individuals, and have not accounted for individual mobility, thus inappropriate for studying health and well-being at an individual level. This research proposed a new concept of individual-based rurality by integrating personal activity spaces. A feasible method was developed to quantify individuals’ rural experience using household travel surveys and geographic information systems (GIS). For illustration, the proposed method was applied to understand the well-being and social isolation among rural Latino immigrants, who had participated in a community-based participatory research (CBPR) study in North Florida, USA. The resulting individuals’ rurality indices were paired with their scores of well-being and social isolation to identify potential associations. The correlation analysis showed that the proposed rurality can be related to the social isolation, mental and physical well-being of individuals in different gender groups, and hence could be a suitable tool to investigate rural health issues. PMID:26615336

Educational Facility Evaluations of Primary Schools in Rural Honduras: Departments of Cortes and Meambar.

ERIC Educational Resources Information Center

Council of Educational Facility Planners, International, Scottsdale, AZ.

A team of 11 educational facility planners and architects from the United States and Canada conducted a facility evaluation of schools in the rural areas of Meambar and Cortes, Honduras. Team members were all part of the Council of Educational Facility Planners, International and traveled to Honduras under the auspices of a Christian mission…

Lewis Online Travel System: Preparer's/Traveler's Manual, Release 1.0

NASA Technical Reports Server (NTRS)

Seese, Michael

1992-01-01

The Lewis Online Travel System (LOTS) is a menu-driven interactive application that automates nearly all of the functions associated with government travel. The purpose of this manual is to provide LOTS users with concise instructions for using the computerized application. As such, it will not go into the details of travel regulations.

Disparities in Patterns of Health Care Travel Among Inpatients Diagnosed With Congestive Heart Failure, Florida, 2011.

PubMed

Jia, Peng; Xierali, Imam M

2015-09-17

Congestive heart failure (CHF) is a major public health problem in the United States and is a leading cause of hospitalization in the elderly population. Understanding the health care travel patterns of CHF patients and their underlying cause is important to balance the supply and demand for local hospital resources. This article explores the nonclinical factors that prompt CHF patients to seek distant instead of local hospitalization. Local hospitalization was defined as inpatients staying within hospital service areas, and distant hospitalization was defined as inpatients traveling outside hospital service areas, based on individual hospital discharge data in 2011 generated by a Dartmouth-Swiss hybrid approach. Multiple logistic and linear regression models were used to compare the travel patterns of different groups of inpatients in Florida. Black patients, no-charge patients, patients living in large metropolitan areas, and patients with a low socioeconomic status were more likely to seek local hospitalization than were white patients, those who were privately insured, those who lived in rural areas, and those with a high socioeconomic status, respectively. Findings indicate that different populations diagnosed with CHF had different travel patterns for hospitalization. Changes or disruptions in local hospital supply could differentially affect different groups in a population. Policy makers could target efforts to CHF patients who are less likely to travel to seek treatment.

Disparities in Patterns of Health Care Travel Among Inpatients Diagnosed With Congestive Heart Failure, Florida, 2011

PubMed Central

Xierali, Imam M.

2015-01-01

Introduction Congestive heart failure (CHF) is a major public health problem in the United States and is a leading cause of hospitalization in the elderly population. Understanding the health care travel patterns of CHF patients and their underlying cause is important to balance the supply and demand for local hospital resources. This article explores the nonclinical factors that prompt CHF patients to seek distant instead of local hospitalization. Methods Local hospitalization was defined as inpatients staying within hospital service areas, and distant hospitalization was defined as inpatients traveling outside hospital service areas, based on individual hospital discharge data in 2011 generated by a Dartmouth–Swiss hybrid approach. Multiple logistic and linear regression models were used to compare the travel patterns of different groups of inpatients in Florida. Results Black patients, no-charge patients, patients living in large metropolitan areas, and patients with a low socioeconomic status were more likely to seek local hospitalization than were white patients, those who were privately insured, those who lived in rural areas, and those with a high socioeconomic status, respectively. Conclusion Findings indicate that different populations diagnosed with CHF had different travel patterns for hospitalization. Changes or disruptions in local hospital supply could differentially affect different groups in a population. Policy makers could target efforts to CHF patients who are less likely to travel to seek treatment. PMID:26378896

Traveling with breathing problems

MedlinePlus

... obstructive lung disease - travel; Chronic bronchitis - travel; Emphysema - travel ... you: Are short of breath most of the time Get short of breath ... doctor if you plan to travel in a place at a high altitude (such ...

What proportion of international travellers acquire a travel-related illness? A review of the literature.

PubMed

Angelo, Kristina M; Kozarsky, Phyllis E; Ryan, Edward T; Chen, Lin H; Sotir, Mark J

2017-09-01

As international travel increases, travellers may be at increased risk of acquiring infectious diseases not endemic in their home countries. Many journal articles and reference books related to travel medicine cite that between 22-64% of international travellers become ill during or after travel; however, this information is minimal, outdated and limited by poor generalizability. We aim to provide a current and more accurate estimate of the proportion of international travellers who acquire a travel-related illness. We identified studies via PubMed or travel medicine experts, published between January 1, 1976-December 31, 2016 that included the number of international travellers acquiring a travel-related illness. We excluded studies that focused on a single disease or did not determine a rate based on the total number of travellers. We abstracted information on traveller demographics, trip specifics, study enrollment and follow-up and number of ill travellers and their illnesses. Of 743 studies, nine met the inclusion criteria. The data sources were from North America (four studies) and Europe (five studies). Most travellers were tourists, the most frequent destination regions were Asia and Africa, and the median trip duration ranged from 8-21 days. Six studies enrolled participants at the travellers' pre-travel consultation. All studies collected data through either extraction from the medical record, weekly diaries, or pre- and post-travel questionnaires. Data collection timeframes varied by study. Between 6-87% of travellers became ill across all studies. Four studies provided the best estimate: between 43-79% of travellers who frequently visited developing nations (e.g. India, Tanzania, and Kenya) became ill; travellers most frequently reported diarrhoea. This is the most comprehensive assessment available on the proportion of international travellers that develop a travel-related illness. Additional cohort studies would provide needed data to more precisely

Season and Weather Effects on Travel-Related Mood and Travel Satisfaction.

PubMed

Ettema, Dick; Friman, Margareta; Olsson, Lars E; Gärling, Tommy

2017-01-01

This study examines the effects of season and weather on mood (valence and activation) and travel satisfaction (measured by the Satisfaction with Travel Scale). Analyses are presented of 562 time-sampled morning commutes to work made by 363 randomly sampled people in three different Swedish cities asking them to use smartphones to report their mood in their home before and directly after the commutes. These reports as well as satisfaction with the commute obtained in summer and winter are linked to weather data and analyzed by means of fixed-effects regression analyses. The results reveal main effects of weather (temperature and precipitation) on mood and travel satisfaction (temperature, sunshine, precipitation, and wind speed). The effects of weather on mood and travel satisfaction differ depending on travel mode. Temperature leads to a more positive mood, wind leads to higher activation for public transport users, and sunshine leads to a more negative mood for cyclists and pedestrians. Sunshine and higher temperatures make travel more relaxed although not for cycling and walking, and rain and snow lead to a higher cognitive assessed quality of travel.

Immunizations for foreign travel.

PubMed Central

Hill, D. R.

1992-01-01

One of the most important aspects of preparing travelers for destinations throughout the world is providing them with immunizations. Before administering any vaccines, however, a careful health and immunization history and travel itinerary should be obtained in order to determine vaccine indications and contraindications. There are three categories of immunizations for foreign travel. The first category includes immunizations which are routinely recommended whether or not the individual is traveling. Many travelers are due for primary vaccination or boosting against tetanus-diphtheria, measles-mumps-rubella, pneumococcal pneumonia, and influenza, for example, and the pre-travel visit is an ideal time to administer these. The second category are immunizations which might be required by a country as a condition for entry; these are yellow fever and cholera. The final category contains immunizations which are recommended because there is a risk of acquiring a particular disease during travel. Typhoid fever, meningococcal disease, rabies, and hepatitis are some examples. Travelers who are pregnant or who are infected with the human immunodeficiency virus require special consideration. Provision of appropriate immunizations for foreign travel is an important aspect of preventing illness in travelers. PMID:1337807

The quantified self during travel: mapping health in a prospective cohort of travellers.

PubMed

Farnham, Andrea; Furrer, Reinhard; Blanke, Ulf; Stone, Emily; Hatz, Christoph; Puhan, Milo A

2017-09-01

Travel medicine research has remained relatively unchanged in the face of rapid expansion of international travel and is unlikely to meet health challenges beyond infectious diseases. Our aim was to identify the range of health outcomes during travel using real-time monitoring and daily reporting of health behaviours and outcomes and identify traveller subgroups who may benefit from more targeted advice before and during travel. We recruited a prospective cohort of travellers ≥ 18 years and planning travel to Thailand for <5 weeks from the travel clinics in Zurich and Basel (Switzerland). Participants answered demographic, clinical and risk behaviour questionnaires pre-travel and a daily health questionnaire each day during travel using a smartphone application. Environmental and location data were collected passively by GPS. Classification trees were used to identify predictors of health behaviour and outcomes during travel. Non-infectious disease events were relatively common, with 22.7% (17 out of 75 travellers) experiencing an accident, 40.0% ( n  = 30) a wound or cut and 14.7% ( n  = 11) a bite or lick from an animal. Mental health associated events were widely reported, with 80.0% ( n  = 60) reporting lethargy, 34.7% ( n  = 26) anxiety and 34.7% ( n  = 26) feeling tense or irritable. Classification trees identified age, trip length, previous travel experience and having experienced a sports injury in the past year as the most important discriminatory variables for health threats. Our study offers a revolutionary look at an almost real-time timeline of health events and behaviours during travel using mHealth technology. Non-infectious disease related health issues were common in this cohort, despite being largely unaddressed in traditional travel medicine research and suggest a substantial potential for improving evidence-based travel medicine advice. © International Society of Travel Medicine, 2017. Published by Oxford

No comfort in the rural South: women living depressed.

PubMed

Hauenstein, Emily J

2003-02-01

Despite the widespread notion of the bucolic life in the country, major depressive disorder (MDD) is common among impoverished women in the rural South. Women with MDD seldom get treated because of the paucity of treatment available, the inability to pay for services because of no insurance, and the distance they must travel to reach care. Even if treatment was available, impoverished rural Southern women are unlikely to seek services because of cultural and social prohibitions. These include incongruence between the biomedical model of MDD and sociocultural explanations for its causes and manifestations, stigma, and traditional viewpoints of women that keep them isolated and invisible. Innovative treatment strategies must be devised for these women that are based on local views of MDD and its treatment, and people and monetary resources available in poor rural economies. Needed research with this population include ethnographic studies to gain understanding of the cultural factors associated with MDD and its treatment and evaluation of outreach, and other novel paradigms of rural service delivery including the use of nonprofessional personnel. Although the problems of treatment and research with this population are daunting, there is an opportunity for imagination, innovation, and creativity in devising local solutions to local problems. Copyright 2003, Elsevier Science (USA). All rights reserved.

Travel health prevention.

PubMed

Korzeniewski, Krzysztof

All around the world there has been a rapid growth in the number of international travels. According to the World Tourism Organisation the number of international tourist arrivals reached 1,235 billion in 2016 and continues to grow at a high rate. This has been much due to the development of air transport (including low-cost airlines), increasingly common economic migration, a growing number of travellers visiting friends and relatives, and an increase in medical tourism. With tropical destinations becoming increasingly popular among travellers, doctors have seen a rising number of patients who seek medical advice on health risks prevalent in hot countries and health prevention measures to be taken in tropical destinations, especially where sanitation is poor. The risk for developing a medical condition while staying abroad depends on a variety of factors, including the traveller's general health condition, health prevention measures taken before or during travel (vaccinations, antimalarial chemoprophylaxis, health precautions during air, road and sea travel, proper acclimatisation, prevention of heat injuries, protection against local flora and fauna, personal hygiene, water, food and feeding hygiene), as well as the prevalence of health risk factors in a given location. Health prevention is a precondition for safe travel and maintaining good physical health; in the era of a rapid growth in international tourism it has become of key importance for all travellers.

How Adults' Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast

PubMed Central

Pathman, Donald E; Ricketts, Thomas C; Konrad, Thomas R

2006-01-01

Objective To examine how access to outpatient medical care varies with local primary care physician densities across primary care service areas (PCSAs) in the rural Southeast, for adults as a whole and separately for the elderly and poor. Data Sources Access data from a 2002 to 2003 telephone survey of 4,311 adults living in 298 PCSAs within 150 rural counties in eight Southeastern states were linked geographically with physician practice location data from the American Medical and American Osteopathic Associations and population data from the U.S. Census. Study Design In a cross-sectional study design, we used a series of logistic regression models to assess how 26 measures of various aspects of access to outpatient physician services varied for subjects arranged into five groups based on the population-per-physician ratios of the PCSAs where they lived. Principal Findings Among adults as a whole, more individuals reported traveling over 30 minutes for outpatient care in PCSAs with more than 3,500 people per physician than in PCSAs with fewer than 1,500 people per physician (39.1 versus 18.5 percent, p<.001) and more reported travel difficulties. Otherwise, PCSA density of primary care physicians was unrelated to reported barriers to care, unrelated to people's satisfaction with care, and unrelated to indicators of people's use of services. Use rates of six recommended preventive health services varied in no consistent direction with physician densities. Among the elderly, only the proportion traveling over 30 minutes for care was greater in areas with lowest physician densities. Among subjects covered under Medicaid or uninsured, lower local physician densities were associated with longer travel time, difficulties with travel and reaching one's physician by phone, and two areas of dissatisfaction with care. Conclusions For adults as a whole in the rural South and for the elderly there, low local primary care physician densities are associated with travel

[Evaluation of pre-travel prevention and morbidity in child travelers].

PubMed

Brigot-Rotenberg, D; Quinet, B; Moulin, F; Aurel, M; Carbajal, R; De Suremain, N

2016-04-01

International travel is growing, but few data exist on prevention for children traveling. The aim of this study was to describe a population of children traveling from France to countries outside Europe and to evaluate the quality of prevention and healthcare services provided for these travelers. We conducted a retrospective epidemiological study in three pediatric emergency departments in Paris from August to October 2009 and 2012. Data were collected retrospectively from anonymous questionnaires proposed to families consulting emergency services, irrespective of their reason, who had recently traveled (in the year preceding travel outside the European Union). Of the 166 children included, who for the most part had traveled to visit relatives and friends in Sub-Saharan Africa and North Africa, 76% of their families were from the destination countries, 78% had received prevention counseling, mostly with their doctor. They had been vaccinated against yellow fever, but the hepatitis A vaccine was neglected. The preventive measures had been difficult to achieve in practice. During travel, 54% of children had health problems (39% diarrhea, 29% vomiting, 31% fever) prompting medical care in 28%, 5% were admitted to a hospital, and 4% had return to France earlier than planned. In epidemic areas, 13% of children had malaria. There is poor counseling on basic prevention (hygiene, diarrhea, malaria, immunization). Time constraints in pediatricians and competing priorities could explain this problem. The challenge for healthcare providers to reduce these pathologies is to provide services of sufficient quality and clarity. All medical stakeholders have an important role to play. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Student Travel: Policies - Regulations - Exhibits.

ERIC Educational Resources Information Center

Trujillo, Lorenzo A.; And Others

The Jefferson County (Colorado) Public Schools' regulations and policies concerning student travel covers these forms of travel: student activity travel, extended student travel, district sponsored student travel, district authorized student travel, student exchange, and bonus learning trips. Issues and items addressed include: (1) authorization…

Pre-travel care for immunocompromised and chronically ill travellers: A retrospective study.

PubMed

van Aalst, Mariëlle; Verhoeven, Roos; Omar, Freshta; Stijnis, Cornelis; van Vugt, Michèle; de Bree, Godelieve J; Goorhuis, Abraham; Grobusch, Martin P

2017-09-01

Immunocompromised and chronically ill travellers (ICCITs) are susceptible to travel related diseases. In ICCITs, pre-travel care regarding vaccinations and prophylactics is complex. We evaluated the protection level by preventive measures in ICCITs by analysing rates of vaccination protection, antibody titres, and the prescription of standby antibiotics. We analysed, and reported according to STROBE guidelines, pre-travel care data for ICCITs visiting the medical pre-travel clinic at the Academic Medical Centre, The Netherlands from 2011 to 2016. We analysed 2104 visits of 1826 ICCITs. Mean age was 46.6 years and mean travel duration 34.5 days. ICCITs on immunosuppressive treatment (29.7%), HIV (17.2%) or diabetes mellitus (10.2%) comprised the largest groups. Most frequently visited countries were Suriname, Indonesia, and Ghana. Most vaccination rates were >90%. Of travellers in high need of hepatitis A and B protection, 56.6 and 75.7%, underwent titre assessments, respectively. Of ICCITs with a respective indication, 50.6% received a prescription for standby antibiotics. Vaccination rates in our study population were overall comparable to those of healthy travellers studied previously in our centre. However, regarding antibody titre assessments and prescription of standby antibiotics, this study demonstrates that uniform pre-travel guidelines for ICCITs are highly needed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Inpatient child mortality by travel time to hospital in a rural area of Tanzania.

PubMed

Manongi, Rachel; Mtei, Frank; Mtove, George; Nadjm, Behzad; Muro, Florida; Alegana, Victor; Noor, Abdisalan M; Todd, Jim; Reyburn, Hugh

2014-05-01

To investigate the association, if any, between child mortality and distance to the nearest hospital. The study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates and child mortality rates in the catchment population using inpatient deaths as the numerator. Three thousand hundred and eleven children under the age of 5 years were included of whom 4.6% died; 2307 were admitted from <3 h away of whom 3.4% died and 804 were admitted from ≥ 3 h away of whom 8.0% died. The admission rate declined from 125/1000 catchment population at <3 h away to 25/1000 at ≥ 3 h away, and the corresponding hospital deaths/catchment population were 4.3/1000 and 2.0/1000, respectively. Children admitted from more than 3 h away were more likely to be male, had a longer pre-admission duration of illness and a shorter time between admission and death. Assuming uniform mortality in the catchment population, the predicted number of deaths not benefiting from hospital admission prior to death increased by 21.4% per hour of travel time to hospital. If the same admission and death rates that were found at <3 h from the hospital applied to the whole catchment population and if hospital care conferred a 30% survival benefit compared to home care, then 10.3% of childhood deaths due to febrile illness in the catchment population would have been averted. The mortality impact of poor access to hospital care in areas of high paediatric mortality is likely to be substantial although uncertainty over the mortality benefit of inpatient care is the largest constraint in making an accurate estimate. © 2014 The Authors Tropical Medicine & International Health Published by John Wiley & Sons

Travel and vaccination patterns: a report from a travel medicine clinic in northern Sweden.

PubMed

Angelin, Martin; Evengård, Birgitta; Palmgren, Helena

2011-09-01

The Travel Medicine Clinic in Umeå is one of Sweden's largest public providers of vaccination and counselling prior to international travel. During the study period it was the only travel medicine clinic in Umeå. This study describes the demography of the visitors to the clinic and travel destinations and durations, as well as vaccinations administered. This was a retrospective study for the period January 2005 to April 2008 based on pre-travel consultation questionnaires and on vaccine expenditure data. A 10% sample of 16,735 first visits prior to international travel was consecutively selected according to the chronology of the visits. Data on 1698 travellers were included in the study. Thailand was the most common destination among visitors, accounting for one third of all destinations. Medical problems affecting pre-travel health planning were rare. Four out of 5 visitors (79%) received only 1 vaccination, mainly for hepatitis A. Travellers to Thailand more often sought travel health advice compared to travellers to Turkey, despite the fact that the 2 destinations were almost equally distributed among travellers from Umeå. We found differences between men and women in money spent on vaccines and in particular in vaccination against Japanese encephalitis. To assess the optimal vaccination level at a travel medicine clinic is difficult. Decisions are affected by general recommendations and the risk perception of the travel medicine practitioner, as well as the risk perception of the traveller. The sex difference found in this study might be due to gender differences in risk perception and should be further investigated.

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia.

PubMed

Gallego, Gisselle; Dew, Angela; Lincoln, Michelle; Bundy, Anita; Chedid, Rebecca Jean; Bulkeley, Kim; Brentnall, Jennie; Veitch, Craig

2015-06-30

The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services. This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists - "therapists") living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention. A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs' current job, and their workforce preferences were explored using a best-worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs' relative preferences for six different job attributes. One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, "high autonomy of practice" is the most valued attribute level, followed by "travel BWSDCE arrangements: one or less nights away per month", "travel arrangements: two or three nights away per month" and "adequate access to professional development". On the other hand, the least valued attribute levels were "travel arrangements: four or more nights per month", "limited autonomy of practice" and "minimal access to professional development". Except for "some job flexibility", all other attributes had a statistical influence on AHPs' job

Travel during Pregnancy

MedlinePlus

... are 36 weeks pregnant. When is the best time to travel during pregnancy? The best time to travel is the middle of your pregnancy—between week ... Sitting or not moving for long periods of time, such as during long-distance travel, can increase the risk of DVT. Pregnancy further ...

Profile of Travelers With Preexisting Medical Conditions Attending a Specialist Travel Medicine Clinic in Ireland.

PubMed

Han, Calvin Teo Jia; Flaherty, Gerard

2015-01-01

Patients with complex medical comorbidities travel for protracted periods to remote destinations, often with limited access to medical care. Few descriptions are available of their preexisting health burden. This study aimed to characterize preexisting medical conditions and medications of travelers seeking pre-travel health advice at a specialized travel medicine clinic. Records of travelers attending the Galway Tropical Medical Bureau clinic between 2008 and 2014 were examined and information relating to past medical history was entered into a database. Data were recorded only where the traveler had a documented medical history and/or was taking medications. Of the 4,817 records available, 56% had a documented medical history and 24% listed medications. The majority of travelers with preexisting conditions were female. The mean age of the cohort was 31.68 years. The mean period remaining before the planned trip was 40 days. Southeast Asia was the most popular single destination, and 17% of travelers with medical conditions were traveling alone. The most frequently reported conditions were allergies (20%), insect bite sensitivity (15%), asthma (11%), psychiatric conditions (4%), and hypertension (3%). Of the 30 diabetic travelers, 14 required insulin; 4.5% of travelers were taking immunosuppressant drugs, including corticosteroids. Half of the female travelers were taking the oral contraceptive pill while 11 travelers were pregnant at the time of their pre-travel consultation. This study provides an insight into the medical profile of travelers attending a travel health clinic. The diverse range of diseases reported highlights the importance of educating physicians and nurses about the specific travel health risks associated with particular conditions. Knowledge of the effects of travel on underlying medical conditions will inform the pre-travel health consultation. © 2015 International Society of Travel Medicine.

Impact of travel distance to the treatment facility on overall mortality in US patients with prostate cancer.

PubMed

Vetterlein, Malte W; Löppenberg, Björn; Karabon, Patrick; Dalela, Deepansh; Jindal, Tarun; Sood, Akshay; Chun, Felix K-H; Trinh, Quoc-Dien; Menon, Mani; Abdollah, Firas

2017-09-01

The objective of this study was to investigate the impact of travel distance to the treating facility on the risk of overall mortality (OM) among US patients with prostate cancer (PCa). In total, 775,999 patients who had PCa in all stages and received treatment with different strategies (radical prostatectomy, radiation therapy, observation, androgen-deprivation therapy, multimodal treatment, and chemotherapy) were drawn from the National Cancer Data Base from 2004 through 2012. Independent predictors of travel distance (intermediate [12.5-49.9 miles] and long [49.9-249.9 miles] vs short[<12.5 miles]) and its effect on OM were calculated using multivariable regression analyses. Additional analyses evaluated the distance effect on OM in selected subgroups. In total, 54.5%, 33.4%, and 12.1% of patients traveled short, intermediate, and long distances, respectively. Residency in rural areas and the receipt of treatment at academic/high-volume centers independently predicted long travel distance. Non-Hispanic black men and Medicaid-insured men were less likely to travel long distances (all P < .001). Overall, traveling a long distance (hazard ratio, 0.87; 95% confidence interval, 0.83-0.92; P < .001) was associated with lower OM risk compared with traveling a short distance. This held true among non-Hispanic white men; privately insured and Medicare-insured men; those who underwent radical prostatectomy, received radiation therapy, and received multimodal strategies; and those who received treatment at academic/high-volume centers (P < .01), but not among non-Hispanic black men (P = .3). Long travel distance was associated with an increased OM in Medicaid-insured patients (P < .001). An OM benefit was observed among men who traveled long distances for PCa treatment, which is likely to be a reflection of centralization of care and more favorable patient-level characteristics in those travelers. Furthermore, the survival benefit mediated by long travel distances appears

Season and Weather Effects on Travel-Related Mood and Travel Satisfaction

PubMed Central

Ettema, Dick; Friman, Margareta; Olsson, Lars E.; Gärling, Tommy

2017-01-01

This study examines the effects of season and weather on mood (valence and activation) and travel satisfaction (measured by the Satisfaction with Travel Scale). Analyses are presented of 562 time-sampled morning commutes to work made by 363 randomly sampled people in three different Swedish cities asking them to use smartphones to report their mood in their home before and directly after the commutes. These reports as well as satisfaction with the commute obtained in summer and winter are linked to weather data and analyzed by means of fixed-effects regression analyses. The results reveal main effects of weather (temperature and precipitation) on mood and travel satisfaction (temperature, sunshine, precipitation, and wind speed). The effects of weather on mood and travel satisfaction differ depending on travel mode. Temperature leads to a more positive mood, wind leads to higher activation for public transport users, and sunshine leads to a more negative mood for cyclists and pedestrians. Sunshine and higher temperatures make travel more relaxed although not for cycling and walking, and rain and snow lead to a higher cognitive assessed quality of travel. PMID:28220100

Practical problems for Aboriginal palliative care service provision in rural and remote areas: equipment, power and travel issues.

PubMed

McGrath, Pam; Holewa, Hamish; McGrath, Zoe

2007-07-01

With regards to end-of-life care, there is scant published research that looks specifically at the provision of palliative care services for Indigenous people. In addition, for Indigenous people in the rural and remote areas there is only limited literature that focuses on the problems associated with geography. To address the hiatus in the literature on Aboriginal, rural and remote palliative care, the following article provides findings from a two-year research project, funded by Australia's National Health and Medical Research Council (NH&MRC), which developed an innovative model for Indigenous palliative care. The data was collected through a qualitative methodology (descriptive phenomenology) which involved open-ended in-depth interviews, audio-recorded, transcribed verbatim and thematically analysed. The sub-set of findings from the study presented in this paper examine issues in relation to the many practical obstacles in relation to palliative care service provision to Indigenous people in the rural and remote areas. The findings are a testament to the ingenuity and dedication of those who provide end-of-life care for Aboriginal peoples in rural and remote locations. The information about the many obstacles associated with equipment, power, transport, distance and telephone access provide important insights to inform the development of health policy planning and funding. The topic is specifically relevant to nurses as further findings from the study indicate that clinic and community nurses are key health professionals providing care to Indigenous people in the rural and remote areas.

41 CFR Appendix C to Chapter 301 - Standard Data Elements for Federal Travel [Traveler Identification

Code of Federal Regulations, 2013 CFR

2013-07-01

... for Federal Travel [Traveler Identification] C Appendix C to Chapter 301 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES Ch. 301, App. C Appendix C to Chapter 301—Standard Data Elements for Federal Travel [Traveler Identification] Group name Data...

Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness.

PubMed Central

Adams, E K; Houchens, R; Wright, G E; Robbins, J

1991-01-01

Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individual characteristics on hospital choice, using McFadden's conditional logit model. Some patient characteristics have not previously been accounted for in this type of analysis. In particular, the effect of a patient's complexity of illness (as measured by Disease Staging) on the choice of hospital is taken into account. The data consist of over 12,000 Medicare discharges in three overlapping rural market areas during 1986. The hospital choice set was aggregated into seven groups of urban and rural hospitals. Results indicate that rural Medicare beneficiaries tend to choose hospitals with a large scope of service and with teaching activity over those with a lower scope of service and no teaching activity, holding other factors constant. Distance is a deterrent to hospital choice, especially for older Medicare beneficiaries. The more complex cases tend to choose larger urban and rural hospitals over small rural hospitals more often than less complex cases do. PMID:1743970

How far will we need to go to reach HIV-infected people in rural South Africa?

PubMed

Wilson, David P; Blower, Sally

2007-06-19

The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. Here, we calculate the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART. Specifically, we address the health policy question 'How far will we need to go to reach PLWHA in rural KwaZulu-Natal?'. We developed a model to quantify treatment accessibility in rural areas; the model incorporates heterogeneity in spatial location of HCFs and patient population. We defined treatment accessibility in terms of the number of PLWHA that have access to an HCF. We modeled the treatment-accessibility region (i.e. catchment area) around an HCF by using a two-dimensional function, and assumed that treatment accessibility decreases as distance from an HCF increases. Specifically, we used a distance-discounting measure of ART accessibility based upon a modified form of a two-dimensional gravity-type model. We calculated the effect on treatment accessibility of: (1) distance from an HCF, and (2) the number of HCFs. In rural areas in KwaZulu-Natal even substantially increasing the size of a small catchment area (e.g. from 1 km to 20 km) around an HCF would have a negligible impact (~2%) on increasing treatment accessibility. The percentage of PLWHA who can receive ART in rural areas in this province could be as low as ~16%. Even if individuals were willing (and able) to travel 50 km to receive ART, only ~50% of those in need would be able to access treatment. Surprisingly, we show that increasing the number of available HCFs for ART distribution ~ threefold does not lead to a threefold increase in treatment accessibility in rural KwaZulu-Natal. Our results show that many PLWHA in rural KwaZulu-Natal are unlikely to have access to ART, and that the impact of an additional 37 HCFs on treatment accessibility in

Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

PubMed

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

2017-01-01

Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Pre-Travel Health Preparation of Pediatric International Travelers: Analysis From the Global TravEpiNet Consortium.

PubMed

Hagmann, Stefan; LaRocque, Regina C; Rao, Sowmya R; Jentes, Emily S; Sotir, Mark J; Brunette, Gary; Ryan, Edward T

2013-12-01

Children frequently travel internationally. Health-related data on such children are limited. We sought to investigate the demographics, health characteristics, and preventive interventions of outbound US international pediatric travelers. We analyzed data from 32 099 travelers presenting for pre-travel healthcare at the Global TravEpiNet (GTEN), a national consortium of 19 travel clinics, from January 1, 2009 to June 6, 2012. A total of 3332 (10%) of all GTEN travelers were children (<18 years of age). These children traveled mostly for leisure (36%) or to visit friends or relatives (VFR) (36%). Most popular destination regions were Africa (41%), Southeast Asia (16%), Central America (16%), and the Caribbean (16%). Compared with children traveling for leisure, VFR children were more likely to present <14 days before departure for pre-travel consultation (44% vs 28%), intended to travel for 28 days or longer (70% vs 22%), and to travel to Africa (62% vs 32%). Nearly half of the pediatric travelers (46%) received at least 1 routine vaccine, and most (83%) received at least 1 travel-related vaccine. Parents or guardians of one third of the children (30%) refused at least 1 recommended travel-related vaccine. Most pediatric travelers visiting a malaria-endemic country (72%) received a prescription for malaria chemoprophylaxis. Ten percent of travelers seeking pre-travel healthcare at GTEN sites are children. VFR-travel, pre-travel consultation close to time of departure, and refusal of recommended vaccines may place children at risk for travel-associated illness. Strategies to engage pediatric travelers in timely, pre-travel care and improve acceptance of pre-travel healthcare interventions are needed. © The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Do travel clinic visitors read information on sexual risk abroad in travel health brochures?

PubMed Central

Croughs, Mieke; de Gouw, Annemarie; Remmen, Roy; Van den Ende, Jef

2016-01-01

Background: A substantial proportion of travel clinic visitors have sexual encounters while abroad. Hence, guidelines on travel health recommend discussing sexual risk in a pre-travel consultation. However, previous studies showed that it often is not discussed. Although travel clinic visitors usually do receive written information on sexual risk abroad, few data are available on whether this information is read. Therefore, this prospective cohort study in travel clinic visitors was performed. Methods: Travel clinic visitors were invited to complete a questionnaire after return from their journey. Results: A total of 130 travellers (55%) responded. Half of them recorded they read the information on sexual risk. Male gender (OR 9.94 95% CI 3.12 – 31.63) and ‘travelling with others’ (OR 2.7 95% CI 1.29 – 5.78) were significant independent predictors of reading the information on sexual risk. High risk travellers, i.e. those travelling without a steady partner, were less likely to have read it. Although websites and apps were mentioned as better methods of providing information, none of the participants visited the websites on sexual behaviour and sexually transmitted infections recommended in the travel health brochure. Conclusion: Only half of travel clinic visitors read information on sexual risk in the health brochure received in the clinic and none of them visited the related websites mentioned in the brochure. Further research to identify the most effective way to inform travellers about sexual risk is needed. PMID:28989499

Do travel clinic visitors read information on sexual risk abroad in travel health brochures?

PubMed

Croughs, Mieke; de Gouw, Annemarie; Remmen, Roy; Van den Ende, Jef

2017-01-01

A substantial proportion of travel clinic visitors have sexual encounters while abroad. Hence, guidelines on travel health recommend discussing sexual risk in a pre-travel consultation. However, previous studies showed that it often is not discussed. Although travel clinic visitors usually do receive written information on sexual risk abroad, few data are available on whether this information is read. Therefore, this prospective cohort study in travel clinic visitors was performed. Travel clinic visitors were invited to complete a questionnaire after return from their journey. A total of 130 travellers (55%) responded. Half of them recorded they read the information on sexual risk. Male gender (OR 9.94 95% CI 3.12 - 31.63) and 'travelling with others' (OR 2.7 95% CI 1.29 - 5.78) were significant independent predictors of reading the information on sexual risk. High risk travellers, i.e. those travelling without a steady partner, were less likely to have read it. Although websites and apps were mentioned as better methods of providing information, none of the participants visited the websites on sexual behaviour and sexually transmitted infections recommended in the travel health brochure. Only half of travel clinic visitors read information on sexual risk in the health brochure received in the clinic and none of them visited the related websites mentioned in the brochure. Further research to identify the most effective way to inform travellers about sexual risk is needed.

Improving health sector travel.

PubMed

Hurdle, David; Davis, Adrian

2004-10-01

Preventing ill health and obesity and building more physical activity into our daily lives have never been so high on the agenda, and the way we travel can help. Many workplaces and schools are drawing up travel plans, with the aims usually to minimise car use and encourage healthier and more environmentally friendly travel. The Transport White Paper of 1998 advocated travel plans and singled out hospitals for action. Travel plans continue to be a focus within the latest Transport White Paper, launched in July 2004. This article covers various prompts to the health sector to implement travel plans. It addresses issues and concerns facing NHS Trusts, the practical things Trusts can do, and the increasing amount of good practice available. Finally, it demonstrates that travel plans can work, and are working, in the health sector.

Alex Lord's British Columbia: Recollections of a Rural School Inspector, 1915-36. The Pioneers of British Columbia.

ERIC Educational Resources Information Center

Calam, John, Ed.

Alex Lord, a pioneer inspector of rural British Columbia (Canada) schools, shares in these recollections of his experiences in a province barely out of the stagecoach era. Traveling through vast northern territory, using unreliable transportation, and enduring climate extremes, Lord became familiar with the aspirations of remote communities and…

Airport surveys at travel destinations--underutilized opportunities in travel medicine research?

PubMed

Bauer, Irmgard L

2015-01-01

Research in destination airports, especially in resource-poor areas, allows unique immediate access to travelers at the conclusion of their trip. Response rates are high and the recall gap small. Trip-related health matters can be elicited relatively easily. An insight into travelers' decision-making processes on location would fill large gaps in our knowledge regarding travel health advice provision; yet, this approach is still much underutilized. Using PubMed, ScienceDirect, Google Scholar, and ProQuest, a review of the literature on airport surveys was conducted to determine where they were used, their response rates and purpose, and location-relevant methodological information. The lack of methodological guidelines in the reviewed literature resulted in recommendations for planning and conducting an airport survey at a destination airport. Millions of travelers in airports around the world represent an underutilized sample of potential study participants for topics that cannot be studied adequately in other settings. Benefiting from close cooperation between travel health professionals and airport authorities, researchers can expect not only large-scale convenience samples for surveys, but also opportunities to explore exciting and creative research topics to broaden our understanding of travel medicine and health. © 2014 International Society of Travel Medicine.

Childhood and Travel Literature.

ERIC Educational Resources Information Center

Espey, David

If children are not present in most travel literature--precisely because the genre has most typically been the domain of solitary male travelers who are escaping domestic obligation, routine, the familiar, and the family--they nevertheless are an integral part of the genre. The traveler is in many ways a child, an innocent abroad. Traveler writers…

Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel.

PubMed

Hagmann, Stefan H F; Han, Pauline V; Stauffer, William M; Miller, Andy O; Connor, Bradley A; Hale, DeVon C; Coyle, Christina M; Cahill, John D; Marano, Cinzia; Esposito, Douglas H; Kozarsky, Phyllis E

2014-12-01

US residents make 60 million international trips annually. Family practice providers need to be aware of travel-associated diseases affecting this growing mobile population. To describe demographics, travel characteristics and clinical diagnoses of US residents who present ill after international travel. Descriptive analysis of travel-associated morbidity and mortality among US travellers seeking care at 1 of the 22 US practices and clinics participating in the GeoSentinel Global Surveillance Network from January 2000 to December 2012. Of the 9624 ill US travellers included in the analysis, 3656 (38%) were tourist travellers, 2379 (25%) missionary/volunteer/research/aid workers (MVRA), 1580 (16%) travellers visiting friends and relatives (VFRs), 1394 (15%) business travellers and 593 (6%) student travellers. Median (interquartile range) travel duration was 20 days (10-60 days). Pre-travel advice was sought by 45%. Hospitalization was required by 7%. Compared with other groups of travellers, ill MVRA travellers returned from longer trips (median duration 61 days), while VFR travellers disproportionately required higher rates of inpatient care (24%) and less frequently had received pre-travel medical advice (20%). Illnesses of the gastrointestinal tract were the most common (58%), followed by systemic febrile illnesses (18%) and dermatologic disorders (17%). Three deaths were reported. Diagnoses varied according to the purpose of travel and region of exposure. Returning ill US international travellers present with a broad spectrum of travel-associated diseases. Destination and reason for travel may help primary health care providers to generate an accurate differential diagnosis for the most common disorders and for those that may be life-threatening. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel

PubMed Central

Hagmann, Stefan H F; Han, Pauline V; Stauffer, William M; Miller, Andy O; Connor, Bradley A; Hale, DeVon C; Coyle, Christina M; Cahill, John D; Marano, Cinzia; Esposito, Douglas H; Kozarsky, Phyllis E

2015-01-01

Background US residents make 60 million international trips annually. Family practice providers need to be aware of travel-associated diseases affecting this growing mobile population. Objective To describe demographics, travel characteristics and clinical diagnoses of US residents who present ill after international travel. Methods Descriptive analysis of travel-associated morbidity and mortality among US travellers seeking care at 1 of the 22 US practices and clinics participating in the GeoSentinel Global Surveillance Network from January 2000 to December 2012. Results Of the 9624 ill US travellers included in the analysis, 3656 (38%) were tourist travellers, 2379 (25%) missionary/volunteer/research/aid workers (MVRA), 1580 (16%) travellers visiting friends and relatives (VFRs), 1394 (15%) business travellers and 593 (6%) student travellers. Median (interquartile range) travel duration was 20 days (10–60 days). Pre-travel advice was sought by 45%. Hospitalization was required by 7%. Compared with other groups of travellers, ill MVRA travellers returned from longer trips (median duration 61 days), while VFR travellers disproportionately required higher rates of inpatient care (24%) and less frequently had received pre-travel medical advice (20%). Illnesses of the gastrointestinal tract were the most common (58%), followed by systemic febrile illnesses (18%) and dermatologic disorders (17%). Three deaths were reported. Diagnoses varied according to the purpose of travel and region of exposure. Conclusions Returning ill US international travellers present with a broad spectrum of travel-associated diseases. Destination and reason for travel may help primary health care providers to generate an accurate differential diagnosis for the most common disorders and for those that may be life-threatening. PMID:25261506

Bangkok as a magnet for rural labour: changing conditions, 1900-1970.

PubMed

Ouyyanont, P

1998-06-01

This article describes labor force shifts, in Thailand, from rural areas to Bangkok during 1900-1970 and is a revision of a chapter from a doctoral thesis. Urban growth of Bangkok occurred primarily after World War II. Pre-war wages in rural areas were higher than coolie wages in Bangkok. Opportunity costs of changing occupations were high. Chinese immigration was the key to development of non-farm occupations. The Chinese from Siam were drawn to higher wages in Bangkok than were possible in South China ports. After the war, the Lewis-Fei and Ranis migration model fits a pattern of migration that adjusts the disequilibrium between urban and rural markets. There are shifts from low productivity rural sectors to urban high productivity sectors. Capital investment in commerce and industry raised urban labor productivity. The wage data suggest a growing gap between urban and rural sectors postwar. Rail travel during the 1950s brought higher wages for the unskilled in railroad construction. There was high agricultural productivity relative to labor input due to availability of land. Underpopulation meant little unemployment. After 1950, conditions changed. The population growth rate increased. More in rural areas lived below the poverty line. Low rice productivity constrained rural wages and incomes during the 1950s and 1960s. The more favored commercial crops needed less labor. Chinese immigration declined, and demand for labor increased in urban areas. Low urban wages due to cheap labor stimulated profits and growth. Major roads connected Bangkok to the south and the north. Bangkok was viewed as a magical and desirable place.

Population levels of, and inequalities in, active travel: A national, cross-sectional study of adults in Scotland.

PubMed

Olsen, Jonathan R; Mitchell, Richard; Mutrie, Nanette; Foley, Louise; Ogilvie, David

2017-12-01

This study aimed to describe active travel (walking or cycling) in Scotland and explore potential demographic, geographic, and socio-economic inequalities in active travel. We extracted data for the period 2012-13 (39,585 journey stages) from the Scottish Household Survey. Survey travel diaries recorded all journeys made on the previous day by sampled individuals aged 16 + living within Scotland, and the stages within each journey. Descriptive statistics were calculated for journey stages, mode, purpose and distance. Logistic regression models were fitted to examine the relationship between the likelihood of a journey stage being active, age, sex, area deprivation and urban/rural classification. A quarter of all journey stages were walked or cycled (26%, n: 10,280/39,585); 96% of these were walked. Those living in the least deprived areas travelled a greater average distance per active journey stage than those in the most deprived. The likelihood of an active journey stage was higher for those living in the most deprived areas than for those in the least deprived (Odds Ratio (OR) 1.21, 95% CI 1.04-1.41) and for those in younger compared to older age groups (OR 0.44, 95% CI 0.34-0.58). In conclusion, socio-economic inequalities in active travel were identified, but - contrary to the trends for many health-beneficial behaviours - with a greater likelihood of active travel in more deprived areas. This indicates a potential contribution to protecting and improving health for those whose health status tends to be worse. Walking was the most common mode of active travel, and should be promoted as much as cycling.

The New England travel market: generational travel patterns, 1979 to 1996

Treesearch

Rod Warnick

2002-01-01

Generations of travelers who select New England as a primary destination are examined over time from the years of 1979 through 1996 and the analysis serves to update an earlier review of generational travel patterns of the region (Warnick, 1994). Changes in travel patterns are noted by overall adjusted annual change rates by demographic and geographic regions of...

Health preparations and travel-related morbidity of kidney transplant recipients traveling to developing countries.

PubMed

Roukens, A H E; van Dissel, J T; de Fijter, J W; Visser, L G

2007-01-01

A cross-sectional, descriptive study was conducted among Dutch kidney transplant recipients to investigate travel health knowledge, attitudes and practices while staying abroad. A total of 290 individuals visiting the nephrology outpatient clinic completed the questionnaires. Thirty four percent of the responders had traveled outside Western Europe (WE) and Northern America (NA); 22% of these travelers did not seek pre-travel health advice. Transplant physicians were most frequently consulted for pre-travel advice (53%). Of the responders traveling outside WE and NA 29% were ill during their most recent journey. Diabetic transplant recipients were at the highest risk. Four of seventeen ill recipients (24%) were hospitalized, reflecting the high morbidity of travel-related disease in this patient group. Our data show that there is need for improvement of pre-travel healthcare, and suggest an important role for transplant physicians in providing adequate counseling.

Travelers' Health: Pregnant Travelers

MedlinePlus

... Most experts recommend a slower ascent with adequate time for acclimatization. No studies or case reports show harm to a fetus if the mother travels briefly to high altitudes during pregnancy. However, it ...

Travelers' Health: Hepatitis C

MedlinePlus

... Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers Road Safety Senior Citizens Sex Tourism STDs Sun Exposure Swimming and Diving Study Abroad ...

Travelers' Health: Motion Sickness

MedlinePlus

... Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers Road Safety Senior Citizens Sex Tourism STDs Sun Exposure Swimming and Diving Study Abroad ...

Travel Behavior Change in Older Travelers: Understanding Critical Reactions to Incidents Encountered in Public Transport.

PubMed

Sundling, Catherine

2015-11-18

Accessibility of travel may be better understood if psychological factors underlying change in travel behavior are known. This paper examines older (65+) travelers' motives for changing their travel behavior. These changes are grounded in critical incidents earlier encountered in public-transport travel. A scientific framework is developed based on cognitive and behavioral theory. In 29 individual interviews, travelers' critical reactions (i.e., cognitive, emotional, and/or behavioral) to 77 critical incidents were examined. By applying critical incident technique (CIT), five reaction themes were identified that had generated travel-behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. To improve older travelers' access to public transport, key findings were: (a) service must be designed so as to strengthen the feeling of being in control throughout the journey; (b) extended personal service would increase predictability in the travel chain and decrease travel complexity; consequently, (c) when designing new services and making effective accessibility interventions, policy makers should consider and utilize underlying psychological factors that could direct traveler behavior.

Travelers' Health: Hepatitis B

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Meningococcal Disease

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: HIV Infection

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Leishmaniasis, Visceral

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Hepatitis A

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Varicella (Chickenpox)

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Japanese Encephalitis

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Leishmaniasis, Cutaneous

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Health Behavior of International Travelers to Calcutta: Identifying the Need for a Travelers' Clinic.

PubMed

Chatterjee

1994-12-01

With the growing rates of travel and, potentially therefore, of travel-related illness in India, this study was conducted to establish both the need of a travelers' clinic in Calcutta and a profile of the group or groups at risk of illness best served by such facilities. A total of 452 visitors, half business and package holiday travelers (group A) and half younger, low-budget tourists with less pretravel advice (group B), were compared. Through a questionnaire, their health, pretravel advice and prophylaxis, use of first aid, safe water use, posttravel treatment, and opinion concerning the need for a travelers' clinic were determined. Group A travelers stayed in deluxe hotels with more pretravel advice (90% compared to 72% in group B), were taking antimalarial agents (82% compared to 61% in group B), remained healthy (72% compared to 58% in group B), consumed safe water (87% compared to 47% in group B), and were more likely to seek posttravel treatment (75% compared to 60% in group B). The group B travelers, consequently, felt an increasing need for a travelers' clinic (92% compared to 82% in group A). Given the complexities of travel in India, there is a palpable need for appropriate medical attention to travelers, especially among the young, budget tourists, which is best provided at a travelers' clinic.

Feasibility of mileage-based user fees : application in rural/small urban areas of northeast Texas, final report, October 31, 2008.

DOT National Transportation Integrated Search

2008-10-31

This study explores the application of mileage-based user fees, or vehicle-miles traveled (VMT) fees, as an : alternative to the fuel tax in rural and small urban areas. The purpose of the study is to identify the issues : associated with implementat...

A Heart for Travel: Travel Health Considerations for Patients with Heart Disease and Cardiac Devices.

PubMed

Flaherty, G; De Freitas, S

2016-12-12

Cardiovascular disease is the leading cause of death in adult international travellers. Patients living with heart disease should receive specific, individualised pre-travel health advice. The purpose of this article is to provide evidence-based advice to physicians who are consulted by travellers with cardiovascular disease. Fitness-to-travel evaluation will often be conducted by the general practitioner but other medical specialists may also be consulted for advice. Patients with chronic medical conditions should purchase travel health insurance. The general pre-travel health consultation addresses food and water safety, insect and animal bite avoidance, malaria chemoprophylaxis, and travel vaccinations. Patients with devices such as cardiac pacemakers should be familiar with how these may be affected by travel. Cardiac medications may cause adverse effects in cold or hot environments, and specific precautions must be followed by anticoagulated travellers. The physician should be aware of how to access medical care abroad, and of the potential for imported tropical diseases in returned travellers.

Traveling with Food Allergies

MedlinePlus

... to know Tips for Traveling with Food Allergies Restaurants and Travel All-Inclusive Resorts See All Resources ... risk of exposure to allergens on the flight. Restaurants and Travel Watch these webinars for expert advice ...

Travel medicine and HIV infection.

PubMed

Igreja, Ricardo

2008-09-01

The number of HIV-infected persons who travel is increasing. This increase arises from those who have benefited from advances in antiretroviral therapy. The key to successful travel is careful pre-trip planning although many patients do not obtain advice before travelling. Travel advice for HIV patients is becoming increasingly specialized, and includes travel vaccination and highly active antiretroviral therapy-related issues. A closer collaboration between HIV and travel health clinics could provide better care for HIV-infected individuals.

Pre-travel health advice-seeking behavior among US international travelers departing from Boston Logan International Airport.

PubMed

LaRocque, Regina C; Rao, Sowmya R; Tsibris, Athe; Lawton, Thomas; Barry, M Anita; Marano, Nina; Brunette, Gary; Yanni, Emad; Ryan, Edward T

2010-01-01

Globally mobile populations are at higher risk of acquiring geographically restricted infections and may play a role in the international spread of infectious diseases. Despite this, data about sources of health information used by international travelers are limited. We surveyed 1,254 travelers embarking from Boston Logan International Airport regarding sources of health information. We focused our analysis on travelers to low or low-middle income (LLMI) countries, as defined by the World Bank 2009 World Development Report. A total of 476 survey respondents were traveling to LLMI countries. Compared with travelers to upper-middle or high income (UMHI) countries, travelers to LLMI countries were younger, more likely to be foreign-born, and more frequently reported visiting family as the purpose of their trip. Prior to their trips, 46% of these travelers did not pursue health information of any type. In a multivariate analysis, being foreign-born, traveling alone, traveling for less than 14 days, and traveling for vacation each predicted a higher odds of not pursuing health information among travelers to LLMI countries. The most commonly cited reason for not pursuing health information was a lack of concern about health problems related to the trip. Among travelers to LLMI countries who did pursue health information, the internet was the most common source, followed by primary care practitioners. Less than a third of travelers to LLMI countries who sought health information visited a travel medicine specialist. In our study, 46% of travelers to LLMI countries did not seek health advice prior to their trip, largely due to a lack of concern about health issues related to travel. Among travelers who sought medical advice, the internet and primary care providers were the most common sources of information. These results suggest the need for health outreach and education programs targeted at travelers and primary care practitioners. © 2010 International Society of

Holiday travel and morbidity reported to general practitioners.

PubMed Central

Beale, N; Nethercott, S

1994-01-01

AIM. This study set out to explore the influence that holiday travel might have on the rate at which new episodes of illness are reported to general practitioners. METHOD. The study was carried out in a semi-rural practice of five doctors in Wiltshire in 1989. Details of patients' holiday travel were determined by postal questionnaire. Sociodemographic and clinical data were obtained from the patients' medical records. RESULTS. The response rate to the questionnaire was 85%. The study subjects were divided into those who had taken their holiday abroad (n = 643), those who had taken their holiday in the United Kingdom (n = 973), and those who had taken no holiday (n = 668) during the study year. Interim assessment of clinical results revealed no changes in morbidity indices in relation to holiday intervals in any of the groups except for an apparent rise in the number of new episodes of illness presented in the month before departure by those about to go abroad. Further analysis showed that this was due to a significant 112% increase in the number of episodes of illness presented by this study group in the week before they left home. CONCLUSION. This study suggests that the present focus on the supposed excess morbidity of patients returning from foreign holidays is misplaced. PMID:8204316

A comparison of exposure to risk factors for giardiasis in non-travellers, domestic travellers and international travellers in a Canadian community, 2006-2012.

PubMed

Swirski, A L; Pearl, D L; Peregrine, A S; Pintar, K

2016-04-01

The purpose of this study is to determine how demographic and exposure factors related to giardiasis vary between travel and endemic cases. Exposure and demographic data were gathered by public health inspectors from giardiasis cases reported from the Region of Waterloo from 2006 to 2012. Logistic regression models were fit to assess differences in exposure to risk factors for giardiasis between international travel-related cases and Canadian acquired cases while controlling for age and sex. Multinomial regression models were also fit to assess the differences in risk profiles between international and domestic travel-related cases and endemic cases. Travel-related cases (both international and domestic) were more likely to go camping or kayaking, and consume untreated water compared to endemic cases. Domestic travel-related cases were more likely to visit a petting zoo or farm compared to endemic cases, and were more likely to swim in freshwater compared to endemic cases and international travel-related cases. International travellers were more likely to swim in an ocean compared to both domestic travel-related and endemic cases. These findings demonstrate that travel-related and endemic cases have different risk exposure profiles which should be considered for appropriately targeting health promotion campaigns.

Summary travel characteristics : Hawaii

DOT National Transportation Integrated Search

1997-10-01

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Massachusetts

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Arkansas

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Virgina

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Florida

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Kansas

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : California

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Texas

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Illinois

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Montana

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Kentucky

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Wisconsin

DOT National Transportation Integrated Search

1997-10-01

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Maryland

DOT National Transportation Integrated Search

1997-09-19

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Nevada

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Iowa

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Washington

DOT National Transportation Integrated Search

1997-10-01

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Alabama

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Nebraska

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Oregon

DOT National Transportation Integrated Search

1997-10-01

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Maine

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Utah

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Michigan

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Missouri

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Colorado

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Alaska

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Oklahoma

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Indiana

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Idaho

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Tennessee

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Georgia

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Delaware

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Ohio

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Arizona

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Wyoming

DOT National Transportation Integrated Search

1997-01-01

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Minnesota

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Vermont

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Louisiana

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Mississippi

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Connecticut

DOT National Transportation Integrated Search

1997-09-29

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Pennsylvania

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Travelling activity and travel-related risks after allogeneic haematopoietic stem cell transplantation - a single centre survey.

PubMed

Hollenstein, Yvonne; Elzi, Luigia; Hatz, Christoph; Passweg, Jakob; Weisser, Maja; Stöckle, Marcel; Halter, Joerg P; Egli, Adrian

2015-01-01

Travel activity and travel-related risks of patients after allogeneic haematopoietic stem cell transplantation (allo-HSCT) remain largely unknown. The aim of our study was to examine travel activity after allo-HSCT including travel behaviour and travel patterns. We analysed travel characteristics of allo-HSCT recipients by using a retrospective cross-sectional survey. Allo-HSCT patients were asked to complete a questionnaire during their annual health visits from 2010 to 2012. Overall, 118/153 (77%) participating patients reported travel activity for a total of 201 travelling episodes. Travellers versus non-travellers were receiving immunosuppressive treatment in 35.6% versus 65.7% (p=0.002), and had graft-versus-host-disease (GvHD) in 52.5% versus 62.9% (p=0.17). In a multivariate analysis, the time between the transplantation and the survey was the only factor associated with travel activity (p<0.0001) and taking pretravel advice (p<0.0001). In 34.8% of travel episodes pretravel advice was sought. Patients with pretravel advice reported travel-related symptoms more frequently. Minor respiratory (27/201) and gastrointestinal (23/201) symptoms were most frequently indicated. Four percent (8/201) of the patients were hospitalised while travelling. We conclude that travelling after allo-HSCT is frequent and linked to the time since transplantation. We could not define specific risks for any destination. Nevertheless, pretravel advice and preparation are highly recommended for immunosuppressed patients.

Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet.

PubMed

Lammert, Sara M; Rao, Sowmya R; Jentes, Emily S; Fairley, Jessica K; Erskine, Stefanie; Walker, Allison T; Hagmann, Stefan H; Sotir, Mark J; Ryan, Edward T; LaRocque, Regina C

2016-07-01

International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59-0.95)). Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for

Pre-travel preparation and outcome of HIV-infected travellers from a UK clinic.

PubMed

Cathcart, S; Boyle, J; Sabin, C; Johnson, M; Zuckerman, J N

2003-05-01

Objectives. To review the pre-travel preparations and travel health outcomes of HIV-infected individuals. Methods. A prospective questionnaire-based study among English speaking adults with HIV infection attending an outpatient clinic from July to November 2000. Results. Baseline and follow-up questionnaire data were available for 34 individuals whose median CD4 count was 451 cells/mm(3). Eleven of these (32%) had sought travel advice before departure. Eight (23.5%) had been vaccinated or were planning vaccination against at least one condition and 17 (50%) listed travel-specific medications they planned to take with them. Those who were travelling to Africa were more likely to be vaccinated than those who were not travelling to Africa (3/4 vs 5/30, respectively, P=0.03). Those travelling to Europe were less likely to be vaccinated than those who were not (1/16 vs 7/18, P=0.04). The median duration of travel was 14 days (1-180). Fifteen subjects (44%) became ill while abroad. Those who became ill abroad were more likely to have visited Asia (P=0.003) and less likely to have visited the Americas (P=0.02) than those who did not become ill abroad. In addition, they tended to have stayed abroad for longer periods (P=0.07) and had visited more countries (P=0.04) than those who did not become ill abroad. Sixteen individuals (47%) reported illness on their return to the UK. Conclusions. HIV-infected travellers have an increased susceptibility to opportunistic and other travel-related infections and the need for appropriate advice, vaccination and prophylactic therapy is important. Health care provision in this field is in need of uniform guidelines to coordinate travel health management for this particular high risk group.

Has the economic crisis led to a new risk profile for international travellers?

PubMed

Roure, S; Pérez-Quílez, O; Vallès, X; Martínez-Cuevas, O; Sabrià, M; Valerio, L

2015-11-01

The economic world crisis has led to the migration of European workers to developing countries with a high incidence of infectious diseases. The objective of this study was to assess whether this context has produced an increase in the risks to international travellers for work reasons (TWR). Observational, retrospective study. The study population included TWR who were attended before travelling at an International Health Unit in the year 2007 (the year before the initiation of the European crisis) and in the year 2012 (when the structural crisis was established). A comparative socioeconomic analysis was performed as well as an analysis of the risk factors present in both groups. In 2007 and 2012 a total of 9,197 travellers were attended. Of these, there were 344 TWR (3.4%); 101 TWR (2.8%) in 2007 and 243 TWR (4.5%) in 2012 (p<0.001). The average age of the travellers was 38.1 years (SD: 10.57). The most common destination was Sub-Saharan Africa, in 164 (47.6%) of the cases. Malaria chemoprophylaxis was prescribed to 152 travellers (44%) and 80 presented comorbidity (23.25%). The TWR from 2012 presented a significantly greater age (p=0.05), more comorbidity (p=0.018) and a greater proportion of stays in rural areas (p=0.0009) for longer time periods (p=0.001). At 5 years from the start of the economic crisis, there was a change in the profile of TWR. Their number has increased significantly, as has the proportion who present risk factors for contracting imported diseases. The International Health Units should adapt to these new circumstances and adopt preventive measures for this population. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Travel Overview

Science.gov Websites

Top Department of Administration logo Alaska Department of Administration Division of Finance Search Search the Division of Finance site DOF State of Alaska Finance Home Content Area Accounting Charge Cards You are here Administration / Finance / Travel Travel The Department of Administration administers the

Travel immunization update for older adults.

PubMed

Spain, Margaret P; Edlund, Barbara J

2010-04-01

Older Americans are among the most widely traveled group in our society. Recent trends point to more international travel, more travel to Third World countries, and more travel by older adults with significant health problems. Regardless of the reason for travel, older adults need to plan for healthy travel. Primary care providers need to inquire at routine visits if patients have plans for international travel. If travel to other countries or regions is being considered, patients must be advised of the importance of early travel preparation. To begin with, older adults should be up to date on all routine immunizations. Those planning on international travel may need additional required and/or recommended immunizations, depending on the individual's health status, travel itinerary, length of stay, and health risks associated with destination sites. Primary care providers should be knowledgeable about travel medicine resources in the community to make referrals for travelers requiring additional immunizations and health information. Copyright 2010, SLACK Incorporated.

Traveling-wave photodetector

DOEpatents

Hietala, V.M.; Vawter, G.A.

1993-12-14

The traveling-wave photodetector of the present invention combines an absorptive optical waveguide and an electrical transmission line, in which optical absorption in the waveguide results in a photocurrent at the electrodes of the electrical transmission line. The optical waveguide and electrical transmission line of the electrically distributed traveling-wave photodetector are designed to achieve matched velocities between the light in the optical waveguide and electrical signal generated on the transmission line. This velocity synchronization provides the traveling-wave photodetector with a large electrical bandwidth and a high quantum efficiency, because of the effective extended volume for optical absorption. The traveling-wave photodetector also provides large power dissipation, because of its large physical size. 4 figures.

Traveling-wave photodetector

DOEpatents

Hietala, Vincent M.; Vawter, Gregory A.

1993-01-01

The traveling-wave photodetector of the present invention combines an absorptive optical waveguide and an electrical transmission line, in which optical absorption in the waveguide results in a photocurrent at the electrodes of the electrical transmission line. The optical waveguide and electrical transmission line of the electrically distributed traveling-wave photodetector are designed to achieve matched velocities between the light in the optical waveguide and electrical signal generated on the transmission line. This velocity synchronization provides the traveling-wave photodetector with a large electrical bandwidth and a high quantum efficiency, because of the effective extended volume for optical absorption. The traveling-wave photodetector also provides large power dissipation, because of its large physical size.

A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports

PubMed Central

2012-01-01

Background Pre-travel health assessments aim to promote risk reduction through preventive measures and safe behavior, including ensuring travelers are up-to-date with their immunizations. However, studies assessing pre-travel health-seeking practices from a variety of medical and non-medical sources and vaccine uptake prior to travel to both developing and developed countries within the Asia-Pacific region are scarce. Methods Cross-sectional surveys were conducted between July and December 2007 to assess pre-travel health seeking practices, including advice from health professionals, health information from other sources and vaccine uptake, in a sample of travelers departing Sydney and Bangkok airports. A two-stage cluster sampling technique was used to ensure representativeness of travelers and travel destinations. Pre-travel health seeking practices were assessed using a self-administered questionnaire distributed at the check-in queues of departing flights. Logistic regression models were used to identify significant factors associated with seeking pre-travel health advice from a health professional, reported separately for Australian residents, residents of other Western countries and residents of countries in Asia. Results A total of 843 surveys were included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, pre-travel health information from any source was sought by 415 (49%) respondents with 298 (35%) seeking pre-travel advice from a health professional, the majority through general practice. Receipt of a pre-travel vaccine was reported by 100 (12%) respondents. Significant factors associated with seeking pre-travel health advice from a health professional differed by region of residence. Asian travelers were less likely to report seeking pre-travel health advice and uptake of pre-travel vaccines than Australian or other Western travelers. Migrant Australians were less likely to report seeking pre-travel health

A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports.

PubMed

Heywood, Anita E; Watkins, Rochelle E; Iamsirithaworn, Sopon; Nilvarangkul, Kessarawan; MacIntyre, C Raina

2012-05-02

Pre-travel health assessments aim to promote risk reduction through preventive measures and safe behavior, including ensuring travelers are up-to-date with their immunizations. However, studies assessing pre-travel health-seeking practices from a variety of medical and non-medical sources and vaccine uptake prior to travel to both developing and developed countries within the Asia-Pacific region are scarce. Cross-sectional surveys were conducted between July and December 2007 to assess pre-travel health seeking practices, including advice from health professionals, health information from other sources and vaccine uptake, in a sample of travelers departing Sydney and Bangkok airports. A two-stage cluster sampling technique was used to ensure representativeness of travelers and travel destinations. Pre-travel health seeking practices were assessed using a self-administered questionnaire distributed at the check-in queues of departing flights. Logistic regression models were used to identify significant factors associated with seeking pre-travel health advice from a health professional, reported separately for Australian residents, residents of other Western countries and residents of countries in Asia. A total of 843 surveys were included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, pre-travel health information from any source was sought by 415 (49%) respondents with 298 (35%) seeking pre-travel advice from a health professional, the majority through general practice. Receipt of a pre-travel vaccine was reported by 100 (12%) respondents. Significant factors associated with seeking pre-travel health advice from a health professional differed by region of residence. Asian travelers were less likely to report seeking pre-travel health advice and uptake of pre-travel vaccines than Australian or other Western travelers. Migrant Australians were less likely to report seeking pre-travel health advice than Australian

Travelers' Health: Yellow Fever

MedlinePlus

... and local rate of virus transmission at the time of travel. Although reported cases of human disease are the ... be receiving yellow fever vaccine for the first time. If travel is unavoidable, the decision to vaccinate travelers aged ≥ ...

A travel clinic in your office: grow your practice and protect international travelers.

PubMed

Kirsch, Michael

2009-01-01

Medical practices today face economic challenges from declining reimbursements and rising overhead costs. Physicians need to develop new income sources to invigorate their practices and remain viable. Travel medicine-advising and immunizing international travelers-is a rapidly growing specialty in the United States that generates substantial cash reimbursements and professional satisfaction. Travel Clinics of America, a physician-operated company, specializes in helping physicians to incorporate travel medicine into their existing practices.

[Analysis of prevention of diseases in travellers on the basis of latest results in travel medicine].

PubMed

Felkai, Péter

2008-09-07

When we survey the possibilities of prevention in travel medicine, it is soon detected that the "classical" or "infectology-oriented" approach of prevention (vaccination - chemoprophylaxis - pretravel advice) cannot respond to all peritravel medical problems. These newly arisen challenges require a new, complex outlook for travel medicine, mainly in the field of prevention, treatment and management of travel-related illnesses. Although travellers are still exposed to various infectious diseases, which are mostly preventable by the primary prevention methods (biomedical prophylaxis), the majority of travellers suffer from non-infectious diseases and fall ill or suffer accident by other, travel-relating factors. Moreover, the predominant destination is Europe for an average Hungarian traveller. The travellers, whose destination is not any tropical or developing country, i.e. adventure travellers, people in extreme sports, chronic patients all require same-level peritravel (prevention-oriented) advice, too. Thus besides vaccination, helmets, salt-tablets, medical kit, mobile oxygenator must belong to a travel doctors' arsenal. We also have to mention the travellers' acute illness/accident abroad, travellers who require repatriation, and also the appropriate travel insurance policy which should be worked out following evidence-based medical considerations. The above-mentioned complex task requires not only a broad-spectrum, multidisciplinary knowledge, but an appropriate co-operation between the travel medicine physician, the general practitioner of the patient, and the doctor of the insurance company. But, above all, we have to redefine the topic of travel medicine, its subspecialties and role in the three-level (primary, secondary and tertiary) prevention. We have to redefine the different prevention levels and the used methods relating to the different subdisciplines of travel medicine. Upon the recent scientific researches, we can lay down four topics of travel

Health hazards of international travel.

PubMed

Cossar, J H; Reid, D

1989-01-01

The growth of travel and the increasing numbers of those affected by travel-related illnesses, some of a serious nature, will cause this subject to demand the attention of the medical profession, the travel trade, travellers themselves and the health authorities of countries receiving tourists. Provision of appropriate advice for the traveller is a shared responsibility, best channelled mainly through travel agencies; it can moreover be shown to be cost-beneficial. Continued monitoring of illness in travellers and provision of information systems geared to this problem and its prevention are fully justified. They should be based on traditional channels of communication and currently-available modern technology, and be readily accessible to medical and related workers. Increased collaboration between medical workers, health educators and those involved in the travel trade would be a positive and useful contribution towards the reduction of illness and discomfort among travellers and the associated expense incurred by the various national health services concerned. There are clearly economic benefits from the development of international tourism, but these have to be balanced in countries accepting tourists by attention to the prevention of illnesses associated with travel.

Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet

PubMed Central

Lammert, Sara M.; Rao, Sowmya R.; Jentes, Emily S.; Fairley, Jessica K.; Erskine, Stefanie; Walker, Allison T.; Hagmann, Stefan H.; Sotir, Mark J.; Ryan, Edward T.

2017-01-01

Background: International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. Methods: We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. Results: Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59–0.95)). Conclusions: Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective

Travel medicine and mHealth technology: a study using smartphones to collect health data during travel.

PubMed

Farnham, Andrea; Blanke, Ulf; Stone, Emily; Puhan, Milo A; Hatz, Christoph

2016-06-01

mHealth methodology such as smartphone applications offers new opportunities to capture the full range of health risks during travel in real time. Our study aims to widen the scope of travel health research in tropical and subtropical destinations by using a smartphone application to collect detailed information on health behaviours, clinical symptoms, accidents and environmental factors during travel. We enrolled travel clinic clients in Zurich and Basel ≥18 years of age travelling to Thailand for <5 weeks. Sociodemographic, clinical and risk behaviour information was collected pre-travel. Participants were equipped with a smartphone and an application that (1) actively administers a daily self-report questionnaire on the health risks, behaviours and symptoms the traveller encountered, and (2) passively collects information on the traveller's location and environmental conditions by transformation of raw GPS data. A prospective cohort of 101 travellers planning travel to Thailand between January and June 2015 was recruited. Of the 101 enrolled travellers, 75 (74.3%) answered at least one questionnaire during travel, 10 (9.9%) had technical difficulties and 16 (15.8%) dropped out. Those who completed questionnaires were a median of 27.0 years old (range 18-57). Travellers filled out a median of 12.0 questionnaires during their trip (range 1-30), corresponding to a median completion rate of 85.0% days of travel. The typical example of a healthy female traveller shows that many and diverse health issues arise during a trip that clusters on certain days. The rich data on behaviour and local environment may be used to explain the occurrence and clustering of health issues. Use of a smartphone app to collect health information is technically feasible and acceptable amongst a traveller population, minimizes recall bias and greatly increases the quality and quantity of data collected during travel. mHealth technology shows great potential for innovation in travel

Travel burden associated with granulocyte colony-stimulating factor administration in a Medicare aged population: a geospatial analysis.

PubMed

Stephens, J Mark; Bensink, Mark; Bowers, Charles; Hollenbeak, Christopher S

2017-07-31

Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is recommended for patients receiving myelosuppressive chemotherapy regimens with a high risk of febrile neutropenia (FN). G-CSFs should be administered starting the day after chemotherapy, necessitating return trips to the oncology clinic at the end of each cycle. We examined the travel burden related to prophylactic G-CSF injections after chemotherapy in the US. We used 2012-2014 Medicare claims data to identify a national cohort of beneficiaries age 65+ with non-myeloid cancers who received both chemotherapy and prophylactic G-CSFs. Patient travel origin was based on residence ZIP code. Oncologist practice locations and hospital addresses were obtained from the Medicare Physician Compare and Hospital Compare websites and geocoded using the Google Maps Application Programming Interface (API). Driving distance and time to the care site from each patient ZIP code tabulation area (ZCTA) were calculated using Open Street Maps road networks. Geographic and socio-economic characteristics of each ZCTA from the US Census Bureau's American Community Survey were used to stratify and analyze travel estimates. The mean one-way driving distance to the G-CSF provider was 23.8 (SD 30.1) miles and the mean one-way driving time was 33.3 (SD 37.8) minutes. When stratified by population density, the mean one-way travel time varied from 12.1 (SD 10.1) minutes in Very Dense Urban areas to 76.7 (SD 72.1) minutes in Super Rural areas. About 48% of patients had one-way travel times of <20 minutes, but 19% of patients traveled ≥50 minutes one way for G-CSF prophylaxis. Patients in areas with above average concentrations of aged, poor or disabled residents were more likely to experience longer travel. Administration of G-CSF therapy after chemotherapy can present a significant travel burden for cancer patients. Technological improvements in the form and methods of drug delivery for G-CSFs might significantly reduce

76 FR 43236 - Federal Travel Regulation (FTR): Temporary Duty (TDY) Travel Allowances: Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

...; Sequence 5] Federal Travel Regulation (FTR): Temporary Duty (TDY) Travel Allowances: Notice of Public... public meeting. SUMMARY: The General Services Administration (GSA) is revising the Federal Travel Regulation (FTR) in an effort to streamline travel policies, increase travel efficiency and effectiveness...

Travelers' Health: Immunocompromised Travelers

MedlinePlus

... clinical and epidemiologic studies are insufficient at this time to evaluate the actual risk of severe adverse effects associated with YF vaccine among recipients with limited immune deficits. If international travel requirements, and not true exposure risk, are the ...

[Travelers' diarrhea].

PubMed

Markwalder, K

2001-06-01

Diarrhea is the most common health problem of travelers to tropical destinations, affecting up to over 50%, with however considerable regional and seasonal variation. Orally acquired bacterial pathogens, particularly enterotoxigenic Escherichia coli, are the most frequent etiology of travelers' diarrhea occurring during the first three weeks of travel. Protozoal infections, e.g. giardia and Entamoeba histolytica, are more often the cause of diarrhea and prolonged problems of intestinal motility of the returning traveler--as are postinfectious irritable bowel syndromes. Prevention seems theoretically simple by avoiding any potentially contaminated food and drinks, but the principle of 'cook it, boil it, peel it, or avoid it is obviously a goal difficult to achieve. Several antibiotics have shown to be able to prevent diarrhea for a short period of time, but the potential of adverse effects and selection of resistant pathogens calls for a restrictive use for short trips of particularly vulnerable subjects only. The use of probiotics--e.g. Saccharomyces boulardi, Streptococcus faecium--gave conflicting results--both in prevention and treatment. The basics of treatment is appropriate fluid replacement--mostly by the oral route. Although this measure can safely bridge the time until spontaneous remission, it fails to reduce the duration of illness. Appropriate antibiotics are fairly effective to reduce the duration of travelers' diarrhea, especially if combined with loperamid. The administration of the later is contraindicated in small children. The most commonly used and well documented antibiotics belong to the fluoroquinolones. Alternatives for pediatric use are azithromycin and cotrimoxazole. Considering the mostly short duration of travelers' diarrhea the administration of antibiotics can be limited to cases of acute febrile dysentery and violent diarrhea when rapid relief is essential. In cases of febrile diarrhea malaria must be considered if the patient has been

Epidemic spreading by objective traveling

NASA Astrophysics Data System (ADS)

Tang, Ming; Liu, Zonghua; Li, Baowen

2009-07-01

A fundamental feature of agent traveling in social networks is that traveling is usually not a random walk but with a specific destination and goes through the shortest path from starting to destination. A serious consequence of the objective traveling is that it may result in a fast epidemic spreading, such as SARS etc. In this letter we present a reaction-traveling model to study how the objective traveling influences the epidemic spreading. We consider a random scale-free meta-population network with sub-population at each node. Through a SIS model we theoretically prove that near the threshold of epidemic outbreak, the objective traveling can significantly enhance the final infected population and the infected fraction at a node is proportional to its betweenness for the traveling agents and approximately proportional to its degree for the non-traveling agents. Numerical simulations have confirmed the theoretical predictions.

Commercializing diarrhea vaccines for travelers

PubMed Central

López-Gigosos, Rosa; Segura-Moreno, Marina; Díez-Díaz, Rosa; Plaza, Elena; Mariscal, Alberto

2014-01-01

Continued growth in international travel and forecasts for a great increase in the number of people who travel from industrialized to emerging and developing countries make it necessary to develop and improve the capacity to provide health protection to travelers. Measures available to prevent some diseases include a currently limited number of marketed vaccines which represent extremely useful tools to protect travelers. Travelers very often experience diarrheal and gastrointestinal diseases for which some vaccines are available. Use of these vaccines should be evaluated based on traveler and travel destination and characteristics. Vaccines available include those against cholera, typhoid fever, hepatitis A, hepatitis E (only available in China), and rotavirus. The aim of this review is to provide an updated summary about each of the abovementioned vaccines that may be useful for making decisions regarding their use and assessing their indications in recommendations for travelers. PMID:24496054

Travel Characteristics and Pretravel Health Care Among Pregnant or Breastfeeding U.S. Women Preparing for International Travel.

PubMed

Hagmann, Stefan H F; Rao, Sowmya R; LaRocque, Regina C; Erskine, Stefanie; Jentes, Emily S; Walker, Allison T; Barnett, Elizabeth D; Chen, Lin H; Hamer, Davidson H; Ryan, Edward T

2017-12-01

To study characteristics and preventive interventions of adult pregnant and breastfeeding travelers seeking pretravel health care in the United States. This cross-sectional study analyzed data (2009-2014) of pregnant and breastfeeding travelers seen at U.S. travel clinics participating in Global TravEpiNet. Nonpregnant, nonbreastfeeding adult female travelers of childbearing age were used for comparison. We evaluated the prescription of malaria chemoprophylaxis and antibiotics for this population as well as the administration of three travel-related vaccines: hepatitis A, typhoid, and yellow fever. We also evaluated use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis and influenza vaccines, because these are widely recommended in pregnancy. Of 21,138 female travelers of childbearing age in Global TravEpiNet, 170 (0.8%) were pregnant and 139 (0.7%) were breastfeeding. Many traveled to destinations endemic for mosquito-borne illnesses, including malaria (pregnant: 95%; breastfeeding: 94%), dengue (pregnant: 87%; breastfeeding: 81%), or yellow fever (pregnant: 35%; breastfeeding: 50%). Compared with nonpregnant, nonbreastfeeding adult female travelers, eligible pregnant travelers were less likely to be vaccinated against hepatitis A (28% compared with 51%, P<.001) and typhoid (35% compared with 74%, P<.001). More than 20% of eligible pregnant travelers did not receive influenza vaccination. Yellow fever vaccine was occasionally provided to pregnant and breastfeeding travelers traveling to countries entirely endemic for yellow fever (6 [20%] of 30 pregnant travelers and 18 [46%] of 39 breastfeeding travelers). Half of pregnant travelers and two thirds of breastfeeding travelers preparing to travel to malaria-holoendemic countries received a prescription for malaria prophylaxis. Most pregnant and breastfeeding travelers seen for pretravel health consultations traveled to destinations with high risk for vector-borne or other travel-related diseases

Travel Characteristics and Pretravel Health Care Among Pregnant or Breastfeeding U.S. Women Preparing for International Travel

PubMed Central

Hagmann, Stefan H. F.; Rao, Sowmya R.; LaRocque, Regina C.; Erskine, Stefanie; Jentes, Emily S.; Walker, Allison T.; Barnett, Elizabeth D.; Chen, Lin H.; Hamer, Davidson H.; Ryan, Edward T.

2018-01-01

OBJECTIVE To study characteristics and preventive interventions of adult pregnant and breastfeeding travelers seeking pretravel health care in the United States. METHODS This cross-sectional study analyzed data (2009–2014) of pregnant and breastfeeding travelers seen at U.S. travel clinics participating in Global TravEpiNet. Nonpregnant, nonbreastfeeding adult female travelers of childbearing age were used for comparison. We evaluated the prescription of malaria chemoprophylaxis and antibiotics for this population as well as the administration of three travel-related vaccines: hepatitis A, typhoid, and yellow fever. We also evaluated use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis and influenza vaccines, because these are widely recommended in pregnancy. RESULTS Of 21,138 female travelers of childbearing age in Global TravEpiNet, 170 (0.8%) were pregnant and 139 (0.7%) were breastfeeding. Many traveled to destinations endemic for mosquito-borne illnesses, including malaria (pregnant: 95%; breastfeeding: 94%), dengue (pregnant: 87%; breastfeeding: 81%), or yellow fever (pregnant: 35%; breastfeeding: 50%). Compared with nonpregnant, nonbreastfeeding adult female travelers, eligible pregnant travelers were less likely to be vaccinated against hepatitis A (28% compared with 51%, P<.001) and typhoid (35% compared with 74%, P<.001). More than 20% of eligible pregnant travelers did not receive influenza vaccination. Yellow fever vaccine was occasionally provided to pregnant and breastfeeding travelers traveling to countries entirely endemic for yellow fever (6 [20%] of 30 pregnant travelers and 18 [46%] of 39 breastfeeding travelers). Half of pregnant travelers and two thirds of breastfeeding travelers preparing to travel to malaria-holoendemic countries received a prescription for malaria prophylaxis. CONCLUSION Most pregnant and breastfeeding travelers seen for pretravel health consultations traveled to destinations with high risk for vector

Managed lane travelers : do they pay for travel as they claimed they would?

DOT National Transportation Integrated Search

2011-05-01

This study examined if travelers are paying for travel on managed lanes (MLs) as they indicated that they : would in a 2008 survey. To achieve the objectives, an Internet-based stated preference (SP) survey of : Houstons Katy Freeway travelers was...

76 FR 46216 - Federal Travel Regulation (FTR): Temporary Duty (TDY) Travel Allowances: Notice of Public Meeting...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-02

...; Sequence 5] Federal Travel Regulation (FTR): Temporary Duty (TDY) Travel Allowances: Notice of Public... and the general public in an effort to streamline travel policies, incorporated travel efficiency and.... Flynn, Deputy Director, Office of Travel, Transportation & Asset Management. [FR Doc. 2011-19482 Filed 8...

Travel health advice: benefits, compliance, and outcome.

PubMed

Angelin, Martin; Evengård, Birgitta; Palmgren, Helena

2014-06-01

Travel health advice is an important and difficult part of a pre-travel consultation. The aim of this study was to determine whether the travel health advice given is followed by the traveller and whether it affects disease and injury experienced during travel. A prospective survey study was carried out from October 2009 to April 2012 at the Travel Medicine Clinic of the Department of Infectious Diseases, Umeå University Hospital, Umeå, Sweden. The Travel Medicine Clinic in Umeå is the largest travel clinic in northern Sweden. We included 1277 individuals in the study; 1059 (83%) responded to the post-travel questionnaire. Most visitors (88%) remembered having received travel health advice; among these, 95% found some of the health advice useful. Two-thirds (67%) claimed to have followed the advice, but fell ill during travel to the same extent as those who did not. Younger travellers (< 31 y) found our travel health advice less beneficial, were less compliant with the advice, took more risks during travel, and fell ill during travel to a greater extent than older travellers. Helping travellers stay healthy during travel is the main goal of travel medicine. Younger travellers are a risk group for illness during travel and there is a need to find new methods to help them avoid illness. Travellers find travel health advice useful, but it does not protect them from travel-related illness. Factors not easily influenced by the traveller play a role, but a comprehensive analysis of the benefits of travel health advice is needed.

Associations of individual, household and environmental characteristics with carbon dioxide emissions from motorised passenger travel

PubMed Central

Brand, Christian; Goodman, Anna; Rutter, Harry; Song, Yena; Ogilvie, David

2013-01-01

Carbon dioxide (CO2) emissions from motorised travel are hypothesised to be associated with individual, household, spatial and other environmental factors. Little robust evidence exists on who contributes most (and least) to travel CO2 and, in particular, the factors influencing commuting, business, shopping and social travel CO2. This paper examines whether and how demographic, socio-economic and other personal and environmental characteristics are associated with land-based passenger transport and associated CO2 emissions. Primary data were collected from 3474 adults using a newly developed survey instrument in the iConnect study in the UK. The participants reported their past-week travel activity and vehicle characteristics from which CO2 emissions were derived using an adapted travel emissions profiling method. Multivariable linear and logistic regression analyses were used to examine what characteristics predicted higher CO2 emissions. CO2 emissions from motorised travel were distributed highly unequally, with the top fifth of participants producing more than two fifth of emissions. Car travel dominated overall CO2 emissions, making up 90% of the total. The strongest independent predictors of CO2 emissions were owning at least one car, being in full-time employment and having a home-work distance of more than 10 km. Income, education and tenure were also strong univariable predictors of CO2 emissions, but seemed to be further back on the causal pathway than having a car. Male gender, late-middle age, living in a rural area and having access to a bicycle also showed significant but weaker associations with emissions production. The findings may help inform the development of climate change mitigation policies for the transport sector. Targeting individuals and households with high car ownership, focussing on providing viable alternatives to commuting by car, and supporting planning and other policies that reduce commuting distances may provide an equitable and

Infectious disease following travel to developed regions: a snapshot of presentations to an Australian travel medicine clinic.

PubMed

Drewett, George; Leder, Karin

2016-06-01

Much of the travel medicine literature focuses on travel to 'developing' regions by travellers from 'developed' regions; however literature about travel to developed regions is scarce. This article examines presentations to a travel medicine clinic over a 17-year period with illnesses resulting from travel to developed regions. From a cohort of general presentations to the clinic of 1077 patients, 85 patients acquired infections due to travel to developed regions, with a total of 99 infectious diagnoses made. This serves to highlight the risk of infectious disease even among travel to only developed regions, and the importance of travel advice in these situations. © International Society of Travel Medicine, 2016.. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Drug use, travel and HIV risk.

PubMed

Lee, D; Bell, D C; Hinojosa, M

2002-08-01

A study was conducted to examine the travel experiences of a community sample of 160 drug users and 44 non-users recruited as part of a study of HIV risk. Of the sample, 47% (96/204) reported intercity travel in the previous ten years. Results showed that men were more likely to travel than women, Anglos more than minorities, and young persons more than old. When travellers testing HIV-seropositive (n = 13) were compared with seronegative travellers, HIV-positive travellers reported more sex while travelling than HIV-negative persons, but virtually all of the difference reported involved sex with condoms. There were no significant differences in sex risk behaviours while travelling between drug users and non-drug users, or in sex risk behaviors between drug injectors and non-injectors. Travellers had fewer injection partners while travelling than they had while at home. There was also a significant difference in number of sex partners with whom a condom was not used, with fewer sex partners while travelling.

Hepatitis A - prevention in travellers.

PubMed

Mayer, Cora A; Neilson, Amy A

2010-12-01

Hepatitis A is the second most common vaccine preventable infection in travellers. Highly effective vaccines exist for its prevention for travellers from 12 months of age, including last minute travellers and those in special risk groups. Information about hepatitis A infection, its epidemiology and existing vaccine options is presented for use in travel related consultations in general practice. Most travellers at risk of hepatitis A should be vaccinated, as the vaccine is a safe and effective means of prevention. Combination vaccines - hepatitis A/hepatitis B and hepatitis A/typhoid - aim to facilitate the vaccination process for travellers, who are often also at risk of exposure to hepatitis B and typhoid fever.

Investigations of Section Speed on Rural Roads in Podlaskie Voivodeship

NASA Astrophysics Data System (ADS)

Ziolkowski, Robert

2017-10-01

Excessive speed is one of the most important factors considered in road safety and not only affects the severity of a crash but is also related to the risk of being involved in a crash. In Poland the problem of speeding drivers is widely common. Properly recognized and defined drivers behaviour is the base for any effective activities taken towards road safety improvements. Effective enforcement of speed limits especially on rural road plays an important role but conducted speed investigations basically focus on spot speed omitting travel speed on longer sections of roads which can better reflect driver’s behaviour. Possible solutions for rural roads are limited to administrative means of speed limitations, installations of speed cameras and police enforcement. However due to their limited proved effectiveness new solutions are still being sought. High expectations are associated with the sectional speed system that has recently been introduced in Poland and covered a number of national road sections. The aim of this paper is to investigate section speed on chosen regional and district roads located in Podlaskie Voivodeship. Test sections included 19 road segments varied in terms of functional and geometric characteristics. Speed measurements on regional and district roads were performed with the use of a set of two ANPR (Automatic Number Plate Recognition) cameras. Conducted research allowed to compare driver’s behaviour in terms of travel speed depending on roads’ functional classification as well as to evaluate the influence of chosen geometric parameters on average section speed.

Risk factors for infections in international travelers: an analysis of travel-related notifiable communicable diseases.

PubMed

Baer, Atar; Libassi, Lisa; Lloyd, Jennifer K; Benoliel, Eileen; Brucker, Rachel; Jones, Megan Q; Kwan-Gett, Tao Sheng; McKeirnan, Shelly; Pecha, Monica; Rietberg, Krista; Serafin, Lauri; Walkinshaw, Lina P; Duchin, Jeffrey S

2014-01-01

We sought to describe travel-related illness among our residents and gain insight into targeting pre-travel health advice to prevent travel-related illness. A supplemental travel questionnaire was developed and administered for cases with a legally notifiable communicable disease reported in 2011-2012, who spent at least part of their exposure period outside the United States. Among 451 cases meeting the eligibility criteria, 259 were interviewed. Forty four percent reported receiving pre-travel advice. Two-thirds adhered fully with risk behavior recommendations; 94% followed immunization recommendations partially or fully; and 84% adhered fully with malaria prophylaxis recommendations. The primary reasons for not obtaining pre-travel advice were being unaware of the need (47.5%), or believing they already knew what to do (34.5%). Adults (OR = 2.8, 95% CI = 1.4-5.5), males (OR = 1.8, 95% CI = 1.1-3.0), those born outside the United States (OR = 2.0, 95% CI = 1.1-3.7), and those with planning time under two weeks (OR = 4.8, 95% CI = 1.5-15.9) or travel duration less than 7 days (OR = 7.9, 95% CI = 3.0-20.9) were more likely to travel without seeking pre-travel advice. The majority of cases reported not receiving pre-travel advice. Understanding the predictors of failure to receive pre-travel advice may help target public health prevention efforts. Copyright © 2014 Elsevier Ltd. All rights reserved.

Self-Reported Barriers to Healthcare Access for Rheumatoid Arthritis Patients in Rural and Northern Saskatchewan: A Mixed Methods Study.

PubMed

Nair, B V; Schuler, R; Stewart, S; Taylor-Gjevre, R M

2016-12-01

The aim of the present study was to identify potential barriers for access to medical and allied health services from the perspective of rural and Northern Saskatchewan rheumatoid arthritis (RA) patients. A total of 100 adults with established RA, residing in rural and Northern Saskatchewan, were recruited from two rheumatology practices. Structured interviews with standardized scripts solicited patient perspectives on appointment waiting times, travel required to access medical services and satisfaction with healthcare provision. Thematic analysis was employed for qualitative data. Patients-reported concerns regarding waiting time for their first rheumatology appointment. There was reduced access to allied health professionals, with only 53% of the participants having seen a physiotherapist (PT), and only 26% an occupational therapist (OT). Patients had similar driving distances to their family physician, PT, pharmacy and laboratory services but commuted significantly further for rheumatologist and OT services. There were high levels of satisfaction with their rheumatologist and family physician appointments (8.96 and 8.04 on a ten-point scale). Patients with longer travel times had higher satisfaction with their health care appointments: Patients who travelled one, two and more than two hours had satisfaction scores of 0.93, 0.88 and 1.32 points higher on a ten-point scale (p < 0.03). Access to medical services is a concern for this population. Patients were dissatisfied with the waiting time for their first specialist appointment and with decreased access to allied health professionals. Patients travelling longer distances were more satisfied with their health care provider's care, suggesting that good patient-care giver relationships helped to ameliorate the difficulties of travelling to their appointments. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia.

PubMed

Heywood, Anita E; Zhang, Meng; MacIntyre, C Raina; Seale, Holly

2012-02-17

Forward planning and preventative measures before travelling can significantly reduce the risk of many vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk of importing infectious disease as many undertake multiple visits to regions with higher infectious disease endemicity. Little is known about the health behaviours of domestic or international university students, particularly students from low resource countries who travel to high-resource countries for education. This study aimed to assess travel-associated health risks and preventative behaviours in a sample of both domestic and international university students in Australia. In 2010, a 28 item self-administered online survey was distributed to students enrolled at the University of New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised. The survey examined the international travel history, travel intentions, infection control behaviours and self-reported vaccination history. A total of 1663 respondents completed the online survey, 22.1% were international students and 83.9% were enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of those travelling only once during that time with no difference in travel from Australia between domestic and international students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip. Domestic students were more likely to report uptake of a range of preventative travel health measures compared to international students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001). Overall, students reported low risk perception of travel threats and a low corresponding concern for these threats. Our study highlights the need to educate students

Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia

PubMed Central

2012-01-01

Background Forward planning and preventative measures before travelling can significantly reduce the risk of many vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk of importing infectious disease as many undertake multiple visits to regions with higher infectious disease endemicity. Little is known about the health behaviours of domestic or international university students, particularly students from low resource countries who travel to high-resource countries for education. This study aimed to assess travel-associated health risks and preventative behaviours in a sample of both domestic and international university students in Australia. Methods In 2010, a 28 item self-administered online survey was distributed to students enrolled at the University of New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised. The survey examined the international travel history, travel intentions, infection control behaviours and self-reported vaccination history. Results A total of 1663 respondents completed the online survey, 22.1% were international students and 83.9% were enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of those travelling only once during that time with no difference in travel from Australia between domestic and international students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip. Domestic students were more likely to report uptake of a range of preventative travel health measures compared to international students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001). Overall, students reported low risk perception of travel threats and a low corresponding concern for these threats. Conclusions Our study

The Jet Travel Challenge

ERIC Educational Resources Information Center

Roman, Harry T.

2007-01-01

Airplane travelers are dismayed by the long lines and seemingly chaotic activities that precede boarding a full airplane. Surely, the one who can solve this problem is going to make many travelers happy. This article describes the Jet Travel Challenge, an activity that challenges students to create some alternatives to this now frustrating…

Knowledge, attitudes, and practices evaluation about travel medicine in international travelers and medical students in Chile.

PubMed

Guerrero-Lillo, Lisette; Medrano-Díaz, Jorge; Pérez, Carmen; Chacón, Rodrigo; Silva-Urra, Juan; Rodriguez-Morales, Alfonso J

2009-01-01

Because information about travel medicine in Chile is lacking, a knowledge, attitudes, and practices evaluation in international travelers and medical students was done. The travelers and medical students did not know the travel medicine and sanitary conditions of their destinations, although they perceived travel-associated health risks, but <10% had any vaccination and 5% got sick during international trips.

[Traveler's thrombosis].

PubMed

Riedel, M; Bohanes, V

2002-08-01

It is pathophysiologically conceivable that prolonged sitting in a tight space (e.g., in airplane or other transport vehicle) may lead to leg vein thrombosis. The association between the incidence of venous thromboembolism and long travel has not been sufficiently documented but seems probable. However, this association is only weak and the incidence of symptomatic thromboembolism much lower than the impression given by the recent publicity. In a healthy person, the risk of suffering a clinically relevant leg vein thrombosis solely because of a flight is extreme low. In persons with risk factors for venous thromboembolism, the flight represents an additional, as yet not quantifiable risk. This risk increases with the duration of the travel. The most important cause of thrombosis during long journeys seems to be venostasis due to relative immobilization. It is not clear whether flight travel represents a higher risk of thrombosis compared to other transport vehicles with comparable duration and immobilization. Until more exact information becomes available, it seems reasonable to recommend simple isometric and isotonic leg exercises during long travel. More aggressive measures must be considered for persons with risk factors for thromboembolism, but these measures should be individualized.

Travelers' Health: Cruise Ship Travel

MedlinePlus

... Motion Sickness ). PRECAUTIONS FOR CRUISE SHIP TRAVELERS Pretravel Evaluate the type and length of the planned cruise ... Peake DE, Gray CL, Ludwig MR, Hill CD. Descriptive epidemiology of injury and illness among cruise ship ...

Regional travel survey

DOT National Transportation Integrated Search

1992-04-01

Mid-America Regional Council, the designated Metropolitan Planning Organization for the Kansas City Metropolitan Area, performed a Small Sample Travel Survey for the Kansas City region to collect data to update the MARC travel demand models. The resu...

[Vaccination for international travelers].

PubMed

Arrazola, M Pilar; Serrano, Almudena; López-Vélez, Rogelio

2016-05-01

Traveler's vaccination is one of the key strategies for the prevention of infectious diseases during international travel. The risk of acquiring an infectious disease is determined in each case by the characteristics of the traveler and the travel, so the pre-departure medical advice of the traveler must be individualized. The World Health Organization classifies travelerś vaccines into three groups. - Vaccines for routine use in national immunization programs: Haemophilus influenzae type b, hepatitis B, polio, measles-mumps-rubella, tetanus-diphtheria-whooping a cough, and chickenpox. - Vaccinations required by law in certain countries before to enter them: yellow fever, meningococcal disease and poliomyelitis. - Vaccines recommended depending on the circumstances: cholera, japanese encephalitis, tick-borne encephalitis, meningococcal disease, typhoid fever, influenza, hepatitis A, hepatitis B, rabies and BCG. This review is intended to introduce the reader to the field of international vaccination. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Travel-related thrombosis.

PubMed

Cannegieter, Suzanne C

2012-09-01

Travel-related thrombosis is a serious public health concern considering the large and increasing number of travellers. Due to a lack of evidence, counselling air travellers on their venous thrombosis risk is not immediately straightforward, and advice will have to be based mostly on theoretical grounds. In this review a basis for these considerations is given. First of all it needs to be recognized that venous thrombosis is a multicausal disease, i.e. several risk factors have to be present before an event occurs. This is reflected in the literature where clearly increased risks have been described for certain groups, such as subjects with factor V Leiden, those who use oral contraceptives or are obese. Also, an increased risk for tall and short people has been reported. So, for subjects with a known risk factor who plan to travel, benefits and risks of thrombosis prophylaxis, (pharmacological or other), need to be weighed. This review provides some theoretical examples. For all other travellers, the advice to move and exercise as much as possible is likely to be sufficient. Copyright © 2012. Published by Elsevier Ltd.

Travel/Travelers and Parasitic Diseases

MedlinePlus

... Be Acquired During Travel* From Contaminated Food and Water More Common Giardiasis Cryptosporidiosis Cyclosporiasis Less Common Amebiasis ... Page last updated: April 20, 2018 Content source: Global Health – Division of Parasitic Diseases Email Recommend Tweet ...

mHealth to the Rescue: Growing use of wireless and mobile technologies improves community health, even in rural areas.

PubMed

Mertz, Leslie

2016-01-01

In rural areas, it is not unusual for patients to travel 50 miles or more to reach their doctors? offices or for doctors to refer patients to specialists whose offices are 80, 100, even 200-plus miles away. The sheer distance is a major obstacle for patients of all kinds: those who need urgent specialist care, those who have a chronic condition that requires regular visits, those who live in areas prone to poor weather-related driving conditions-really, anyone who has better things to do than spend hours traveling to and from a medical appointment.

Rural emergency medical technician pre-hospital electrocardiogram transmission.

PubMed

Powell, A M; Halon, J M; Nelson, J

2014-01-01

Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

Examining the Relationship between Online Travel Agency Information and Traveler Destination Transaction Decisions

ERIC Educational Resources Information Center

Yerby, Dennis

2012-01-01

The purpose of this quantitative study was to examine the role that available Online Travel Agency (OTA) destination information may have on a traveler's perceptions and intent in transaction decisions with that respective OTA. Specifically, this research examined a pleasure traveler's transaction perceptions and intentions with an OTA…

Travel Agent Course Outline.

ERIC Educational Resources Information Center

British Columbia Dept. of Education, Victoria.

Written for college entry-level travel agent training courses, this course outline can also be used for inservice training programs offered by travel agencies. The outline provides information on the work of a travel agent and gives clear statements on what learners must be able to do by the end of their training. Material is divided into eight…

Enquiries to the United Kingdom National Travel Advice Line by healthcare professionals regarding immunocompromised travellers.

PubMed

Allen, Joanna E; Patel, Dipti

2016-03-01

People who travel while immunocompromised are more at risk of serious travel-related infection. Their condition, medications or treatments can contraindicate, decrease the effectiveness of or increase the toxicity of vaccinations or malaria chemoprophylaxis. Therefore, immunocompromised travellers require careful assessment and specialized pre-travel advice. The aims of this study were to investigate enquiries by healthcare professionals (HCPs) to the UK National Travel Health Network and Centre (NaTHNaC) advice line regarding travellers with immunocompromise and to identify their most common concerns. Documentation for all calls taken by advisers at the London office during 2013 was reviewed. Of the 4910 enquiries to the London NaTHNaC advice line, 397 calls concerned immunocompromised travellers (8.1%). The majority of immunocompromised travellers were planning to visit Sub-Saharan Africa (53%) for the purpose of tourism (43%). Sixty-seven percent of enquiries concerned vaccine use, 11% were about malaria chemoprophylaxis, 20% were about both and 2% were for other reasons. Causes of immunocompromise included inflammatory or autoimmune conditions (43%), cancer (18%), splenic dysfunction (13%), immunosuppressive drugs (12%), human immunodeficiency virus (11%), primary immunodeficiency (1%), neutropenia (0.5%) and thymus abnormalities (0.5%). There were frequent enquires to the advice line by UK HCPs regarding immunocompromised travellers. The travellers in this study had a wide range of underlying medical conditions and varying levels of immunocompromise. These enquiries may reflect a lack of clarity in current national guidelines, difficulties in interpreting them or both. Establishing the reasons for these deficiencies as well as the reasons behind UK HCP concerns and lack of confidence requires further investigation. This research has highlighted potential knowledge gaps and will help inform future guidance and educational activities for UK HCPs advising

The Traveler with Sickle Cell Disease

PubMed Central

Willen, Shaina M.; Thornburg, Courtney D.; Lantos, Paul M.

2014-01-01

Background Sickle cell disease (SCD) is the most common genetic disease among persons with African ancestry. This article provides a background on SCD and reviews many important aspects of travel preparation in this population. Methods The medical literature was searched for studies about travel-associated preparedness and complications in individuals with SCD. Topics researched included malaria, bacterial infections, vaccinations, dehydration, altitude, air travel, and travel preparedness. Results There is very little published literature that specifically addresses the risks faced by travelers with SCD. Rates of medical complications during travel appear to be high. There is a body of literature that describes complications of SCD in indigenous populations, particularly within Africa. The generalizability of these data to a traveler are uncertain. Combining these sources of data and the broader medical literature we address major travel-related questions that may face a provider preparing an individual with SCD for safe travel. Conclusions Travelers with SCD face considerable medical risks when traveling to developing tropical countries; these include malaria, bacterial infections, hypovolemia, and sickle cell-associated vaso-occlusive crises. Frank counseling about risks, vigilant preventative measures, and contingency planning for illness while abroad are necessary parts of the pre-travel visit for individuals with SCD. PMID:24947546

Travel Behavior Change in Older Travelers: Understanding Critical Reactions to Incidents Encountered in Public Transport

PubMed Central

Sundling, Catherine

2015-01-01

Accessibility of travel may be better understood if psychological factors underlying change in travel behavior are known. This paper examines older (65+) travelers’ motives for changing their travel behavior. These changes are grounded in critical incidents earlier encountered in public-transport travel. A scientific framework is developed based on cognitive and behavioral theory. In 29 individual interviews, travelers’ critical reactions (i.e., cognitive, emotional, and/or behavioral) to 77 critical incidents were examined. By applying critical incident technique (CIT), five reaction themes were identified that had generated travel-behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. To improve older travelers’ access to public transport, key findings were: (a) service must be designed so as to strengthen the feeling of being in control throughout the journey; (b) extended personal service would increase predictability in the travel chain and decrease travel complexity; consequently, (c) when designing new services and making effective accessibility interventions, policy makers should consider and utilize underlying psychological factors that could direct traveler behavior. PMID:26593935

49 CFR 229.55 - Piston travel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Piston travel. 229.55 Section 229.55... Piston travel. (a) Brake cylinder piston travel shall be sufficient to provide brake shoe clearance when... piston travel may not exceed 11/2 inches less than the total possible piston travel. The total possible...

Hand therapy services for rural and remote residents: Results of a survey of Australian occupational therapists and physiotherapists.

PubMed

Kingston, Gail A; Williams, Gary; Judd, Jenni; Gray, Marion A

2015-04-01

The aim of this study was to explore how interventions were provided to meet the needs of rural/remote residents who have had a traumatic hand injury, including the coordination of services between rural/remote and metro/regional therapists. Barriers to providing services, use of technology and professional support provided to therapists in rural/remote areas were also explored. Cross-sectional survey. Metropolitan/regional and rural/remote public health facilities in Australia. Occupational therapists and physiotherapists who provide hand therapy to rural/remote patients. Quantitative and qualitative questionnaire responses analysed with descriptive statistics and inductive analysis. There were 64 respondents out of a possible 185. Over half of rural/remote respondents provided initial splinting and exercise prescriptions, and over 85% reported that they continued with exercise protocols. Videoconferencing technology for patient intervention and clinical review was used by 39.1% respondents. Barriers to providing services in rural/remote locations included transport, travelling time, limited staff, and lack of expert knowledge in hand injuries or rural/remote health care. Four major themes emerged from the open-ended questions: working relationships, patient-centred care, staff development and education, and rural and remote practice. The use of technology across Australia to support rural/remote patient intervention requires attention to achieve equity and ease of use. Flexible and realistic goals and interventions should be considered when working with rural/remote patients. A shared care approach between metropolitan/regional and rural/remote therapists can improve understanding of rural/remote issues and provide support to therapists. Further research is recommended to determine the suitability of this approach when providing hand therapy to rural/remote residents. © 2015 National Rural Health Alliance Inc.

Travelers' Health: Injuries and Safety

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Traveler's Health: Avoid Bug Bites

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travelers' Health: Animal-Associated Hazards

MedlinePlus

... Climates Humanitarian Aid Workers Humanitarian Aid Workers in Ecuador Insurance International Adoption Jet Lag Last-Minute Travel Long-Term Travel Mass Gatherings Medical Tourism Mental Health Motion Sickness Natural Disasters Pregnant Travelers ...

Travel and biologic therapy: travel-related infection risk, vaccine response and recommendations.

PubMed

Hall, Victoria; Johnson, Douglas; Torresi, Joseph

2018-01-01

Biologic therapy has revolutionized the management of refractory chronic autoimmune and auto-inflammatory disease, as well as several malignancies, providing rapid symptomatic relief and/or disease remission. Patients receiving biologic therapies have an improved quality of life, facilitating travel to exotic destinations and potentially placing them at risk of a range of infections. For each biologic agent, we review associated travel-related infection risk and expected travel vaccine response and effectiveness. A PUBMED search [vaccination OR vaccine] AND/OR ['specific vaccine'] AND/OR [immunology OR immune response OR response] AND [biologic OR biological OR biologic agent] was performed. A review of the literature was performed in order to develop recommendations on vaccination for patients in receipt of biologic therapy travelling to high-risk travel destinations. There is a paucity of literature in this area, however, it is apparent that travel-related infection risk is increased in patients on biologic therapy and when illness occurs they are at a higher risk of complication and hospitalization. Patients in receipt of biologic agents are deemed as having a high level of immunosuppression-live vaccines, including the yellow fever vaccine, are contraindicated. Inactivated vaccines are considered safe; however, vaccine response can be attenuated by the patient's biologic therapy, thereby resulting in reduced vaccine effectiveness and protection. Best practice requires a collaborative approach between the patient's primary healthcare physician, relevant specialist and travel medicine expert, who should all be familiar with the immunosuppressive and immunomodulatory effects resulting from the biologic therapies. Timing of vaccines should be carefully planned, and if possible, vaccination provided well before established immunosuppression.

Evidence on global medical travel.

PubMed

Ruggeri, Kai; Záliš, Ladislav; Meurice, Christopher R; Hilton, Ian; Ly, Terry-Lisa; Zupan, Zorana; Hinrichs, Saba

2015-11-01

The potential benefits of travelling across national borders to obtain medical treatment include improved care, decreased costs and reduced waiting times. However, medical travel involves additional risks, compared to obtaining treatment domestically. We review the publicly-available evidence on medical travel. We suggest that medical travel needs to be understood in terms of its potential risks and benefits so that it can be evaluated against alternatives by patients who are seeking care. We propose three domains -quality standards, informed decision-making, economic and legal protection - in which better evidence could support the development of medical travel policies.

Evidence on global medical travel

PubMed Central

Záliš, Ladislav; Meurice, Christopher R; Hilton, Ian; Ly, Terry-Lisa; Zupan, Zorana; Hinrichs, Saba

2015-01-01

Abstract The potential benefits of travelling across national borders to obtain medical treatment include improved care, decreased costs and reduced waiting times. However, medical travel involves additional risks, compared to obtaining treatment domestically. We review the publicly-available evidence on medical travel. We suggest that medical travel needs to be understood in terms of its potential risks and benefits so that it can be evaluated against alternatives by patients who are seeking care. We propose three domains –quality standards, informed decision-making, economic and legal protection – in which better evidence could support the development of medical travel policies. PMID:26549906

Michigan's Statewide Travel Demand Model

DOT National Transportation Integrated Search

1999-09-01

The Travel Demand and Intermodal Services Section of Michigan's Department of Transportation is responsible for the development, maintenance and application of the Statewide Travel Demand Model. Michigan's Statewide and Urban Travel Demand Models are...

Travel time data collection handbook

DOT National Transportation Integrated Search

1998-03-01

This Travel Time Data Collection Handbook provides guidance to transportation : professionals and practitioners for the collection, reduction, and presentation : of travel time data. The handbook should be a useful reference for designing : travel ti...

TRAVELLERS: a school-based early intervention programme helping young people manage and process change, loss and transition. Pilot phase findings.

PubMed

Dickinson, Pauline; Coggan, Carolyn; Bennett, Sara

2003-06-01

This paper outlines the conceptual background and findings from the pilot phase of TRAVELLERS--an early intervention programme designed to enhance protective factors for young people experiencing change, loss and transition events and early signs of emotional distress. The pilot study aimed to determine whether TRAVELLERS was a feasible, acceptable and promising intervention for young people within secondary schools in Aotearoa/New Zealand. The conceptual origins of the TRAVELLERS programme are described in terms of: adolescent mental health concerns; emerging mental health promotion theory and practice; and prevention and early intervention models. The key elements of the TRAVELLERS programme are described. The programme was piloted in two secondary schools, one rural and one urban with 34 participants (females n = 24, males n = 10). Evaluation methods included: review of programme materials; identification of potential selection tools appropriate to Year 9 students; analysis of selection questionnaire; and conduct of feedback from participants, facilitators and parents/caregivers. The TRAVELLERS programme provides a means of identifying and selecting young people who may benefit from participating in an early intervention programme. The programme has achieved a statistically significant reduction in participants' distress (p < 0.01). Young people were overwhelmingly enthusiastic about most aspects of TRAVELLERS. School personnel reported that TRAVELLERS was an appropriate and acceptable programme to the school. Targeted interventions provided within a supportive school environment can contribute to enhancing protective factors such as personal and interpersonal coping strategies, increased help-seeking behaviour, and young people feeling more positive about themselves and their lives. The pilot programme has been amended and prepared for a two year trial phase in 10 secondary schools during 2002-2003.

Summary travel characteristics : New Jersey

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : New Hampshire

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : New York

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : New Mexico

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : South Dakota

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : South Carolina

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : North Carolina

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : West Virginia

DOT National Transportation Integrated Search

1997-10-01

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : North Dakota

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Summary travel characteristics : Rhode Island

DOT National Transportation Integrated Search

1997-09-30

The Summary Travel Characteristics publication series contains summary tables of travel statistics for census regions and divisions, States, and metropolitan areas. The tables in this report provide an overview of the findings of the American Travel ...

Creation of an Interprofessional Teledementia Clinic for Rural Veterans: Preliminary Data.

PubMed

Powers, Becky B; Homer, Marcia C; Morone, Natalia; Edmonds, Natali; Rossi, Michelle I

2017-05-01

The teledementia clinic is a new model of care that expands the reach of specialized geriatric and dementia care using clinical video telehealth (CVT) to rural veterans, who frequently lack access to specialty care. The clinic is a Veterans Affairs (VA) Geriatric Research, Education, and Clinical Center clinical demonstration project. It is located in the Pittsburgh VA Healthcare System tertiary referral hospital and serves veterans in affiliated rural community-based outpatient clinics (CBOCs). Rural CBOC primary care providers refer clinic patients, or referral is according to previous cognitive impairment diagnosis in a VAPHS geriatric clinic. Patients undergo interprofessional dementia assessment by a geriatrician, geropsychologist, geriatric psychiatrist or neurologist, and social worker using CVT technology. Metrics for clinic evaluation included rural patients served and savings in travel time, distance, and costs. Assessments collected depended upon individual presentation and included cognitive tests, geriatric depression scales, functional assessment, and the Zarit Burden Interview. A patient satisfaction survey was created and administered. In the first year, 95 individuals were served in 156 clinic visits and 251 interprofessional provider encounters. Of patients served, 61 lived in rural ZIP codes, 72 were diagnosed with dementia, 19 were diagnosed with mild cognitive impairment, and four were found to have primarily psychiatric diagnoses rather than cognitive impairment. The average Functional Assessment Staging of Alzheimer's Disease Scale score was 4.3 ± 1.3. This clinic model demonstrates that CVT technology is a feasible means of providing interprofessional dementia evaluations and follow-up to rural presidents. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Travel Pattern and Prescription Analysis at a Single Travel Clinic Specialized for Yellow Fever Vaccination in South Korea.

PubMed

Chin, Bum Sik; Kim, Jae Yoon; Gianella, Sara; Lee, Myunghee

2016-03-01

Travel-related risks for infectious diseases vary depending on travel patterns such as purpose, destination, and duration. In this study, we describe the patterns of travel and prescription of vaccines as well as malaria prophylaxis medication (MPM) at a travel clinic in South Korea to identify the gaps to fill for the optimization of pre-travel consultation. A cohort of travel clinic visitors in 2011 was constructed and early one-third of the visitors of each month were reviewed. During the study period, 10,009 visited the travel clinic and a retrospective chart review was performed for 3,332 cases for analysis of travel patterns and prescriptions. People receiving yellow fever vaccine (YFV) (n = 2,933) were traveling more frequently for business and tourism and less frequently for providing non-medical service or research/education compared to the 399 people who did not receive the YFV. Overall, most people were traveling to Eastern Africa, South America, and Western Africa, while South-Eastern Asia was the most common destination for the non-YFV group. Besides YFV, the typhoid vaccine was the most commonly prescribed (54.2%), while hepatitis A presented the highest coverage (74.7%) considering the natural immunity, prior and current vaccination history. Additionally, 402 (82.5%) individuals received a prescription for MPM among the 487 individuals travelling to areas with high-risk of malaria infection. Age over 55 was independently associated with receiving MPM prescription, while purpose of providing service and travel duration over 10 days were associated with no MPM prescription, despite travelling to high-risk areas. Eastern Africa and South America were common travel destinations among the visitors to a travel clinic for YFV, and most of them were travelling for tourism and business. For the individuals who are traveling to areas with high-risk for malaria, more proactive approach might be required in case of younger age travelers, longer duration, and

Travel Pattern and Prescription Analysis at a Single Travel Clinic Specialized for Yellow Fever Vaccination in South Korea

PubMed Central

Gianella, Sara

2016-01-01

Background Travel-related risks for infectious diseases vary depending on travel patterns such as purpose, destination, and duration. In this study, we describe the patterns of travel and prescription of vaccines as well as malaria prophylaxis medication (MPM) at a travel clinic in South Korea to identify the gaps to fill for the optimization of pre-travel consultation. Materials and Methods A cohort of travel clinic visitors in 2011 was constructed and early one-third of the visitors of each month were reviewed. During the study period, 10,009 visited the travel clinic and a retrospective chart review was performed for 3,332 cases for analysis of travel patterns and prescriptions. Results People receiving yellow fever vaccine (YFV) (n = 2,933) were traveling more frequently for business and tourism and less frequently for providing non-medical service or research/education compared to the 399 people who did not receive the YFV. Overall, most people were traveling to Eastern Africa, South America, and Western Africa, while South-Eastern Asia was the most common destination for the non-YFV group. Besides YFV, the typhoid vaccine was the most commonly prescribed (54.2%), while hepatitis A presented the highest coverage (74.7%) considering the natural immunity, prior and current vaccination history. Additionally, 402 (82.5%) individuals received a prescription for MPM among the 487 individuals travelling to areas with high-risk of malaria infection. Age over 55 was independently associated with receiving MPM prescription, while purpose of providing service and travel duration over 10 days were associated with no MPM prescription, despite travelling to high-risk areas. Conclusion Eastern Africa and South America were common travel destinations among the visitors to a travel clinic for YFV, and most of them were travelling for tourism and business. For the individuals who are traveling to areas with high-risk for malaria, more proactive approach might be required in

Immunocompromised Travelers: Demographic Characteristics, Travel Destinations, and Pretravel Health Care from the U.S. Global TravEpiNet Consortium

PubMed Central

Schwartz, Brian S.; Rosen, Jessica; Han, Pauline V.; Hynes, Noreen A.; Hagmann, Stefan H.; Rao, Sowmya R.; Jentes, Emily S.; Ryan, Edward T.; LaRocque, Regina C.

2015-01-01

An increasing number of immunocompromised individuals are pursuing international travel, and a better understanding of their international travel patterns and pretravel health care is needed. We evaluated the clinical features, itineraries, and pretravel health care of 486 immunocompromised international travelers seen at Global TravEpiNet sites from January 2009 to June 2012. We used bivariate analyses and logistic regressions using random intercept models to compare demographic and travel characteristics, vaccines administered, and medications prescribed for immunocompromised travelers versus 30,702 immunocompetent travelers. Immunocompromised travelers pursued itineraries that were largely similar to those of immunocompetent travelers, with nearly one-third of such travelers visiting countries with low human development indices. Biological agents, including tumor necrosis factor blockers, were commonly used immunosuppressive medications among immunocompromised travelers. A strong collaboration between travel-medicine specialists, primary care doctors, and specialist physicians is needed to prepare immunocompromised people for international travel. Incorporating routine questioning and planning regarding travel into the primary care visits of immunocompromised people may be useful. PMID:26304922

Teaching undergraduate students in rural general practice: an evaluation of a new rural campus in England.

PubMed

Bartlett, Maggie; Pritchard, Katie; Lewis, Leo; Hays, Richard B; Mckinley, Robert K

2016-01-01

structured clinical examination performance and that of their peers in other locations. Some students had difficulty with the isolation from peers and academic activities, and travel was a problem despite their accommodation close to the practices. Students valued the learning opportunities offered by the rural practice placements. The general practice tutors, patients and community hospital staff found teaching to be a positive experience overall and perceived a value to the health system and broader community in students learning locally for substantial periods of time. The evaluation has identified some student concerns about transport times and costs, social isolation, and access to resources and administrative tasks, and these are being addressed.

Understanding taxi travel patterns

NASA Astrophysics Data System (ADS)

Cai, Hua; Zhan, Xiaowei; Zhu, Ji; Jia, Xiaoping; Chiu, Anthony S. F.; Xu, Ming

2016-09-01

Taxis play important roles in modern urban transportation systems, especially in mega cities. While providing necessary amenities, taxis also significantly contribute to traffic congestion, urban energy consumption, and air pollution. Understanding the travel patterns of taxis is thus important for addressing many urban sustainability challenges. Previous research has primarily focused on examining the statistical properties of passenger trips, which include only taxi trips occupied with passengers. However, unoccupied trips are also important for urban sustainability issues because they represent potential opportunities to improve the efficiency of the transportation system. Therefore, we need to understand the travel patterns of taxis as an integrated system, instead of focusing only on the occupied trips. In this study we examine GPS trajectory data of 11,880 taxis in Beijing, China for a period of three weeks. Our results show that taxi travel patterns share similar traits with travel patterns of individuals but also exhibit differences. Trip displacement distribution of taxi travels is statistically greater than the exponential distribution and smaller than the truncated power-law distribution. The distribution of short trips (less than 30 miles) can be best fitted with power-law while long trips follow exponential decay. We use radius of gyration to characterize individual taxi's travel distance and find that it does not follow a truncated power-law as observed in previous studies. Spatial and temporal regularities exist in taxi travels. However, with increasing spatial coverage, taxi trips can exhibit dual high probability density centers.

Travellers and influenza: risks and prevention.

PubMed

Goeijenbier, M; van Genderen, P; Ward, B J; Wilder-Smith, A; Steffen, R; Osterhaus, A D M E

2017-01-01

Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings. We conducted a PUBMED/MEDLINE search for a combination of the MeSH terms Influenza virus, travel, mass gathering, large scale events and cruise ship. In addition we gathered guidelines and recommendations from selected countries and regarding influenza prevention and management in travellers. By reviewing these search results in the light of published knowledge in the fields of influenza prevention and management, we present best practice advice for the prevention and management of influenza in travel medicine. Seasonal influenza is among the most prevalent infectious diseases in travellers. Known host-associated risk factors include extremes of age and being immune-compromised, while the most relevant environmental factors are associated with holiday cruises and mass gatherings. Pre-travel advice should address influenza and its prevention for travellers, whenever appropriate on the basis of the epidemiological situation concerned. Preventative measures should be strongly recommended for travellers at high-risk for developing complications. In addition, seasonal influenza vaccination should be considered for any traveller wishing to reduce the risk of incapacitation, particularly cruise ship crew and passengers, as well as those participating in mass gatherings. Besides advice concerning preventive measures and vaccination, advice on the use of antivirals may be considered for some travellers. © International Society of

Post-travel screening of asymptomatic long-term travelers to the tropics for intestinal parasites using molecular diagnostics.

PubMed

Soonawala, Darius; van Lieshout, Lisette; den Boer, Marion A M; Claas, Eric C J; Verweij, Jaco J; Godkewitsch, André; Ratering, Marchel; Visser, Leo G

2014-05-01

The incidence of asymptomatic travel-related parasitic infection is uncertain. Previous studies did not distinguish new incident infections, from past infections. Regardless of symptoms, we performed multiplex real-time polymerase chain reaction on pre- and post-travel stool samples of Dutch long-term travelers to the (sub)tropics. Serological screening for Schistosoma spp. was only performed in travelers to sub-Saharan Africa. In total, 679 travelers were included in the study. The follow-up rate was 82% (556 of 679). Participants' median travel duration was 12 weeks. There was one incident infection with Strongyloides stercoralis; there were none with Entamoeba histolytica, 4 with Cryptosporidium spp. (1%), and 22 with Giardia lamblia (4%). Nine of 146 travelers (6%) seroconverted for Schistosoma spp. Routine screening of stool samples for parasitic infection is not indicated for asymptomatic people, who travel to the (sub)tropics for up to 3 months. Screening for Schistosoma spp. should be offered to travelers with fresh-water contact in endemic regions.

Post-Travel Screening of Asymptomatic Long-Term Travelers to the Tropics for Intestinal Parasites Using Molecular Diagnostics

PubMed Central

Soonawala, Darius; van Lieshout, Lisette; den Boer, Marion A. M.; Claas, Eric C. J.; Verweij, Jaco J.; Godkewitsch, André; Ratering, Marchel; Visser, Leo G.

2014-01-01

The incidence of asymptomatic travel-related parasitic infection is uncertain. Previous studies did not distinguish new incident infections, from past infections. Regardless of symptoms, we performed multiplex real-time polymerase chain reaction on pre- and post-travel stool samples of Dutch long-term travelers to the (sub)tropics. Serological screening for Schistosoma spp. was only performed in travelers to sub-Saharan Africa. In total, 679 travelers were included in the study. The follow-up rate was 82% (556 of 679). Participants' median travel duration was 12 weeks. There was one incident infection with Strongyloides stercoralis; there were none with Entamoeba histolytica, 4 with Cryptosporidium spp. (1%), and 22 with Giardia lamblia (4%). Nine of 146 travelers (6%) seroconverted for Schistosoma spp. Routine screening of stool samples for parasitic infection is not indicated for asymptomatic people, who travel to the (sub)tropics for up to 3 months. Screening for Schistosoma spp. should be offered to travelers with fresh-water contact in endemic regions. PMID:24615130

Fecal-orally transmitted diseases among travelers are decreasing due to better hygienic standards at travel destination.

PubMed

Baaten, Gijs G; Sonder, Gerard J B; Van Der Loeff, Maarten F Schim; Coutinho, Roel A; Van Den Hoek, Anneke

2010-01-01

To evaluate whether changes in attack rates of fecal-orally transmitted diseases among travelers are related to changes in pretravel vaccination practices or better hygienic standards at travel destination. National surveillance data on all laboratory-confirmed cases of travel-related hepatitis A, shigellosis, and typhoid fever diagnosed in the Netherlands from 1995 to 2006 were matched with the number of Dutch travelers to developing countries to calculate region-specific annual attack rates. Trends in attack rates of non-vaccine-preventable shigellosis were compared with those of vaccine-preventable hepatitis A and typhoid fever. Trends were also compared with three markers for hygienic standards of the local population at travel destinations, drawn from the United Nations Development Programme database: the human development index, the sanitation index, and the water source index. Attack rates among Dutch travelers to developing regions declined for hepatitis A, shigellosis, and typhoid fever. Region-specific trends in attack rates of shigellosis resembled trends of hepatitis A and typhoid fever. Declining attack rates of the three fecal-orally transmitted diseases correlated with improvements in socioeconomic, sanitary, and water supply conditions of the local population at travel destination. These findings suggest that improved hygienic standards at travel destination strongly contributed to the overall decline in attack rates of fecal-orally transmitted diseases among visiting travelers. © 2010 International Society of Travel Medicine.

Travel-related acquisition of diarrhoeagenic bacteria, enteral viruses and parasites in a prospective cohort of 98 Dutch travellers.

PubMed

van Hattem, Jarne M; Arcilla, Maris S; Grobusch, Martin P; Bart, Aldert; Bootsma, Martin C; van Genderen, Perry J; van Gool, Tom; Goorhuis, Abraham; van Hellemond, Jaap J; Molenkamp, Richard; Molhoek, Nicky; Oude Lashof, Astrid M; Stobberingh, Ellen E; de Wever, Bob; Verbrugh, Henri A; Melles, Damian C; Penders, John; Schultsz, Constance; de Jong, Menno D

2017-09-01

Limited prospective data are available on the acquisition of viral, bacterial and parasitic diarrhoeagenic agents by healthy individuals during travel. To determine the frequency of travel associated acquisition of 19 pathogens in 98 intercontinental travellers, qPCR was used to detect 8 viral pathogens, 6 bacterial enteric pathogens and 5 parasite species in faecal samples collected immediately before and after travel. We found high pre-travel carriage rates of Blastocystis spp. and Dientamoeba fragilis of 32% and 19% respectively. Pre-travel prevalences of all other tested pathogens were below 3%. Blastocystis spp. (10%), Plesiomonas shigelloides (7%), D. fragilis (6%) and Shigella spp. (5%) were the most frequently acquired pathogens and acquisition of enteral viruses and hepatitis E virus in this relatively small group of travellers was rare or non-existent. Our findings suggest that the role of viruses as the cause of persisting traveller's diarrhoea is limited and bacterial pathogens are more likely as a cause of traveller's diarrhoea. The substantial proportion of travellers carrying Blastocystis spp. and D. fragilis before travel warrants cautious interpretation of positive samples in returning travellers with gastrointestinal complaints. Copyright © 2017 Elsevier Ltd. All rights reserved.

Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence.

PubMed

Hoang, Ha; Le, Quynh; Ogden, Kathryn

2014-12-01

Understanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted. To synthesise the best available evidence on the experiences of women's needs in maternity care and existing service models in rural areas. Literature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis. 12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6). The systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address women's maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Pregnancy and travel

MedlinePlus

... a cruise, it may not be the best time to go. Travel by sea may cause motion sickness or nausea. ... out of the country. Plan ahead to allow time for any shots or medicines you may need. When you travel, take a copy of your prenatal care record ...

Travel diaries : an annotated catalog

DOT National Transportation Integrated Search

1995-06-01

The travel diary is the central survey instrument for travel behavior research. In its current form it reflects forty years of development. This paper discusses the current and possible contents of the travel diary against the background of a rapidly...

Clostridium difficile infection in returning travellers.

PubMed

Michal Stevens, A; Esposito, Douglas H; Stoney, Rhett J; Hamer, Davidson H; Flores-Figueroa, Jose; Bottieau, Emmanuel; Connor, Bradley A; Gkrania-Klotsas, Effrossyni; Goorhuis, Abraham; Hynes, Noreen A; Libman, Michael; Lopez-Velez, Rogelio; McCarthy, Anne E; von Sonnenburg, Frank; Schwartz, Eli; van Genderen, Perry J J; Scott Benson, L; Leung, Daniel T

2017-05-01

There is increasing recognition of the contribution of community-acquired cases to the global burden of Clostridium difficile infection (CDI). The epidemiology of CDI among international travellers is poorly understood, and factors associated with international travel, such as antibiotic use and changes in gut microbiota, could potentially put travellers at higher risk. We summarized demographic, travel-associated and geographic characteristics of travellers with CDI in the GeoSentinel database from 1997 to 2015. We also surveyed GeoSentinel sites to compare various testing indications, approaches, and diagnostic modalities. We identified 260 GeoSentinel records, including 187 that satisfied criteria for analysis (confirmed cases in non-immigrant travellers aged >2 years, seen <12 weeks post-travel). CDI was reported in all age groups and in travellers to all world regions; the largest proportions of cases having destinations in Asia (31%), Central/South America or the Caribbean (30%) and Africa (24%). Our site survey revealed substantial heterogeneity of testing approaches between sites; the most commonly used test was the C. difficile toxin gene PCR. CDI is encountered in returning international travellers, although there is considerable variability in testing practices. These data underscore the importance of awareness of C. difficile as a potential cause of travel-associated diarrhoea. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Pre-travel malaria chemoprophylaxis counselling in a public travel medicine clinic in São Paulo, Brazil.

PubMed

Chaves, Tânia do Socorro Souza; Monteiro, Wuelton Marcelo; Alves, Jessé Reis; Lacerda, Marcus; Lopes, Marta Heloisa

2017-02-07

Malaria is one of the most prevalent parasitic diseases in the world and represents a threat to travellers visiting endemic areas. Chemoprophylaxis is the prevention measure used in travel medicine, avoiding clinical manifestations and protecting against the development of severe disease and death. Retrospective and descriptive analysis of malaria prevention data in travellers was recorded from a travel medicine clinic in São Paulo, Brazil, between January 2006 and December 2010. All the medical records of travellers, who had travelled to areas with risk of disease transmission, including Brazil, were analysed. Demographic characteristics of travellers, travel details and recommendations for preventing malaria were also seen. During the study period, 2836 pre-travel consultations were carried out on 2744 individuals (92 were consulted twice). The most common reasons for travelling were tourism and work. The most common destinations were Africa (24.5%), Europe (21.2%), Asia (16.6%) and locations within Brazil (14.9%). In general prophylaxis against malaria was recommended in 10.3% of all the consultations. African destinations vs Asian, Brazilian and other destinations and length of stay ≤30 days were independently associated with the higher odds of chemoprophylaxis recommendation after the logistic regression. The prophylaxis against malaria was recommended in 10.3% of the consultations. The authors believe that a coherent measure of malaria prevention in Brazil and for international travellers would be to recommend for all parts of the North Brazil, avoidance of mosquito bites and immediate consultation of a physician in case of fever during or after the journey is recommended.