Search

Inadequate access to public bariatric surgical services has favoured the growth of bariatric tourism. This study analysed data extracted from bariatric surgical centres that care for patients travelling from abroad. The research highlights apparent deficits in accreditation, communication, perioperative care, and travel health advice. An international registry of accredited bariatric tourism providers and patient education may be indicated.

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

Rationale for review: Eye diseases pose a significant public health and economic burden, particularly for travellers exposed to ocular hazards who may lack access to specialist eye care. This article offers an evidence-based review for travel-health practitioners, with a particular emphasis on ocular infections and trauma that are more prevalent among travellers. Providing an overview of these issues will allow travel health practitioners to comprehensively address ophthalmic considerations of travel. Methods: A systematic literature search was conducted on PubMed and Embase electronic databases, using keywords related to travel medicine and ophthalmology. Inclusion was based on the relevant contribution to epidemiology, aetiology, diagnostics, management, and long-term consequences of travel-related eye conditions. The data were analysed using narrative synthesis. Key findings: This literature review highlighted that various travel-related eye conditions may occur. Travellers should be aware of the risk of travel-related ocular complications, which can arise from ocular infections, high-risk activities, high altitude and space travel. The economic and logistical challenges associated with medical tourism for ophthalmic procedures are discussed. For travellers with pre-existing eye conditions or visual impairment, careful planning may be needed to promote eye health and ensure safety of travel. Conclusions: Travel medicine practitioners should have a comprehensive understanding of the major ocular risks associated with overseas travel, including eye infections, eye injuries and solar eye damage. Further research in this area can enhance overall wellness and alleviate the burden of ocular diseases on travellers. Evidence-based guidelines based on research can also improve the quality of care and prevent long-term vision problems.

Highlight Failure to fully disclose conflicts of interest and funding sources in biomedical and clinical research erodes public confidence in the academic integrity of research publications. This study is the first of its kind to analyse the funding and conflict disclosures in a leading travel medicine journal.

‘Dark tourism’ refers to travel by individuals to destinations and sites linked to death, tragedy and the macabre; with vampire tourism increasingly popular over the last 20 years. The capacity of travellers, especially those with mental disorder, to cope psychologically with travel to associated emotionally challenging destinations requires further investigation.

Prior to the COVID-19 pandemic, there was a rapid increase in international travel. Travel medicine is a branch of preventive medicine focusing on risk assessment pre-travel, during travel and post-travel with the aim of promoting health and preventing adverse health outcomes. Travel medicine specialists inform travelers about potential health risks and mitigate infectious disease risks such as travelers’ diarrhea, yellow fever, and malaria. Travel medicine topics were popular in the American Society of Tropical Medicine and Hygiene conferences between 2016 and 2020, and now comprise approximately 2% of all presentations. Most topics related to the post-travel assessment (50%), followed by diseases contracted during travel (26%), and pre-travel assessment and consultation (24%). Our analysis of the 10 sub-domains of travel medicine issues found that malaria (26%) and immunization (12%) were represented to the greatest extent. We anticipate that both travel and tropical medicine fields will regain their popularity after recovery from the pandemic.

The controversial subject of transplant tourism has been neglected in the travel medicine literature. According to the Declaration of Istanbul, travel for transplantation can be regarded as transplant tourism if it involves organ trafficking and/or commercialised transplantation activities. While no registry of transplant tourism activities exists, published case series point to significant negative clinical outcomes. Adverse outcomes among donors include postoperative depression and anxiety, deterioration in health status, poor surgical wound care, and negative financial effects. Poor perioperative management, inadequate immunosuppression, blood transfusion-associated infections, antibiotic-resistant bacterial infections and invasive fungal infections, are among the most commonly reported complications in transplanted patients. Iran operates a legal and ethically regulated system of rewarded altruistic kidney donation. Travel medicine practitioners have a role to play in protecting the health of intending transplant tourists through targeted pre-travel health counselling and vaccination.

Introduction: Travel medicine has become firmly established as a medical discipline and, as such, it should undergo periodic assessment of its productivity. Scientometrics is a field of study related to data science, which concerns itself with the measurement and analysis of published scholarly literature. Methods: A scientometric evaluation was conducted of all 240 articles published through February 2021 in the International Journal of Travel Medicine and Global Health (IJTMGH), one of the few academic journals dedicated to the study of travel medicine. Results: The majority of articles belonged to the general category of travel medicine (62%, n=149), with 38% of articles (n=91) being focused on global health and non-travel related infectious diseases. The 149 travel medicine-related articles mapped onto the Body of Knowledge syllabus of the International Society of Travel Medicine, with the majority of articles addressing the domain of pre-travel assessment of travellers (49.7%, n=74), including the sub-domains of patient evaluation, special populations of travellers, special itineraries, prevention and self-treatment, and communication of risks to travellers. The most common thematic designation of IJTMGH articles related to medical and health tourism (12.1%, n=29). High levels of geographic diversity, multi-authorship and inter-institutional collaboration were observed in the journal. The subject matter of the most cited and most popular articles reflected the broad coverage of travel medicine and global health by IJTMGH. Conclusion: We recommend that future bibliometric and citation analyses be performed, which will further enhance our understanding of the evolution of these dynamic fields of academic study.

In Ireland, farmers have been identified as a high-risk population, with higher rates of cardiovascular disease (CVD) and overall mortality, compared with the general population. Farming has always been considered a physically active lifestyle. However, in recent times, with the increased use of technology and machinery, farmers may not be completing as much physical activity as before. There is a lack of research on physical activity patterns, fitness, and perception about exercise among farmers. Physical activity patterns were assessed using ActivPAL₃ micro monitors for a duration of 7 consecutive days. Aerobic capacity was measured using a validated sub-maximal exercise test to calculate Metabolic Equivalent Task (MET) levels. The Exercise Benefits and Barriers Scale (EBBS) questionnaire was used to explore perceived benefits and barriers towards exercise. Farmers completed a mean (standard deviation) of 16,452 (5,170) steps and 124 (43) minutes of moderate-vigorous intensity physical activity (MVPA) daily. The volume of weekly MVPA was largely accumulated in bouts lasting10 minutes, with only 17.89% completing bouts of ≥10 minutes. Daily sitting time was 8.26 hours. Farmers are fit, have positive perceptions about exercise, and complete large quantities of physical activity, but not in a CVD protective pattern. CVD risk can be reduced in this population by encouraging them to sit less and engage in MVPA in bouts of ≥10 minutes, in line with current guidelines.

Introduction: Primary care practitioners and travel medicine physicians are primarily responsible for identifying individuals who may be unfit for overseas travel and consulting with them pre-travel. Pre-existing medical conditions such as cardiovascular disease, chronic respiratory conditions and diabetes mellitus (DM) have the potential to complicate travel journeys. A considerable percentage of travel-associated illness may be due to the decompensation of a pre-existing medical condition. This review seeks to address the challenges faced by travellers with each of these conditions, including recently updated and evidence-based practical approaches for travel with comorbidities. Methods: Sources for this review were identified through searches of PubMed/Google Scholar for materials published between 1st January 2000 and 31st December 2019, using combinations of search terms. Results: The volume of literature on travelling with a pre-existing condition exploded with more than 865 associated articles indexed on the PubMed alone as of March 2020. After screening titles, abstracts and, in some cases, the full text version of indexed articles, 121 articles were deemed relevant to the subject matter of this review. Conclusion: Rational approaches to pre-planning for travel with a medical condition will contribute to the prevention of problems while in transit as well as when at the travel destination. It is imperative for health care providers to be aware of the preventative measures and current recommendations that should be taken before and during travel to protect individuals with a chronic illness. Further research and studies should be directed to protect this vulnerable group of travellers.

Parasomnias are undesirable events that occur during sleep. They can be classified into rapid eye movement parasomnias and non-rapid eye movement parasomnias. Those who experience parasomnias may be anxious about travel for many reasons, including the occurrence of unwanted events during the trip, increased exposure to environmental trigger factors, and the propensity for harm to occur due to unfamiliar surroundings while travelling. There is a paucity of literature examining this area. This review summarizes the relevant literature and the clinical experience of the authors to compile clinical practice recommendations. The clinical features of parasomnias and how they relate to trans-meridian and long-distance travel are described. Triggers for non-rapid eye movement parasomnias, particularly the use of sedative hypnotic drugs, alcohol, drug withdrawal, sleep deprivation, emotional stress and environmental stimulations, are described. Management of parasomnias whilst travelling is reviewed, with a particular focus on trigger minimalization. The role for clonazepam and melatonin is outlined. At the pre-travel health consultation, the physician is strongly advised to screen the traveller for co-morbid sleep conditions, which exacerbate parasomnias. Areas for further research are explored, including the extent to which these sleep disorders impact on the travel experience.

BackgroundLearning climate is defined as the learners' perception of their environment. There is growing evidence that learning climate is a major determinant of trainee behaviour. This mixed methods study evaluated the learning climate in anaesthesiology training hospitals in Ireland.MethodsThrough sequential explanatory strategy, learning climate was measured using a validated 40-item questionnaire, which was completed by 118 anaesthesiology trainees from eight training hospitals in Ireland. This was followed by two focus group interviews with 16 participants. Qualitative interpretations were derived using framework analysis.ResultsThe mean learning climate score was from the questionnaire 116 (+/−15.7) out of 160. The highest level of satisfaction recorded was for the perception of atmosphere (scoring 76% of the maximum score), while learning opportunities ranked lowest (67% of the maximum score). Three key themes emerged from the focus groups: lack of resources, the transient nature of the job and the sense of a gap between consultants and trainees.ConclusionsOverall there was an acceptable learning climate in training hospitals in Ireland, but satisfaction levels may vary and lack of learning opportunities appears to be a significant issue for trainees.

Background Sex tourism is defined as travel planned specifically for the purpose of sex, generally to a country where prostitution is legal. While much of the literature on sex tourism relates to the commercial sex worker industry, sex tourism also finds expression in non-transactional sexual encounters. This narrative review explores current concepts related to travel and sex, with a focus on trans-national sex tourism. Methods The PubMed database was accessed to source relevant literature, using combinations of pertinent search terms. Only articles published in the English language were selected. Reference lists of published articles were also examined for relevant articles. Results With regard to preferred destinations, South/Central America and the Caribbean were more likely to receive tourists looking for casual sex. Longer duration of travel, travelling alone or with friends, alcohol or drug use, being younger and being single were factors associated with higher levels of casual sex overseas. The majority of literature retrieved on sex workers focused on risk behaviours, sexually transmitted infections (STI), mobility of sex workers and how these factors affected their lives. Sex tourists require better access to effective methods of preventing HIV, such as pre-exposure prophylaxis, and better education on HIV prevention. Drugs and alcohol play a major role as risk factors for and cofactors in casual sexual behaviour while abroad. Conclusions Travellers need to be informed of the increased risks of STI before travel. They should be aware of the local prevalence of STIs and the risks associated with their sexual practices when they travel, including engaging with commercial sex workers, having unprotected sexual intercourse and becoming victims of sexual violence.

Background A high burden of severe disease and death from the coronavirus disease 2019 (COVID-19) has been consistently observed in older patients, especially those with pre-existing medical co-morbidities. The global pandemic lockdown has isolated many patients with chronic illnesses from their routine medical care. This narrative review article analyses the multitude of issues faced by individuals with underlying medical conditions during the COVID-19 pandemic. Methods Sources for this publication were identified through searches of PubMed for articles published between 31st December 2019 and 4th June 2020, using combinations of search terms. Guidelines and updates from reputable agencies were also consulted. Only articles published in the English language were included. Results The volume of literature on COVID-19 continues to expand, with 17,845 articles indexed on PubMed by 4th June 2020, 130 of which were deemed particularly relevant to the subject matter of this review. Older patients are more likely to progress to severe COVID-19 disease requiring intensive care unit (ICU) admission. Patients with pre-existing cardiovascular disease, especially hypertension and coronary heart disease, are at greatly increased risk of developing severe and fatal COVID-19 disease. A controversial aspect of the management of COVID-19 disease has been the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Obese COVID-19 patients are more likely to require complex ICU management. Putative mechanisms of increased COVID-19 disease severity in diabetes include hyperglycaemia, altered immune function, sub-optimal glycaemic control during hospitalisation, a pro-thrombotic and pro-inflammatory state. Patients with mental health disorders are particularly vulnerable to social isolation, and this has been compounded by the suspension of non-emergency care in hospitals around the world, making it difficult for patients with chronic mental illness to attend outpatient appointments. Conclusions The global pandemic of COVID-19 disease has had a disproportionately negative impact on patients living with chronic medical illness. Future research should be directed at efforts to protect vulnerable patients from possible further waves of COVID-19 and minimising the negative impact of pandemic mitigation strategies on these individuals.

Introduction: High altitude destinations are popular among international travelers. Travel medicine practitioners should be familiar with altitude physiology and high altitude illness recognition, prophylaxis, and management. We performed the first bibliometric analysis of high altitude medicine research. Methods: All articles published in a specialist high altitude medicine journal through April 2020 were mapped against the 34 domains in a theoretical body of knowledge. Citation counts of articles, as well as authors publishing the most articles, were obtained from Scopus. Collaboration analysis was performed using established methods. Results: Mapping of 1150 articles published from 2000 to 2020 identified the leading domains represented by high altitude medicine articles. The top five domains were altitude acclimatization and deterioration (19.4%, n=510); cardiovascular physiology (6.8%, n=180); work at altitude (6.6%, n = 174); acute mountain sickness (6.4%, n=169); respiratory and acid-base physiology (5.9%, n=155). Published articles attracted a total of 13,324 citations, with a mean of 11.6 citations per article. The average number of citations per author was 22.3. The USA was the most productive country with 432 publications (37.6%), followed by the UK (9.5%, n=109) and Switzerland (5.6%, n=64). The collaboration index for multi-authored publications increased from 3.8 in 2002 to 5.4 in 2019. Conclusion: We have performed the first comprehensive bibliometric analysis in high altitude medicine. Efforts to increase the research activity in neglected topics and to promote greater collaboration between high altitude medicine and related fields of study such as travel medicine may be worthwhile.

International tourism has experienced significant growth in recent decades, owing to the convenience in commercial air travel.1 According to the World Tourism Organization, there were more than 1.3 billion international tourist arrivals in 2017, and this figure is expected to reach 1.8 billion by 2030.2 Parallel to the growth in international travel is a rise in the incidence and prevalence of cardiovascular disease (CVD), which remains the leading cause of death globally.3 This also applies to death among international travelers, up to 70% of which may be attributable to CVD based on an analysis of travelers arriving in the United States.4 Cardiovascular disease is one of the most common preexisting medical conditions among international travelers.5 It is reasonable to assume that the presence of CVD will likely alter the overall travel experience, given the disease burden imposed on those who are affected. The effects of air travel on the cardiovascular system have been well documented.6 Partial pressure of inspired oxygen is reduced in the cabin environment, owing to lower atmospheric pressure. This may trigger decompensation of preexisting CVD, for example, heart failure7 and coronary heart disease,8 and exposing passengers to potentially life-threatening inflight cardiac emergencies.9 Although emergency medical kits are available on most passenger-carrying aircrafts,10 a commercial aircraft is far from being a well-equipped medical facility. Cardiac-related emergencies (e.g., cardiac arrest, angina, and stroke) are common precipitants for flight diversion and subsequent hospital admission.11 A study of 148 travelers attending a specialist travel health clinic showed that accessing medical care overseas engendered the greatest concern.12 Given the inherent risks of cardiac decompensation abroad, it is imperative for individuals with CVD to seek appropriate pretravel health advice, particularly those with unstable disease. An observational study showed that among 359 travelers with chronic illness including CVD, only 40% sought pretravel advice from their general practitioner.13 There may be a correlation between self-rated health and the perceived need for pretravel consultation, yet this has not been specifically explored in CVD travelers. Sound knowledge of the relationship between CVD and international travel is essential to guide medical practitioners in providing optimal pretravel advice. Within the individual published European Society of Cardiology guidelines, there are disparities in the level of recommendation, such as vaccination advice for CVD patients, for example.14 The travel experiences of CVD travelers may thus serve as a valuable resource for generating more robust travel recommendations. However, the extent to which CVD affects the experiences of international travelers has not been determined. A previous study described the challenges of overseas travel for obese individuals,15 but these may not be directly applicable to nonobese patients with CVD. Likewise, the travel health considerations for CVD patients have been previously discussed,16 but whether the known health benefits of travel17 extend to this cohort of travelers remains undetermined. The primary aim of this study was to ascertain the travel experiences of a cohort of patients with CVD. In addition, this study aimed to identify perceived barriers to travel, to explore potential travel health benefits, and to generate recommendations for CVD travelers and the clinicians caring for and advising them.

The impact of reduced adherence in randomized clinical trials is well documented in the literature. Nonadherence can negatively affect the trial sample size and estimation of the treatment effect. This protocol aims to evaluate the effects of a telephone call reminder on the adherence rates of participants to interventions in a cardiovascular randomized trial. This is a study within a trial (SWAT). The host trial is evaluating the effectiveness of a multidisciplinary 16-wk cardiovascular disease prevention program on risk factor profile among patients with carotid artery stenosis. Simultaneously, this SWAT will evaluate the effectiveness of telephone call reminders on the participants' adherence to the host trial intervention. The primary outcome is adherence to the protocol of the host trial. Secondary outcomes are level of adherence, number of dropouts, and time to drop out from the host trial.

Background Transportation of medications across borders can present challenges for international travellers. We investigated the provision of official country-specific information available to individuals travelling with medications. Methods Data from official government sources relating to restrictions on the transportation of medications for personal use were analysed to determine compliance with international recommendations and identify variation in practice between countries. Results Schedule 1 drug classifications and import restrictions for narcotic and psychotropic drugs varied widely between countries. Some countries do not conform to recommendations from the International Narcotics Control Board. Conclusions Healthcare professionals should be broadly aware of country-specific restrictions on therapeutic drug transportation and be able to direct travellers to definitive sources of information.

This cross-sectional study evaluated the adaptations of current International Society of Travel Medicine (ISTM) members in relation to the disruption caused by the coronavirus disease 2019 (COVID-19) pandemic. It demonstrates that the majority of members remain engaged with travel medicine and ISTM educational activities, while adapting to COVID-related clinical demands.

Air rage has the potential to threaten the safety of flight crew and passengers. We aimed to describe the occurrence of serious air rage incidents based on a recognised scale of severity, their associated factors and outcomes. A web-based content analysis of written media reports relating to air rage incidents occurring between 2000 and 2020 was conducted. Multiple variables were extracted, including year, flight details, age and nationality of passengers, involvement of flight crew, stage of air journey, flight diversions, presence of intoxication, psychiatric history or fear of flying. A total of 270 passengers were involved in this series of air rage incidents, with 76.2% (n = 204) male. The most frequent age group for unruly passengers was 30–39 years (n = 61). Precipitating factors included alcohol consumption (55.7%, n = 127) and nicotine withdrawal (9.2%, n = 21). Flight diversions were necessitated in 35.5% (n = 81) of cases. The majority (52.6%, n = 120) of air rage incidents were categorised as level 2 on a 4-point scale of severity. The findings of this study will be of interest to the aviation industry and to air passengers and crew. Further research is needed to elucidate the precipitants of air rage. Flight crew training should incorporate early recognition and de-escalation of air rage.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of mobile health technologies to improve walking distance in people with intermittent claudication.

The unfamiliarity of their surroundings and dependence on internet connections make international travellers particularly vulnerable to cybercrime. Travel medicine clinicians should be aware of the cybersecurity threats facing travellers and be able to recognize particularly vulnerable travellers. This article outlines these threats and provides advice to mitigate them.

The authors assert that social media influencer tourism should be recognized as a novel entity in travel medicine, in order to protect this vulnerable group of travellers from harm to themselves and their host destinations, and to harness their potential as communicators of positive public health messages.

Stem cell tourism is an emerging area of medical tourism activity. Frustrated by the slow translation of stem cell research into clinical practice, patients with debilitating conditions often seek therapeutic options that are not appropriately regulated. This review summarises recent developments in the field of stem cell tourism and provides clinicians with the information necessary to provide basic pretravel health advice to stem cell tourists. PubMed and Scopus databases were consulted for relevant publications, using combinations of the terms ‘stem cell’, ‘tourism’, ‘regenerative medicine’, ‘international’, ‘travel medicine’ and ‘environmental health’. The leading countries in the international stem cell tourism market are the USA, China, India, Thailand and Mexico. As the majority of clinics offering stem cell therapies are based in low- and-middle-income countries, stem cell tourists place themselves at risk of receiving an unproven treatment, coupled with the risk of travel-related illnesses. These clinics do not generally provide even basic travel health information on their websites. In addition to often being ineffective, stem cell therapies are associated with complications such as infection, rejection and tumorigenesis. Physicians, researchers, regulatory bodies, advocacy groups and medical educators are encouraged to work together to improve patient and physician education and address current legislative deficiencies.

Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD). In addition to common CVD risk factors, the presence of CKD is independently associated with an elevated cardiovascular (CV) risk. We examined the association between CKD and CVD, focusing on coronary artery disease (CAD) in both primary and secondary CVD. A total of 94 articles were included for this review using search strategies on Pubmed and Google scholar. The main findings of our review included that besides sharing common risk factors, CKD induces several physiological microscopic changes leading to increased CV risk. These microscopic changes manifest macroscopically with evidence of the development of primary CAD in CKD patients, in addition to accelerating CAD in those with pre-established CV pathology, with CKD consequently being a risk factor for both primary and secondary CAD progression. Current CV guideline recommendations do not discriminate between those patients with and without CKD. Future research is needed in this area, examining if there may be a role for tighter modifiable risk factor targets in this high-risk population.

Face masks have been worn by members of the public for source control during pandemics and major outbreaks of infectious disease across the centuries. As the current coronavirus disease 2019 pandemic evolves, reluctance towards the wearing of face masks and anti-mask sentiments by some people have been encountered, with strongly held personal views and misinformation being disseminated through social media. Some of this resistance may arise from personal beliefs about the limited effectiveness of masks. Negative perceptions towards use of face masks have also been voiced by patients with pre-existing medical conditions such as chronic obstructive pulmonary disease and asthma. There are concerns that face coverings may not be suitable for children or individuals with autism. Health care professionals have an obligation to be advocates for this public health intervention. Individual patients’ concerns about mask use should be sensitively addressed by countering misinformation with reliable evidence from the scientific literature.

Cardiovascular disease (CVD) is the leading cause of death among international travellers. Practitioner knowledge of the effects of CVD on international travel is imperative in order to promote a healthy travel experience. This review aimed to explore the available literature on this topic. The PubMed database was accessed to source relevant literature using combinations of relevant keywords as search terms. Articles were restricted to those published in the English language through March 2019. Of 1726 article records retrieved, 73 relevant papers were examined carefully. The results of this narrative review are related to multiple aspects of CVD and travel. The pre-travel consultation should address issues regarding vaccinations, travel insurance, anticoagulation, and medical devices. Additional vaccines to be discussed include influenza, pneumococcal, and hepatitis B. Patients with CVD should be advised of the need to carry a copy of their ECG, prescription(s), and pacemaker manufacturer’s card. Knowledge of the location overseas of automated external defibrillators and awareness of health risks associated with strenuous adventure activities are important for CVD travellers. Medical tourism for patients with CVD is briefly considered. Space tourism is an emerging category of extreme international travel that requires specialized pre-travel preparation. This narrative review article highlights the gaps in the travel medicine literature in relation to CVD. A strong evidence base for most recommendations is lacking. Future scholarly efforts are warranted to facilitate more robust travel recommendations for CVD patients. No qualitative studies to date have described the experiences of international travellers with CVD.

Road traffic accidents are the leading cause of death in international travelers. With the growth of international travel, the number of visitors who rent a vehicle upon arrival at their destination by air or by sea is expected to increase. Jet lag is a well-recognized maladaptation to international travel across multiple time zones. Little is known about the possible influence of jet lag symptoms on the risk of road traffic collisions. Lack of awareness or failure to recognize the debilitating effects of jet lag and driving immediately after a long-haul flight put the driver at risk of a fatal road traffic accident. This article summarizes the available evidence and suggests reasonable approaches which may serve to minimize the risk of jet lag-induced driver fatigue leading to road injuries and deaths. The future research agenda should focus on routinely recording whether jet lag was a co-factor in road traffic accidents, analyzing the effectiveness of public awareness campaigns to highlight this neglected issue, and investigating the impact of jet lag on pedestrian road safety.

Background/aims:Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses’ perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses’ encounters within the context of the current health service.Methods:This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes.Results:A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses’ training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices.Conclusions:Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.

Introduction: International travel is increasing, yet few studies have reported on country-level death rates among international travelers. The data regarding the death profiles of overseas Irish travelers is insufficient. The current study examined data obtained from the Irish Department of Foreign Affairs and Trade to profile these deaths. Methods: Data on Irish civilian citizen deaths occurring abroad was obtained from the Consular Division of the Irish Department of Foreign Affairs and Trade and analyzed based on age, gender, time of death, travel destination, and recorded cause of death. Results: Between January 2016 and April 2018, the Consular Division received 654 reports of Irish civilians dying abroad, of which 72% (n=469) were males and 23% (n=149) were females; in 6% (n=36) the sex was not recorded. The mean age at death was 58±5 years old (range from 1 to 110, median 62 years). Recorded causes of death were illness (25%; n=162), traumatic deaths including homicides and suicides (24%; n=151), and natural (age-related) (3%; n=19); the rest were classified as unidentified cause (47%; n=309). The majority of deaths (63%; n=309) occurred in European destinations followed by Asia (16%; n=102) and the Americas (12%; n=75). Conclusion: At least 25% of Irish deaths abroad can be considered preventable. More tailored pre-travel medical interventions may prevent further deaths. In the collection of data, consular services miss the opportunity to acquire valuable information for both travelers and healthcare professionals. The authors recommend the creation of a comprehensive database of international traveler deaths.

Objectives The internet is an important source of travel health information. Individuals living with chronic illnesses consult patient organisation websites for illness-related information. We analysed the scope of online travel health information available to patients with pre-existing medical conditions. Study Design A descriptive content analysis of patient organisation websites was conducted. Methods The Google® search engine was interrogated using search terms related to the principal chronic diseases from the Global Burden of Disease Study. Data relating to 41 travel health variables were extracted from each eligible website. An aggregate quality score was derived for each organisation based on the presence of specific website information. Visitor usage and search analytics for each organisation’s website were also described. Results We examined 145 official organisation websites relating to 10 major chronic illnesses. The largest number of websites was retrieved for patients with cancer (n = 36). Only 21 (16.5%) websites provided information on fitness-to-travel considerations. COPD websites had the highest average quality score (17.68%), followed by diabetes (14.91%) and dementia (13.28%). Mental health illness websites had the lowest score of 1.33%. There was a trend towards increased emphasis on pre-travel preparation and medications. Insect bite avoidance, malaria, animal bites, jet lag, and repatriation were addressed to the least extent. Conclusions Our analysis exposes significant deficits in the coverage of travel health topics. Patient organisations should provide accessible pre-travel health advice to website users. Future research should elucidate the influence of web-based pre-travel health information on the behaviour of travellers with chronic disease.

The most significant risk of dental tourism is the timing of air travel after dental interventions in order to avoid the pain or injury caused by barotrauma. Usually the minimum waiting time should be 24 h, but in some cases, it can be up to 2 weeks.

Background Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study, we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors. Methods This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events. Discussion This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high-quality, well-powered clinical trial. Trial registration This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019.

The COVID-19 pandemic and its associated lockdown have had a negative impact on global mental health. Considerable fear and stigma surround the prospects of a return to non-essential international travel. The mental health aspects of travel have been historically neglected in the literature. The current pandemic has prompted a renewed focus on building psychological resilience in travellers by engaging innovative technological tools such as virtual reality.