International Journal of Travel Medicine and Global Health
Volume:7 Issue: 3, Summer 2019

Today telemedicine, or eHealth, is an important tool in everyday medical life. In all areas, from the preclinical to aftercare, significant improvements in communication structures have been seen in various eHealth options, which have had significant, positive effects on the quality of patient care in orthopedics and trauma surgery. Initially, there were several isolated solutions and many small individual projects; however, there was a lack of interdisciplinary and comprehensive systems in all healthcare fields. The German Trauma Society (DGU) together with the AUC GmbH took the lead and paved the way for a modulated, comprehensive, interface-compatible teleradiology system. Nevertheless, there are still deficits across all sectors which, in the future, will need to be optimized by eHealth methods and systems. Overall, there is an effort towards patient-centered solutions (patient empowerment). In Germany, telemedicine has gradually gained acceptance in various sectors and is being used nationwide. Telemedicine has proven itself, especially in trauma networks.

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.

Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults. Data was obtained from the Sacramento Area Latino Study on Aging (SALSA, 1996-2008). A total of 632 older first generation Mexican-American immigrants to the U.S. entered this analysis. The independent variables were education, income, and employment. Polypharmacy was the outcome. Age, gender, physical health, smoking, and drinking were the covariates. Binary logistic regression was used to analyze the data. Employment was associated with lower odds of polypharmacy. The association between education and polypharmacy was above and beyond demographic factors, physical health, health behaviors, and health insurance. Neither education nor income were associated with polypharmacy. Other determinants of polypharmacy were poor self-rated health (SRH) and a higher number of chronic medical conditions (CMCs). Employment appears to be the major SES determinant of polypharmacy in older foreign-born Mexican Americans. Unemployed older Mexican American immigrants with multiple chronic diseases and those who have poor SRH have the highest need for an evaluation of polypharmacy. Given the age group of this population, most of them have health insurance, which provides an opportunity for reducing their polypharmacy.

One major problem in analyzing epidemic data is the lack of data and high dependency among the available data, which is due to the fact that the epidemic process is not directly observable. One method for epidemic data analysis to estimate the desired epidemic parameters, such as disease transmission rate and recovery rate, is data intensification. In this method, unknown quantities are considered as additional parameters of the model and are extracted using other parameters. The Markov Chain Monte Carlo algorithm is extensively used in this field. The current study presents a Bayesian statistical analysis of influenza outbreak data using Markov Chain Monte Carlo data intensification that is independent of probability approximation and provides a wider range of results than previous studies. A method for estimating the epidemic parameters has been presented in a way that the problem of uncertainty regarding the modeling of dynamic biological systems can be solved. The proposed method is then applied to fit an SIR-like flu transmission model to data from 19 years leading up to the seventh week of the 2017 incidence of influenza. The proposed method showed an improvement in estimating the values of all the parameters considered in the study. The results of this study showed that the distributions are significant and the error ranges are real.

The increasing prevalence of overweight and obesity is one of the most critical issues of urban health. The current study investigated the effects of community-based interventions on modification of overweight and obesity. A program based on the Urban Health Equity Assessment and Response Tool (Urban HEART) was developed and implemented in 2013-2014. A total of 166 Iranian females aged 15 years or older who were classified as overweight or obese using body mass index (BMI) were randomly selected and gave verbal consent to participate in this study. The intervention was carried out for a duration of 4 months. The mean age of subjects was 43.6±12.2 years. The total number of overweight and obese individuals were 75 (45.2%) and 91 (54.8%), respectively. The mean BMI of the patients before and after the intervention was 30.3 ± 2.7 and 29.4 ± 2.7 kg/m2, respectively (P < 0.05). Higher education level and greater floor area were recognized as valid predictors for reduced BMI after the intervention (P < 0.001). This study successfully represents the collaborative role of the community in improving health status by reducing overweight and obesity. The Urban HEART provided distinct opportunities for presenting the promising results of interventions to health policymakers and managers so they can adjust macro and micro policies for achieving better community health outcomes.

Although educational attainment is protective against health risk behaviors such as smoking, the Minorities’ Diminished Return theory posits that these protective effects are smaller for ethnic minorities than majority groups. This study compared the effects of educational attainment on the smoking status of American Indian/Alaska Native (AIAN) and White adults. Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21 114 individuals entered the current analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator. Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that suggested that the protective effects of educational attainment against smoking are smaller for AIAN than for Whites. In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites, resulting in additional risk of smoking in highly educated AIANs. To reduce ethnic disparities in tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.