International Journal of Travel Medicine and Global Health
Volume:5 Issue: 1, Winter 2017

Human migration, both voluntary and precipitated by conflict and persecution, continues to pose challenges to the healthcare infrastructure of host countries. The scale of international migration to Ireland has increased substantially in recent years. Both economic migrants and refugees have complex health needs including those related to infectious diseases, malnourishment, gender-specific issues, cultural adaptation, and mental health. While all refugees are highly vulnerable to physical trauma and illness, this vulnerability is heightened for women and children. Linguistically and culturally accessible care for migrants is essential in developing trust in and respect for Western medicine. Integration of migrants and multiculturalism as a national policy has many benefits for the health of incoming migrants and society in general.

Camping and hiking are popular worldwide recreational activities. All age groups, elderly or young, immunocompetent or immunosupressive people may engage in these activities. During these activities, individuals may get injured or be exposed to pathogens. There is also a strong possibility of experiencing mosquito, lice, or tick bites, bee stings, or being bitten by scorpions, snakes, rodents, wild or feral animals. This study reviewed the current literature regarding tick-borne infections encountered during recreational activities.

PubMed and the Web of Science databases were searched for the keywords “campers,” “hikers,” and “tick borne infections.” Major reviews, research papers, and case series on campers and hikers were reviewed, and current articles for tick-borne infections were selected and summarized.

People who engage in recreational activities are potentially at risk for infection from environmental sources. A group of important vector-borne diseases is tick-borne infections, the major agents of which are Babesia spp., Borrelia spp., Rickettsia spp., Ehrlichia spp., Francisella tularensis, Coxiella burnetii, Crimen-Congo Hemorrhagic Fever (CCHF), and Tick-Borne Encephalitis (TBE) viruses. These infections have a widespread geographical distribution.

Participating in outdoor recreational activities is increasing all over the world. While partaking in these activities, humans are frequently exposed to ticks and are potentially at risk for infection. To prevent infection, public and medical awareness is necessary.

Previous studies on Brain and other Nervous System Cancers (BNSC) and aircrew have shown inconsistent results, possibly due to their relatively small sample sizes; therefore, the current study aimed to increase the precision of risk estimates. Systematic searches of PubMed and Embase for pertinent studies up to August 2016 were performed and supplemented by manual reviews of bibliographies. The pooled standard incidence ratio (SIR) and corresponding 95% CIs were estimated with random effects models. Among the 903 studies retrieved, 7 studies (5 cohort studies and 2 pooled analyses) were included in the current meta-analysis. The pooled SIR (95% CI) of BNSC incidence in aircrew was 1.01 (0.77, 1.31) with no significant heterogeneity (I2 = 36.1%, P = .199). The null association persisted when the analysis was stratified by geographic area (Europe or America), publication year (before or after 2001), air population (pilots or cabin crew), cancer site (brain, nervous system, or brain/nervous system), and gender (male or female). The current evidence is not sufficient to support a significant positive association between aircrew employment and BNSC risk. However, the interpretation and extrapolation of this meta-analysis are restricted by the possible impact exerted by health worker effect and potential clinical heterogeneity. More studies based on other populations, including Asian aircrews, are warranted.

This study investigated chikungunya disease awareness and its predictors, the level of adoption of recommended personal protective behaviors against chikungunya, and the health information-seeking behavior of U.S. travelers to Caribbean destinations. A cross-sectional retrospective online survey of 653 adult U.S. international travelers who visited any one of 34 Caribbean destinations was conducted in October 2015. Study participants were recruited through Amazon® Mechanical Turk. Travelers who met the inclusion criteria and gave informed consent were subsequently redirected to complete the survey which was domiciled in Qualtrics®. Results regarding health information-seeking behavior indicated that 51% of study participants had never sought information about chikungunya or any vector-borne illnesses. Only thirty percent of study participants reported having heard of chikungunya disease before participating in this study. After adjusting for the presence of other variables in a logistic regression model, gender of female, higher levels of education, more time spent at the destination, and a higher number of hours spent engaging in outdoor activities were factors significantly associated with chikungunya disease awareness. Study results also showed that twenty-two percent of study participants did not engage in any of the three recommended personal protective behaviors under investigation. Study findings highlighted a gap in existing approaches to health information dissemination vis-à-vis adoption of recommended personal protective behaviors, especially for U.S. travelers at risk for chikungunya and other emerging mosquito-borne infectious diseases in Caribbean destinations.

Frostbite is a common debilitating condition seen in travelers and residents at high altitudes. Emergent on-site management is warranted in the absence of institutionalized care and compromised evacuation facilities. This prospective, observational study assessed the outcome of on-site emergent management in low-resource, high altitude healthcare setups in the field, applicable in situations of delayed evacuation. This is a prospective cohort study. All frostbite patients presenting at 4 Himalayan regions were included. Patients were diagnosed, assessed clinically, and evaluated for causation. On-site emergent management was given in situations of delayed evacuation, and responses were monitored. Further prevention was advised for all patients. Frostbite presented in 172 healthy, acclimatized patients having knowledge of frostbite. A total of 158 (91.86%) males and 14 (8.14%) females with a mean age of 27.8 ± 7 years sustained frostbite at altitudes between 9000-24000 feet with a mean of 14575 ± 3848 feet. First-, second-, and third-degree frostbite comprised 62.2%, 34.3%, and 3.49% of cases, respectively. Fingertips were most frequently affected, followed by toe tips. Of the frostbite cases treated on-site, 57.94% were first-degree and 34.29% were second-degree. Frostbite can occur in people who are cold-experienced and knowledgeable. Therapeutic and preventive rewarming can be attempted in limited-resource setups outside the hospital. Frostbite up to second-degree can be treated under high altitude field conditions; however, this is advisable only in situations of delayed evacuation.

Iran offers many advantages for health tourism, e.g., low costs, high quality healthcare, qualified doctors, and abundant natural attractions, but there are also obstacles to the development of health tourism in Iran. This study aimed to identify and prioritize the barriers to health tourism in hospitals affiliated with Tehran University of Medical Sciences.

This cross-sectional study was conducted in the first 6 months of 2016. Six main components were identified based on experts’ opinions; then, based on these components, a questionnaire for pairwise comparison was produced and completed by the same experts. The Analytical Hierarchy Process (AHP) model was used to prioritize the identified factors.

Results showed that among the barriers to health tourism in the investigated hospitals, the most important obstacle is the unfamiliarity of medical staff with foreign languages with a weight of 0.268. Lack of manpower and inappropriate physical were ranked second and third in priority with weights of 0.214 and 0.157, respectively.

Considering the available capacities and potentials, effective and impressive steps can be taken to economically develop the medical tourism industry in Iran.