International Journal of Travel Medicine and Global Health
Volume:5 Issue: 2, Spring 2017

Nowadays the trend to travel abroad has extremely grown. This is while, paying attention to travelers’ health is an incredibly important issue. Many organizations try their best to provide health services during travelers’ trips. Meanwhile, the biggest and most effecting health care providers all around the world are hospitals. Regarding this fact, a theory has been presented to help these organizations coordinate and direct much more effectively in compared to the past. It is noticeable to mention that this theory can help health care providers to gain a more sustainable position in order to develop medical tourism in their centers. A theory has been presented in this research with different dimensions. The major aspects of this model have been designed according to the relationships which exist in families. These relationships include: parents, children and others. Each of these aspects have been divided into two segments which are female and male. These aspects play their roles in three different dimensions. According to the results this study, it can be mentioned that there are 6 relationships in regards to the HEXAL Model in health service providers. These relationships include mother, father, sister, brother, step sister and other relationships. It can be also said that each of these dimensions have different responsibilities in both health care providers and travel medicine. By using this model, health service providers can collaborate much more effectively. As a result, medical tourists and even other tourists can experience much more satisfying trips throughout their lives.

Traveling to high altitudes can expose the eye to reduced ambient cold and low-pressure environments. These conditions can affect the physiology of the eye and may result in ocular problems and visual disturbances. In this paper, ocular disorders related to high altitudes are briefly reviewed. Then, high-altitude ocular disorders are categorized in three parts: those related to dry and cold environments, those related to low-pressure environments, and those in people with past ocular conditions. In every part, the signs and symptoms of related diseases are discussed. Up-to-date recommendations for the management and prevention of these disorders are presented. The main management for ocular disorders related to dry and cold environments includes the use of eye shields and artificial tear drops. Descending to low-altitude lands is the key to managing eye problems associated with low-pressure environments. Patients with past ocular problems or ocular surgery should consult their doctors before ascending to high altitudes.

The number of travellers from Greece who travel to sub-Saharan Africa has increased during the last decade. Our aim in this research was to study vaccination patterns for travellers travelling to sub-Saharan Africa. A cross-sectional study was conducted from January 2011 until December 2014 in all (57) public health departments in Greece. Travellers over 18 years travelling to sub-Saharan Africa participated in this study. A standard form was used in order to collect data about travellers’ demographics, immunization history and travel information. During the study period, 1768 travellers (median age: 39.2 years) travelling to sub-Saharan Africa participated. Among them, 69.2% of them were male and 95.4% of them had a Greek nationality. Nigeria was their most common destination (15.7%). Among all the travellers, 56.7% stayed in urban areas, 57.9% travelled for less than one month, 58.5% for work, 29% for vacation, and 5.8% for visiting friends and relatives. Furthermore, 79.7%, 30.9%, 19.7%, 16.8%, and 14.1% received the yellow fever, typhoid fever, tetanus-diphtheria, hepatitis A, and meningococcal vaccines, respectively. The purpose of travelling was statistically significantly associated with gender, nationality, and the duration of travel. Tetanus, hepatitis A & B, poliomyelitis, rabies and meningococcal vaccines were more commonly recommended for recreational travel, whereas tetanus, hepatitis A, and poliomyelitis vaccines for short-term travellers and typhoid vaccine for long-term travellers. It can be concluded that vaccination rrecommendations should be improved for the travellers to sub-Saharan Africa. Individualized and more selective pre-travel recommendations are needed taking in consideration the purpose and duration of travel, the area and place of stay.

Immigrants to the United States who return home to visit friends and relatives (VFRs) have high rates of travel-related infections. The data on VFR utilization of pre-travel health care is inadequate. The objective of this study was to describe the travel patterns and adherence to pre-travel recommendations of VFRs. This retrospective study compared pre-travel health care utilization between VFR and non-VFR patients in one travel clinic from 2012-2013. Study investigators reviewed patients’ electronic medical records for demographic data, travel characteristics, and rates of immunizations and preventive medication prescriptions (i.e. antimalarial prophylaxis and antibiotics for traveler’s diarrhea). Categorical variables were compared using chi-square tests. Multivariate logistic regression was used to model adjusted associations of VFR with completion of pre-travel recommendations. VFRs (n = 393) were younger than non-VFRs (n = 1680), more often required interpreters for language translation, and more commonly had government insurance coverage than non-VFRs. VFRs were more likely to travel to lower-income countries in Africa, Asia, and the Middle East. VFRs had longer durations of travel: 51% for >4 weeks vs. 21% for non-VFRs (P < 0.0001). VFRs were less likely to complete tetanus, polio, and rabies vaccinations, but more likely to complete measles, mumps, and rubella vaccinations. Only the association with the rabies vaccination remained significant after adjustment (OR [95% CI] = 0.3 [0.1, 0.8]). VFRs had longer travel durations and lower rates of vaccine completion than non-VFRs. More research is needed to understand this disparity and to promote changes in practice.

The overall objective of this study was to design a progressive multilevel model using the Delphi method for selecting a medical tourism destination which includes three levels of decision making: the destination country, then the destination city, and finally, the healthcare center in the selected city. This model can be used as a new area of research for further planning in Iran’s growing medical tourism industry.

This study is a descriptive, practical research using a qualitative approach. In the preliminary stage, an extensive review of the literature was performed, and the Delphi method was used to identify factors influencing the selection of Iran as a medical tourism destination. Experts participating in the Delphi panel reached consensuses after applying three rounds. Analysis of the data from the Delphi panel resulted in the construction of a multilevel model for selecting a medical tourism destination.

The outcome of this research was a constructed multilevel model for selecting a medical tourism destination. The model indicates all factors influencing the selection of each level of destination. It also includes two stages of decision making (medical tourism and information search), which come before the selection of three levels of destination.

Iran’s political and economic situations after the imposition of sanctions and its problems in providing banking services for medical tourists are among the factors influencing medical tourists not to choose Iran as their destination. Government support, planned promotional activities, and JCI accreditations could increase the attraction of medical tourists to Iran.

International air travel has increased during the recent century, and the number of pregnant women who travel internationally by air is on the rise. Most pregnant women are able to fly safely, but general considerations must be taken into account. Prior to traveling, pregnant women should be assessed for gestational age, fetus and placenta status, blood group and Rh status by laboratory evaluation or with diagnostic ultrasound imaging. The Center for Disease Control and Prevention (CDC) recommends that pregnant women travelers carry a copy of their medical records with them on their trip.1The latest recommendation of the ACOG indicates that occasional travel by air during pregnancy is safe. Specifically, occasional air travel by women with a singleton pregnancy can be done until 36 weeks gestation. Women with an uncomplicated multiple pregnancy are allowed to fly up to the end of the 32nd week. As emergencies usually happen in the first and third trimesters, the safest time to travel is probably the middle of the pregnancy, between 14-18 weeks.2,3Almost all women with a normal pregnancy can travel without limitation up to 28 weeks, but there are few contraindications for air travel, including obstetric complications, severe anemia (Hb33Although air travel is safe, there are specific risks during pregnancy. The incidences of miscarriage and preterm birth are greater among flight attendants than the general population. Exposure to cosmic radiation is not hazardous to the fetus for the occasional pregnant air traveler. One other concern is venous thromboembolism for which flight duration is a key factor. Air travel of more than 4 hours at a time may increase the risk of venous thromboembolism, but this is a weak risk factor. Immobility during long flights can lead to such a condition.4,5 There are some general suggestions for the pregnant traveler to minimize the risk of an adverse outcome related to air travel during pregnancy. Before planning to travel, women should check the airline’s policy about air travel during pregnancy. The traveler’s seat belt should be closed during a flight, and unnecessary traffic should be avoided. Because of the necessity of take occasional walks, pregnant women should have an aisle seat to facilitate movement. Women should drink plenty of fluids to avoid dehydration. Furthermore, the pregnant traveler should avoid gassy foods and drinks preflight

Iran’s population policy underwent a bizarre fluctuation in recent decades. During the Iran–Iraq war (1979–1987), the total fertility rate was about 6.53%. Following this period and owing to economic problems, the government reversed the population policy in 1988. A new population plan was officially proposed to reduce the rate of population growth.1 In the 2011 census, the birth rate was reported to have declined to 1.29%.2 Moreover, according to data from the World Health Organization (WHO), the life expectancy in Iran increased dramatically from 54.67 years in 1980 to 75.5 years in 2015. Both these factors increased the rate of population aging (or the double-aging process). The migration of young adults to other countries has also accelerated this phenomenon. The 2011 census observed a significant demographic change in the elderly population of Iran (the percentage of the elderly population increased from 7.27% to 8.20% from 2006 to 2011, and to 8.65% in 2016). The aging population is predicted to rise to 10.5% in 2025 and to 21.7% in 2050. Recently, considering the predictions relating to population aging, the government policy has changed. It is now pushing for an increase in the rate of population growth.2 As a result of population aging, the fluctuating population policy in Iran, and the lack of an evidence-based approach in making population policy decisions, the country may encounter a lack of capable human resources keeping in mind the increased old age dependency ratio (a greater elderly population with much fewer young people to support them).3 Ezeh et al show that a country with a low or negative growth faces rapid population aging, unsustainable loads on public pensions and healthcare systems, and slow economic growth.4 Aging will have a negative influence on Iran’s economy, health, and social welfare. There will also be an increasing need for hospital beds, sanatoriums, healthcare workers, and specialists in geriatric medicine (which is lacking in the current health system).5 It is clear that serious action should be taken keeping in mind this dilemma. Improving the health and population policy by following a reasonable, evidence-based scientific approach—such as extending hospital beds, establishing geriatric medicine departments and more sanatoriums, and educating more healthcare workers—can be a solution to counter population aging. In this regard, the experience of western countries after the industrial revolution could be an excellent model for Iranian policy-makers.