International Journal of Travel Medicine and Global Health
Volume:4 Issue: 2, Spring 2016

Travel health risks are primarily classified as infectious or non-infectious. Travel-related risks vary according to traveler factors, destination factors, type and reason of travel, duration of travel, accommodations, and budget [1, 2]. Although infectious disease mortality is estimated to be less than 1% of deaths during travel, infection with lethal diseases such as malaria occurs due to lack of effective preventive services before travel. Also, the risk of infectious disease is higher for those who travel to developing countries [1]. Many overseas deaths are due to natural causes, with cardiovascular disease being the most common cause [1, 3]. Traffic accidents are estimated to be the most common cause of death among travelers to developing countries [4]. It is clear that evaluation of underlying medical conditions in travelers and providing preventive strategies can reduce potential harm (morbidity or mortality) to travelers [1, 3]. The following underling diseases are important to identify and address: asthma, diabetes, immunocompromised states such as HIV infection, predisposition to deep venous thrombosis (DVT), blood disorders, and asplenia [1]. Travel-related infectious disease prevention strategies have been described in textbooks [1] and by the Center for Disease Control [5]. Unfortunately, travelers do not seek pre-travel health advice and the health system ignores it [3, 6]. Many factors play a role in disease acquisition by travelers and its prevention. Behavioral factors play a crucial role. These include poor insight to behaviors such as food habits, vaccinations, and prophylaxis [1, 3, 6]. Another factor affecting disease acquisition and prevention is the destination. For example, the risk of malaria is higher in malaria-endemic areas such as sub-Saharan Africa [1]. The type of and reason for travel are other factors. The risk to business travelers is usually less than to other travelers; however, the risk varies according to the activities carried out. Business travelers may be at risk for low back pain or other musculoskeletal complaints from frequent air travel. Poor health literacy of immigrants expose them to higher risk when staying with local families because they do eat selectively or heed advice about preventable disease [1, 2]. A A pre-travel preventive strategic approach is necessary to reduce travel risk. This approach includes a comprehensive medical history and a medical examination. Individualized preventive strategies such as vaccinations, drug prophylaxis and medications, and pre-travel advice should be provide based on these factors. It is highly recommended that pretravel assessment and advice should be carried out 6 to 12 weeks prior to travel [1, 2].

Amodiaquine is a partner drug in the artemisinin-based combination therapy artesunate-amodiaquine. Reports of the adverse drug reaction known as amodiaquine-associated asthenia are scarce, and this adverse reaction needs to be investigated in detail. This article presents and reviews a case of amodiaquine-associated asthenia. A literature search for the characteristics of this adverse reaction highlighted gaps in the literature.

A case of probable amodiaquine asthenia was described and discussed under the sub-headings of epidemiology, clinical features, laboratory features, aetiopathogenesis, and management. A literature search limited to Medline Health Databases (Medline and PubMed Central, PMC) using the search terms and was conducted on 10 March 2015. Retrieved literature on the subject was closely scrutinized for relevant details of adverse drug reactions to amodiaquine when used in the management or prophylaxis of malaria. Cited literature within retrieved manuscripts was examined manually for other relevant literature. Papers retrieved from the search were used to describe the existing knowledge and gaps in it of the adverse drug reaction under sub-categories of incidence, clinical features, laboratory features, aetiopathogenesis, and management. 

Thirty-nine manuscripts were retrieved; 20 had content relevant to the objectives of this review. The frequency of amodiaquine-associated asthenia in different populations ranged from 12–36%. There is a paucity of reports, and no detailed study of this adverse reaction has been published in popular English medical literature.

With the use of amodiaquine as a partner drug in antimalarial combination therapies being scaled up, well-structured studies are needed on adverse reactions to amodiaquine and to investigate amodiaquine-associated asthenia. In addition, approaches to elucidating this adverse reaction more effectively in children need to be developed.

The need for global health training for early-career family medicine physicians is greater than the supply. This paper details the formation of a one-year, self-funded global health fellowship for early-career family medicine physicians. In August of 2012, the University of Washington Department of Family Medicine established a self-funded, non-ACGME (Accreditation Council for Graduate Medical Education)-accredited fellowship in global health. The fellowship is targeted at early-career family medicine physicians. During the one-year fellowship, the global health fellow rotates through a variety of clinics in the greater Seattle area, including HIV, TB, STD, and other infectious disease clinics. Other activities include selected global health courses at the University of Washington, practice in a continuity clinic seeing both family medicine and pre- and post-travel patients, and a variety of teaching, speaking, and publishing opportunities. The fellow may spent up to two months overseas engaged in clinical practice and/or research; one option for fellows is to work and teach at the district hospital in Naivasha, Kenya, at which the University of Washington has established an ongoing teaching and practice program.  The majority of the fellow’s salary and benefits is funded by the fellow’s clinical activities. This funding mechanism allowed the fellowship to be launched with minimal of institutional financial support.   Of the first three graduating fellows, two now practice primarily in the US and one works in Malawi with Seed Global Health. The fifth fellow will begin in August 2016. The robust and increasing number of applications suggest that this fellowship is meeting an ongoing need.  This fellowship demonstrates that the need for global health training of early-career, family medicine physicians can at least be met in part by self-funded fellowships of this nature.

Many patients who have had strokes suffer from dysphagia which can lead to aspiration pneumonia in 20% to 25% of cases. Early assessment of dysphagia has can reduce the risk of death and the cost of medical care. The present study developed a questionnaire to assess dysphagia in adult patients who have suffered strokes and determined the validity and reliability of the content. The phases of the study consisted of item generation, analysis of content validity and determination of reliability. To assess the content validity, the primary questionnaire was rated by five experts on swallowing disorders. Items with low scores were removed from the questionnaire. Next, 30 stroke patients were assessed using the final questionnaire and the reliability was assessed by Cronbach's alpha. The average scores of the items ranged from 0.4 to 1. Only two items were omitted because of insufficient content validity. The Cronbach's alpha was 0.71 and the standard error of deviation was 4.96, signifying that the reliability was acceptable. This questionnaire has good content validity and reliability. Although it can be used for clinical assessment of stroke patients who suffer from dysphagia, the concurrent validity should be determined by comparison with to a gold standard such as videofluoroscopy.

Since medical tourism is considered as an incremental activity in this sector and proper infrastructures in country to make medical tourism are lacking, announcement by authorities to provide perquisites of medical tourism to make the first clinic hotel and health town are necessary for the purpose of developing medical tourism in Iran, all of these side issues should be investigated. Cardiovascular diseases are very common because of pollution and industrial development. In this research, by extracting related studies on medical tourism and its localization, using hospitals data bank and questionnaire of 640 medical tourists, only 528 of them were approved and finally by using IBM SPSS modular 14.1 software decision tree in data algorithm, efficiency and purity level were obtained. The method for data preprocess step is utilized to extract the best model. Two preprocess steps are deleting useless and correlated features, because data should be prepared until model has the least error. Among the examined algorithm including C&RT, CHAID and Multiple Linear Regression, it was shown that C&RT has the optimal results. The results obtained from this research indicate that C&RT binary decision tree has the smallest error value (0.078) and the greatest accuracy value (0.922). In this research, first effective factors on heart medical tourism were investigated with the help of experts in this field, then C&RT and CHASID models using Clementine software and multiple linear regression variables were compared and ranked. With respect to this algorithm, personnel behavior, social security and communication variables are respectively the most important factors for medical tourist attraction.

During trips the imposed costs are aggravated due to time and financial limits, not being familiar with treatment centers that are covered by the insurances and charges for accommodation. Insurance, especially supplementary treatment services insurance can be an appropriate solution to decrease these costs. These kinds of insurances cover a range of services including outpatient services to hospitalization and even sometimes unlimited services. The purpose of this study was to evaluate the satisfaction of war survivors and their families under the cover of supplementary insurance from medical care during trips. This study was cross -sectional descriptive. The size of studied population was 77 people from war survivors and their families who were assessed by a provided questionnaire in 2015. The including criteria was war survivors and their families under the cover of Veterans and Martyrs Affair Foundation (VMAF) and supplementary insurance war survivors. The prepared questionnaire included two sections; the first section was included the personal indications and the second section included satisfaction evaluations. The prevalence of using medical care during trips in war survivors and their families was 2.72% and using medical care with supplemental insurance in trips was 1.5%. The obtained results from the questionnaires revealed that the highest satisfaction on medical care services and its distance belongs to the veterans' families with the mean of 4.57and 4.27, respectively. In the subject of taking back the costs, martyrs’ families were the least satisfied with the mean of 2.17. A significant relationship was found between sex and distance of the medical care services in trips (p=0.046).  Men had more satisfaction compared to women. Finally it can be mentioned that there was not a significant relationship between client group and distance of medical care services during trips (p=0.067). According to the results, affording the costs and paying them back by the insurance company needs modifications.

Zika virus infection is a new problem that is being seen worldwide [1-3]. This disease can be seen in travelers returning from visits to tropical countries. In Thailand, a tropical country in Southeast Asia, the disease has already been reported in some local Thai patients as well as among foreign travelers returning from Thailand [4]. There are at least 2 confirmed cases of Zika virus infection in travelers returning from Thailand [5, 6]. This number is comparable to the 7 confirmed cases of infection in local Thais [4]. The two cases are Western travelers who visited sea resort areas in Thailand and fell ill during their flight back. Their infection was confirmed as an imported case of Zika virus in their hometowns in Europe and Canada [5, 6]. However, there is no confirmed case of Zika virus infection in any local Thai people living in the visited sea resort areas. This situation can confirm the importance of travel medicine. Travelers to any locations should be aware of the risks of infection despite the lack of reports or documented risk notification on that travel destination. It is recommended that any travelers be informed of the situation at the port of entry by the local public health agency and be warned of the risks of Zika virus infection in each specific area.

The question of quality of life has attracted a lot of attention in recent years and is increasingly becoming the object of theoretical and empirical research in various disciplines. The study of such a concept is based on the fundamental assumption that the social and physical environment of an area can influence the well-being of people residing in that area [1]. Hence, measuring the quality of urban life in developed countries is one of the main purposes of urban studies which includes multiple biological, social, environmental, and economic components. Considering this indicator in cities is important as an efficient tool in urban management and planning and in determining the rate of community health [1, 2]. Iran as a developing country has high growth in urban population and in the number of cities. The urban population of the country (0.71.4) and the number of urban areas (up to 1331 areas) have increased according to 2011 statistics [3]. The total number of Afghan nationals in Iran in 2015 was about 2,500,000, about 1,000,000 of whom have been allowed to live in cities. At first glance, this figure seems to be insignificant, but those refugees and illegal immigrants who live in Iran and are unwilling to return to Afghanistan are deprived of many health and safety facilities for reasons of security, employment, and housing [4]. Most Afghan refugees have chosen to live in deprived urban areas that are unlike other urban areas in terms of the health reform and social-economic prosperity; moreover, the quality of life there is low. Studying and identifying the problems of immigrants in old and deprived areas in order to meet their health and security needs is crucial [2, 3]. Until now, few studies have investigated the quality of life in urban areas of Iran, particularly in deprived and old areas. Some studies have shown that no official investigation into the living conditions and access to health, comforts, and service facilities for Afghan immigrants has been done. Questions remain. Even though effective and necessary actions have been taken by the Interior Ministry to meet the needs of Afghan immigrants, are the satisfaction and quality of life of Afghan immigrants as long as they live in this country up to the standards of a community? Is there a significant difference in the quality of life of Afghan immigrants and citizens? It should be noted that considering the quality of life of Afghan immigrants can encourage them to have an effective presence and promote health dimensions in their community and increase their sense of satisfaction with life [1]. It is recommended that the following international assessment strategies be used to improve the quality of life of Afghan immigrants in deprived areas: 1. Assessing Quality of Urban Life, developed by Doctor Fu (2008), has 14 and 18 indicators related to biological, psychological, social, and spiritual health, living conditions, and welfare services [5]. This tool is a good indicator of the ratio of health and safety facilities for a community, especially deprived areas. 2. The quality of life indicator developed by Lee in 2008 is a powerful tool for measuring biological and psychological health, housing, leisure and sports activities, community involvement, and holidays among people in a community [6]. 3. Scientific research that examines the quality of urban life among Afghan immigrants and compares it with common urban lives should be conducted.