The health of the traveller and the spread of disease. Keep well traveller.
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Acclimatization↗
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[A travel by a handicapped person. 2. A personal experience of a severly handicapped person travelling alone].
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Persons with Disabilities↗
International health--a traveler's alert.
The human population of the earth is estimated to be approximately four billion people, the majority of whom live in developing countries of Africa, Asia, and Latin America. They are the poorer segment of the world's population and live in the world's warmest places. Infectious communicable endemic diseases also abound in these poverty areas. Millions of Americans travel to these less developed countries (LDCs), thus exposing themselves to unfamiliar health conditions. The United States no longer requires an immunization certificate for travelers from these LDCs. Tropical diseases also represent a type of pathology infrequently seen by many American medical practitioners. Additionally, the curricula of medical schools allocate only a fractional amount of time to specific disease problems of LDCs. Important gaps exist in both knowledge and application of knowledge in terms of many such diseases.The international travelers to LDCs must not be lulled into believing that travel precautions are unnecessary. Lack of preparedness can be hazardous and even fatal to international travelers. Those who purchase souvenirs such as art works and handicrafts often are not aware that these items may pose health hazards. The health professions, particularly the public health department official, should develop a continuing health education regimen in the area of health care for international travelers. The American traveling public deserves better service in this matter.
Global Health↗
Travel for primary care: expectation and performance in a rural setting.
Data and findings are presented pertaining to the expressed travel limits for general medical care of a rural population and the degree to which their observed travel behavior reflects these limits. Considerable variation in expressed reasonable and maximum travel distances and times was observed among respondents in a countywide cross-section sample of the resident population in western Maine. A substantial proportion of the respondents' visits for general medical care exceeds their reasonable travel limits and some visits exceed the travel limits they considered maximal. Additionally, a comparison of expectations from this study with those of a similar population in another section of the county reveals significant differences. The findings suggest that health planning could be considerably enhanced by a better understanding of patient preferences for medical care travel behavior, the origins of these preferences, and their relationship to the use of available medical care opportunities. This is particularly true if stated goals of incorporating patient preferences into the health planning process are to be realized.
Attitude to Health↗
"World Traveler" addicts in Asia: II. Comparison with "Stay at home" addicts.
Demographic and clinical characteristics of "world traveler" addicts in Asia have been described in a previous paper. In order to understand more about this group, the 56 American and European addicts seen in Laos were compared to 100 American addicts from Minneapolis matched for age, sex, and year of admission to treatment. "World traveler" addicts tended to be older, better educated, and more apt to be single than this sample of "stay at home" addicts. In comparison to the latter, "travelers" began using narcotic drugs at an older age, became addicted more rapidly, and sought treatment earlier. They were also exposed to more inexpensive, readily available narcotic drugs than the "at home" addicts. These data suggest that exposure to inexpensive, readily available narcotic drugs can result in addiction among a group of people who had previously been refractory to narcotic addiction in their own culture. Loneliness and sociocultural isolation appeared to accelerate the rate at which the average "traveler" moved from nonaddictive use to addiction. Further comparisons to other samples of "at home" addicts will be needed to demonstrate whether these findings are due to "travel" per se or to demographic factors.
Adolescent↗
Travel and ischaemic heart disease.
The hypothesis that travel precipitates acute ischaemic heart disease (IHD) was tested in a case-control study of holidaymakers admitted to hospital in Great Yarmouth. The distance that patients with IHD had travelled to reach Great Yarmouth was on average greater than that travelled by patients with other diseases. I conclude that the greater distances travelled by patients with IHD may have helped to precipitate the attack.
Aged↗
Immunization and health advice for international travelers.
Physicians are increasingly being called upon to advise travelers regarding health matters. Travel to virtually all parts of the world can be medically safe, given a modest investment of effort to provide appropriate immunizations and education of travelers regarding precautionary steps regarding food, drink and other matters. Instruction regarding the self administration of a few simple drugs is reasonalbe for most patients anticipating prolonged travel in tropical areas.
Beverages↗
Prophylactic doxycycline for travelers' diarrhea: results of a prospective double-blind study of Peace Corps volunteers in Morocco.
A second randomized double-blind study to determine the efficacy of doxycycline, 100 mg daily, for the prevention of travelers' diarrhea was carried out among 50 Peace Corps Volunteers during their first 10 wk in Morocco. The volunteers took either doxycycline or placebo for 3 wk, and were observed for an additional 7 wk. Eleven of 24 taking the placebo and 2 of 26 taking doxycycline had travelers' diarrhea during the treatment period (P less than 0.01). One week after cessation of the doxycycline, however, persons in that group developed an increase in frequency of travelers' diarrhea (P less than 0.05) so that by 3 wk after the drug was stopped, there were no differences between groups. Enterotoxigenic E. coli, most of which were sensitive to doxycycline, were the most frequently isolated pathogens during the entire study. This study corroborates the effectiveness of doxycycline prophylaxis for travelers' diarrhea.
Adult↗
Geographic access to hospital care: a 30-minute travel time standard.
A review of literature focusing upon geographic accessibility to health facilities indicates that while distance has been the traditional measure, travel time may now be a more meaningful indicator. Applying a 30-minute travel time standard to general hospitals, as advocated by various health plans, this paper illustrates an approach to the determination of geographic accessibility through a combination of a travel time file and sociodemographic profiles. Focusing upon all residents of West Virginia, the study identifies the number and characteristics of persons who reside within and beyond the 30-minute standard. More than 10 per cent of the entire population and nearly 20 per cent of the rural residents live in areas which are, by this standard, inaccessible to general hospitals. The "inaccessible" populations are characterized as having sociodemographic attributes associated with high medical needs. Other applications of travel time data are discussed.
Adolescent↗
Travelers' diarrhea in Mexico. A prospective study of physicians and family members attending a congress.
We conducted a prospective study of travelers' diarrhea on 73 physicians and 48 family members attending a medical congress in Mexico City, in October, 1974. Fecal and blood specimens were collected before, during and after their visit and examined for enteric bacterial pathogens, viruses and parasites. In 59 (49 per cent) participants travelers' diarrhea developed. Median duration of illness was five days. Onset occurred a median of six days after arrival. An etiologic agent was found in 63 per cent of ill participants. Enterotoxigenic Escherichia coli of different, non-"enteropathogenic" serotypes was the most common cause; other responsible pathogens included salmonellae, invasive Esch. coli., shigellae, Vibrio parahaemolyticus, Giardia lamblia and the human reovirus-like agent. Consumption of salads containing raw vegetables was associated with enterotoxigenic Esch. coli infection (P = 0.014). Travelers' diarrhea in Mexico is a syndrome caused by a variety of pathogens, the most common of which is enterotoxigenic Esch. col.
Diarrhea↗
Prophylactic doxycycline for travelers' diarrhea. Results of a prospective double-blind study of Peace Corps volunteers in Kenya.
We performed a randomized double-blind study to determine the efficacy of doxycycline (100 mg daily) in preventing travelers' diarrhea among 39 Peace Corps volunteers during their first five weeks in Kenya. The volunteers took either doxycycline or placebo for three weeks and were observed for an additional two weeks. Nine of 21 taking placebo and one of 18 taking doxycycline had travelers' diarrhea during the treatment period (P = 0.012). The protection seemed to persist for at least one week after the drug was stopped. Enterotoxigenic Escherichia coli was the only pathogen isolated from the placebo group, but was not detected in persons taking doxycycline. None of these organisms were resistant to doxycycline or tetracycline, whereas resistance to tetracyclines and other antibiotics was common among the nonenterotoxigenic Esch. coli. We conclude that doxycycline effectively prevented most episodes of travelers' dirrhea.
Adult↗
Laboratory investigation of diarrhea in travelers to Mexico: evaluation of methods for detecting enterotoxigenic Echerichia coli.
A laboratory investigation was conducted on cultures collected from travelers before, during, and after a trip to Mexico to characterize the etiology of traveler's diarrhea. Four laboratory methods for detecting enterotoxigenicity of Escherichia coli were evaluated: the infant mouse assay, the Chinese hamster ovary (CHO) cell assay, the Y1 adrenal cell assay, and the rabbit ileal loop. Although a number of common enteric pathogens were identified as a cause of traveler's diarrhea, including six serotypes of Salmonella, two serotypes of Shigella, Vibrio parahaemolyticus, Giardia lamblia, and Entamoeba histolytica, enterotoxigenic Escherichia coli was most commonly isolated. Strains were identified that produced only heat-labile enterotoxin (LT), only heat-stable enterotoxin (ST), or both LT and ST. The infant mouse assay yielded results falling into two distinct groups, providing a clear separation of positive and negative cultures. The CHO assay also formed two groups, with positive cultures producing 11% or more of the elongated cells. There was good agreement between the CHO and the Y1 adrenal cell assays for detection of LT. The adrenal cell system for detection of LT was more suitable than the CHO assay for processing large numbers of specimens because of the miniculture modification of this method utilized in this study. The infant mouse method was a simple and reliable method for detecting ST.
Animals↗
"World Traveler" addicts in Asia: I. Demographic and clinical description.
Fifty-six addicted "world travelers" were studied at a treatment facility for opium addicts in Laos. They were primarily in their twenties (80%), male (80%), and single (70%). Most had begun narcotic use away from their own country during their travels. A majority were traveling alone, currently living alone, and using narcotic drugs alone. Their addiction at the time of seeking treatment was well established: narcotic drugs comprised their main daily expenditure, they had numerous problems associated with narcotic use, and high doses of methadone were necessary for detoxification.
Adolescent↗
Giardiasis in American travelers to Madeira Island, Portugal.
A high incidence of diarrhea was reported in a group of approximately 1,400 Americans who traveled to the Portuguese island of Madeira in October 1976. A mail questionnaire survey revealed that 39% of the responding 859 travelers experienced diarrhea; in 42% of these diarrhea lasted for longer than 1 week. The most frequent accompanying symptoms were abdominal cramps (75%), abdominal distention (72%), nausea (70%), and weight loss (40%). Of all travelers surveyed, 33% developed an illness resembling giardiasis with a median incubation period of 4 days. Of 35 ill patients who had a stool culture, enteric pathogens were recovered from 4 (3 Shigella and 1 Salmonella). On the other hand, of 58 ill patients whose stools were examined for parasites, Giardia lamblia was recovered from 27 (47%). Analysis of the epidemiologic data showed that drinking tap-water on the island was significantly associated with illness; eating ice cream or raw vegetables on the island was also implicated. There was no evidence of continuing transmission of giardiasis in American tourists visiting Madeira 8--12 months after the outbreak.
Aged↗
Heat-labile enterotoxigenic Escherichia coli and intestinal protozoa in asymptomatic travellers.
Thirty-two asymptomatic travellers who had recently journeyed in the Near, Middle, and Far East and had experienced a high incidence of diarrhoeal disease were screened for heat-labile enterotoxigenic Escherichia coli (ent+ E. coli) and other bacterial and parasitic pathogens. Six percent were colonized with ent+ E. coli and while other bacterial pathogens were not found, the intestinal protozoa Giardia lamblia (13%), Entamoeba histolytica (6%), Entamoeba coli (6%), Endolimax nana (6%), and Entamoeba hartmanni (3%) were detected in the stools. Ent+ E. coli, G. lamblia and E. histolytica should be considered in the differential diagnosis of gastrointestinal disease in travellers returning from the Orient. Furthermore, these travellers may be a potential source for the introduction of ent+ E. coli into communities where such organisms are relatively rare.
Adult↗
Effect of a lactobacilli preparation on traveler's diarrhea. A randomized, double blind clinical trial.
The effectiveness of prophylactic ingestion of a commercial preparation of lactobacilli (Lactinex) for the prevention or modification of traveler's diarrhea was tested in a randomized double blind clinical trial in 50 volunteer travelers to Mexico from the United States. Twenty-six subjects received the lactobacilli preparation and 24 received placebo. The incidence of diarrhea and its duration during the 4 weeks of observation were quite similar for the two preparations: 35% for lactobacilli-treated subjects and 29% for placebo subjects. Typically, the diarrhea was mild, lasting 2 days. From the observations during this study we conclude that prophylactic ingestion of lactobacilli for 1 week does not reduce the incidence or duration of traveler's diarrhea either during the period of ingestion or during the following 3 weeks.
Adolescent↗
Stability of periodic travelling wave solutions of a nerve conduction equation.
Nagumo's nerve conduction equation has travelling wave solutions of pulse type and periodic wave type. We consider the stability of the latter ones. We denote by L(c) the minimum spatial period of a periodic travelling wave solution whose propagation speed is c. It is shown that this travelling wave solution is unstable if L'(c) less than 0.
Axons↗
Travellers' diarrhoea: does it occur in the United Kingdom?
Of 485 persons who replied to a questionnaire after attending a European Congress in September 1974, diarrhoea was experienced by 4 of 143 British residents and 2 of 342 visitors to the United Kingdom. This extremely low incidence of travellers' diarrhoea contrasts with the high incidence reported in travellers from countries with cool climates and north European standards of hygiene to countries where these conditions do not hold.
Diarrhea↗