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Recent years have seen unprecedented growth in international travel. Travellers are at high risk for acquiring infections while abroad and potentially bringing these infections back to their home country. There are many ways to mitigate this risk by seeking pre-travel advice (PTA), including receiving recommended vaccinations and chemoprophylaxis, however many travellers do not seek or adhere to PTA. We conducted a systematic review to further understand PTA-seeking behaviour with an ultimate aim to implement interventions that improve adherence to PTA and reduce morbidity and mortality in travellers. We conducted a systematic review of published medical literature selecting studies that examined reasons for not seeking PTA and non-adherence to PTA over the last ten years. 4484 articles were screened of which 56 studies met our search criteria after full text review. The major reason for not seeking or non-adherence to PTA was perceived low risk of infection while travelling. Side effects played a significant role for lack of adherence specific to malaria prophylaxis. These data may help clinicians and public health providers to better understand reasons for non-adherence to PTA and target interventions to improve travellers understanding of potential and modifiable risks. Additionally, we discuss specific recommendations to increase public health education that may enable travellers to seek PTA.

Understanding barriers to seeking and following pre-travel advice in Visiting Friends and Relatives (VFR) travelers might enhance preventive behaviors before and during travel. A mixed-method research with an explanatory sequential design among West African VFR travelers was conducted between 2019 and 2022 in an area with a high number of immigrants. Firstly, all travelers were advised to seek pre-travel advice and prospectively followed after the trip. Secondly, focus groups and individual semi-structured interviews were conducted to explain results in more depth. Finally, quantitative and qualitative data were integrated. Eighty-eight travelers, mostly men (92 %), were prospectively followed. Main countries of origin were Mali (29.5 %) and Senegal (29.5 %). Fifty-three percent of travelers did not seek pre-travel advice at the vaccination center. Only 29.5 % took malaria chemoprophylaxis properly. Travelers visiting their home country for the first time, among others, were more likely to attend pre-travel advice (p < 0.005). No differences in risk activities and preventive measures were found between those who sought pre-travel advice and those who did not. Upon returning, 25 travelers (28.7 %) presented with some infectious diseases such as malaria (n = 10; 11.4 %). In the qualitative phase, most VFR travelers did not perceive returning home as a health risk and deemed pre-travel advice unnecessary and culturally inappropriate. Social and family pressure were significant barriers to follow preventive measures, perceiving them as an act of rejection towards their community. Redesigning pre-travel counseling programs from a holistic approach is needed to improve communication and overcome barriers and cultural gaps. Community health workers, facilitated appointments and interventions through primary care may be helpful. •Despite efforts in promoting pre-travel advice, VFRs showed poor adherence to such advice and to malaria prophylaxis.•First-time travelers were more likely to attend official travel counseling.•Pre-travel advice did not significantly change risk behaviors during the trip.•Fatalism, social pressure and cultural beliefs limit effectiveness of educational actions.•Culturally tailored counseling is crucial for improving VFR travel health.

The most significant risk of dental tourism is the timing of air travel after dental interventions in order to avoid the pain or injury caused by barotrauma. Usually the minimum waiting time should be 24 h, but in some cases, it can be up to 2 weeks.

Student travellers are recognised as a group at high risk of travel-related morbidity, but few previous studies have evaluated students' perceptions of or willingness to take risks during travel. Individual risk propensities may influence travellers’ engagement in pre-travel healthcare and can therefore inform strategies in pre-travel risk communication. This study aimed to describe the factors influencing risk-taking willingness, risk perceptions and future health-seeking intention among student travellers. We conducted a cross-sectional online survey (June–August 2021) among students enrolled at Monash University, Melbourne, Australia. Primary outcomes were travel-related risk-taking willingness and risk perceptions, measured using the health/safety items of the validated Domain-Specific Risk-Taking (DOSPERT) scale. Four hundred and eighteen students completed the survey. The mean age of respondents was 25.61 years, 78% were female and 46% were born outside Australia. Greater willingness to take risks was predicted by younger age (<25 years), being Australian-born, greater travel experience (3+ trips), having previously sought PTA, and perceiving oneself at low risk of severe COVID-19. We found no significant predictors of risk perception. Increased intention to seek pre-travel advice in the future was associated with greater risk perception, younger age, and perceiving oneself at high risk of severe COVID-19. These findings support the rationale for a greater role of risk communication in travel medicine promotion strategies. We recommend that this could be achieved through 1) increasing risk perception by emphasising potential travel-associated risks, 2) personalising information about travel risks, 3) addressing perceived benefits of engaging in risky behaviours, and 4) reinforcing self-efficacy.

In high-income, low-prevalence settings, travel patterns largely govern malaria transmission; the COVID-19 pandemic has led to travel restrictions resulting in a decrease in malaria case incidence. The proportion of travellers seeking pre-travel has decreased; with the easing of borders, an increase in malaria cases may occur.

International travel poses unique health risks for individuals with diabetes. This study explored their travel patterns, preparations, and morbidity, as well as identify factors influencing pre-travel health-seeking behavior from primary healthcare providers. This cross-sectional, questionnaire-based study recruited adults with diabetes who had traveled internationally within the past 12 months. Data on sociodemographic and clinical characteristics, travel patterns, preparations, and travel-associated morbidity were collected via questionnaires and electronic medical records. Multivariate logistic regression analyses were conducted to identify predictors of patients informing physicians about travel plans. Among 250 participants (median age: 65 years [57–69]; median HbA1c: 7.1 % [6.6–7.9]), 16.4 % were on insulin therapy. The median travel duration was 6 days (5–10), with a median of one time zone crossed. Insulin-treated individuals tended to plan shorter trips to closer destinations than their non-insulin-treated counterparts. While 70.8 % of participants carried medicines for acute illness, only 10.8 % informed their primary care physicians about travel plans, and 11.2 % experienced travel-associated morbidity, including acute illness, falls, and hypoglycemia. Predictors of informing physicians about travel plans included travel duration exceeding ten days (OR: 4.87, 95 % CI: 1.34–17.63), insulin therapy (OR: 4.37, 95 % CI: 1.21–15.80), taking preventive measures against hypoglycemia during travel (OR: 3.40, 95 % CI: 1.26–9.14), and good antidiabetic medication adherence (OR: 2.96, 95 % CI: 1.10–7.96). This study underscored the impact of diabetes self-care practices on pre-travel health-seeking behavior and demonstrated how insulin therapy shapes travel patterns, highlighting the need for reinforced self-management skills and targeted pre-travel guidance, especially for insulin-treated patients. •Insulin-treated individuals plan shorter trips to closer destinations than their non-insulin-treated counterparts.•Travel-related morbidities in people with diabetes are typically mild and rarely require medical assistance while abroad.•Diabetes self-care skills are positively associated with travelers informing their primary care physicians of travel plans.

Abstract Background The incurred mental alteration of a traveler abroad should be an alarming signal for patient, for family and for the local healthcare professionals alike. It is estimated that 11.3% of travelers experience some kind of psychiatric problem, with 2.5% suffering from severe psychosis and 1.2% requiring more than 2 months of therapy upon return from a trip abroad. Acute psychotic episode represents approximately one-fifth of travel-related psychiatric events. Yet, the travel-related mental problems have been a neglected topic till today. Now a good selection of literature is available to help further researches. Methods Besides describing the most relevant literature of travel-related mental disturbances, authors present two key issues of dealing with psychiatric problems of travelers abroad: to identify the origin of the mental alteration and the process of the patient with psychiatric problems. Results Identifying the origin and the nature of the mental symptoms of travelers is often difficult because of the language barrier, among extraordinary circumstances. A simple two-step three-branch algorithm could make the decision easier for the attending physician. Some of the brief psychotic disorder and organic origin of mental disturbance can be and often are treated in place. Conclusions Some mental problems probably originated from or triggered by the travel or a foreign environment itself. In these cases the full recovery will be expected if the triggering factor is eliminated. The solution is early repatriation. The repatriation for psychiatric reasons is highly different from repatriation for other medical emergencies. The authors describe a proposal of a step-by-step action of repatriation of a psychotic patient. By the help of this suggested protocol, the patient may successfully be taken home.

Abstract Background The worldwide prevalence of dementia is increasing and represents a major public health concern. In the last decades, air travel services have undergone an impressive expansion and one of ten passengers is aged 65 years and older. While air travel can be stressful at all ages and health conditions, older individuals with cognitive impairment carry a greater risk for air-travel-related complications. Consequently, demands to general practitioners for assessing their older patient’s fitness to fly are increasing. Methods We conducted a search of the literature in PubMed on the impact of in-flight environmental changes on passengers with cognitive impairment and possible resulting complications. This set the base for a discussion on pharmacological and non-pharmacological interventions aimed at preventing in-flight complications in this vulnerable population. Results While our research strategy identified a total of 11 articles related to older age and air travel, only three focused on passengers with cognitive impairment. Our literature review showed that the airplane environment may lead to a large spectrum of symptoms in passengers of all age groups. However, passengers with cognitive impairment due to neurodegenerative diseases are at increased risk for experiencing the most extreme symptoms such as acute confusional state. Non-pharmacological and pharmacological interventions at different stages of the travel process (before, during and after) can help prevent complications in this vulnerable population. Conclusion The decision to let a patient with cognitive impairment fly requires a solid understanding of the in-flight environmental changes and their impact on older patients with cognitive impairment. Moreover, a sound weighing of the risks and benefits while considering different aspects of the patient’s history is demanded. In this regard, the role of the treating physicians and caregivers is essential along with the support of the medical department of the airline.

Intercontinental travel contributes to the spread of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE). We assessed risk factors for intestinal ESBL-PE colonization in people travelling to low and middle income countries in the tropics and subtropics to better understand how travel affects ESBL-PE spread. This prospective cohort study in travellers attending a travel clinic in Leipzig, Germany was conducted in 2016–2017. Information on risk factors related to travel, symptoms, antibiotic use, health care usage, accommodation, destination, diet and hygiene was collected by questionnaire after travel. Stools were phenotypically tested for ESBL-PE before and after travel. Risk factors for ESBL-PE colonization were identified using logistic regression. Of the 230 travellers that were ESBL-PE negative before travelling, 23% (n = 53) travellers returned positive. Multivariable analyses showed that age, type of accommodation and travelling to Asia were associated with ESBL-PE colonization. Given that a considerable amount of travellers returned with ESBL-PE, we recommend raising awareness in returning high-risk travellers, e.g. those returning from high-risk areas. They should be aware that they may carry antimicrobial-resistant bacteria after travel, and how they can prevent its spread. The role of the type of accommodation as a factor favouring intestinal colonization with ESBL-PE requires further investigation.