Gerard Flaherty

Journeys to high altitude - risks and recommendations for travelers with preexisting medical conditions.

A literature review was completed using Ovid/ Medline (1950–Present) and Pubmed databases. The following search terms were employed: preexisting medical conditions and altitude, each individual condition and altitude, air travel and preexisting medical conditions, and high altitude medicine. Published articles were used as a source of further references not yielded by the primary search. Textbooks written by recognized experts in the field of high altitude medicine were consulted to source information not available elsewhere. The demographics of adventure travel are shifting. Expanding road, rail, and air networks as well as mechanized mountain lifts have rendered it increasingly possible for people of varying levels of health and fitness to reach remote high altitude destinations (Table 1). 1 High altitude cities and employment sites also attract holidaymakers, workers, and business travelers (Figure 1). 2 Passive ascent to altitude by airplane, automobile, train, hot air balloon, or cable car may result in sudden exposure to altitude without adequate time for acclimatization. View this table: Table 1 Altitude definitions 1 Figure 1 Relative elevations of selected high altitude destinations. The environmental conditions at altitude and the associated hypobaric hypoxia pose a significant physiologic challenge to the human body (Figure 2). Furthermore, many high altitude sojourns include strenuous physical activities such as skiing, hiking, and climbing. Emergencies in remote locations demand that the sick or injured rely on their companions or on their own compromised abilities to access the medical help they need. The conscientious traveler will take steps to gain the knowledge and skills necessary to minimize personal risk. However, many at‐risk travelers remain naive to the health risks of high altitude travel. 3,4 Similarly, physicians should prepare themselves with the knowledge required to advise their patients on safe travel to altitude (Table 2). The need for knowledge and preparedness is especially critical in the case of individuals with … Corresponding Author: Kelly Mieske, BSc, Department of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland. E‐mail: k.mieske1{at}nuigalway.ie

Recommendations for the practice of travel medicine.

Travel Medicine has emerged as a distinct entity over the last two decades in response to a very substantial increase in international travel and is now forging its own identity, remit and objectives for care of the traveller. Crucial to the formation of any speciality is the definition of recommendations for its practice. This is particularly important and needed for travel medicine as it overlaps with and forms part of day-to-day work in a number of different medical specialities. This document defines a set of recommendations for the practice of travel medicine from the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow. Their objective is to help raise standards of practice and achieve greater uniformity in provision of services, better to protect those who travel. As travel medicine moves towards applying for speciality status, these standards will also contribute to that process.

Case report: bilateral occurrence of a chondroepitrochlearis muscle

The chondroepitrochlearis is an extremely rare muscular anomaly. Bergman et al. (1988) in their book on anatomical variations refer to ‘costoepitrochlearis, chondroepitrochlearis, or chondrohumeralis’ and describe the anomaly as a muscular slip which arises from one or more ribs, crosses the axilla, and inserts into the median intermuscular septum or medial humeral epicondyle. The phylogenetic significance of the muscle has received attention (Landry, 1958; Chiba et al. 1983; Bergman, 1991), and case reports with ulnar nerve entrapment and restriction of arm movements (FitzGerald, 1935–1936; Voto & Weiner 1987; Lin, 1988; Spinner et al. 1991) have emphasised its clinical relevance.

Translating guidelines to practice: findings from a multidisciplinary preventive cardiology programme in the west of Ireland.

Aims The aim of this observational, descriptive study is to evaluate the impact of an intensive, evidence-based preventive cardiology programme on medical and lifestyle risk factors in patients at high risk of developing cardiovascular disease (CVD). Methods Increased CVD risk patients and their family members/partners were invited to attend a 16-week programme consisting of a professional multidisciplinary lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Smoking, dietary habits, physical activity levels, waist circumference and body mass index, and medical risk factors were measured at initial assessment, at end of programme, and at 1-year follow up. Results Adherence to the programme was high, with 375 (87.2%) participants and 181 (84.6%) partners having completed the programme, with 1-year data being obtained from 235 (93.6%) patients and 107 (90.7%) partners. There were statistically significant improvements in both lifestyle (body mass index, waist circumference, physical activity, Mediterranean diet score, fish, fruit, and vegetable consumption, smoking cessation rates), psychosocial (anxiety and depression scales and quality of life indices), and medical risk factors (blood pressure, lipid and glycaemic targets) between baseline and end of programme, with these improvements being sustained at 1-year follow up. Conclusions These findings demonstrate how a holistic model of CVD prevention can improve cardiovascular risk factors by achieving healthier lifestyles and optimal medical management.

Bibliometric analysis and curriculum mapping of travel medicine research

Evidence-based travel medicine requires that research priorities reflect the wide knowledge base of this discipline. Bibliometric analysis of articles published in Journal of Travel Medicine yielded the following results: epidemiology (6%, n = 105); immunology/vaccinology (8.5%, n = 148); pre-travel assessment/consultation (30.5%, n = 533); diseases contracted during travel (48.3%, n = 843); other clinical conditions associated with travel (6.8%, n = 119); post-travel assessment (5.2%, n = 91) and administrative and general travel medicine issues (6%, n = 105).

Travel itinerary uncertainty and the pre-travel consultation—a pilot study

Risk assessment relies on the accuracy of the information provided by the traveller. A questionnaire was administered to 83 consecutive travellers attending a travel medicine clinic. The majority of travellers was uncertain about destinations within countries, transportation or type of accommodation. Most travellers were uncertain if they would be visiting malaria regions. The degree of uncertainty about itinerary potentially impacts on the ability of the travel medicine specialist to perform an adequate risk assessment, select appropriate vaccinations and prescribe malaria prophylaxis. This study reveals high levels of traveller uncertainty about their itinerary which may potentially reduce the effectiveness of their pre-travel consultation.

Repatriation of human remains following death in international travellers

Background: Death during international travel and the repatriation of human remains to one’s home country is a distressing and expensive process. Much organization is required involving close liaison between various agencies. Methods: A review of the literature was conducted using the PubMed database. Search terms included: ‘repatriation of remains’, ‘death’, ‘abroad’, ‘tourism’, ‘travel’, ‘travellers’, ‘travelling’ and ‘repatriation’. Additional articles were obtained from grey literature sources and reference lists. Results: The local national embassy, travel insurance broker and tour operator are important sources of information to facilitate the repatriation of the deceased traveller. Formal identification of the deceased’s remains is required and a funeral director must be appointed. Following this, the coroner in the country or jurisdiction receiving the repatriated remains will require a number of documents prior to providing clearance for burial. Costs involved in repatriating remains must be borne by the family of the deceased although travel insurance may help defray some of the costs. If the death is secondary to an infectious disease, cremation at the site of death is preferred. No standardized procedure is in place to deal with the remains of a migrant’s body at present and these remains are often not repatriated to their country of origin. Conclusions: Repatriation of human remains is a difficult task which is emotionally challenging for the bereaving family and friends. As a travel medicine practitioner, it is prudent to discuss all eventualities, including the risk of death, during the pre-travel consultation. Awareness of the procedures involved in this process may ease the burden on the grieving family at a difficult time.

Research on the move: the potential applications of mobile health technology in travel medicine.

Modern travel is highly reliant on technology, with online flight and hotel reservations, tourist blogs, e-Visa applications and satellite navigation becoming the norm for travellers. Many functions previously ascribed to desktop computers have migrated to mobile smartphones and it is commonplace to witness the majority of passengers on some international flights presenting their Quick Response code on a handheld device instead of a paper-boarding pass. Mobile technology has been comfortably adopted by all age groups. Global wireless infrastructure has tried to keep pace with this increase in demand from the traveller who increasingly chooses to be ‘on the grid’. According to the International Telecommunication Union, 95% of the world’s population live in an area served by a mobile-cellular network, with mobile-broadband networks of 3G or higher reaching 84% of the global population and 67% of rural dwellers.1 There are currently over 7 billion mobile-cellular telephone subscriptions worldwide.1 A recent analysis of mobile applications for travellers and their healthcare providers concluded that there is scope for the development of more reliable and more frequently updated ‘apps’ that consolidate travel health information from multiple sources.2 Social media have opened up new opportunities for travellers to interact with … To whom corresponding should be addressed. Phone: +353-91495469, Fax: +353-91494540, Email: gerard.flaherty{at}nuigalway.ie

The risk of sexual assault and rape during international travel: implications for the practice of travel medicine

International travel presents a risk of sexual violence. In recent years, several high profile incidents, including the gang rape of an Indian woman aboard a bus in New Delhi in 2012, have heightened the awareness of this risk. The British Foreign and Commonwealth Office currently advises female travelers to India to “exercise caution when traveling there, even if they are traveling in a group,” on the basis that British women have been the victims of sexual assaults in Goa, Delhi, Bangalore, and Rajasthan.1 The international travel advice provided by the British Foreign and Commonwealth Office also highlights recent serious sexual attacks involving female Polish, German, and Danish travelers in 2014, and the kidnapping and sexual assault of a Japanese woman in January 2015.1 In the latter incident, a 22-year-old Japanese tourist was allegedly captured in Kolkata, India, by a tour guide using the pretence of bringing the traveler to visit a Buddhist shrine.2 It is reported that she was then locked in a secluded basement and repeatedly raped for one month before she managed to escape.3 In addition to these high profile media reports, there is also increasing research evidence demonstrating that sexual violence is frequently experienced during international travel. The European Institute of Studies on Prevention conducted a cross-sectional airport survey of more than 6,000 young people (aged 16–35 years) who were returning home from holidays in Southern European tourist resorts including Greece, Cyprus, Italy, Portugal, and Spain.4 A total of 1.5% of participants reported having had sex against their will during their holidays …

Profile of Travelers with Preexisting Medical Conditions Attending a Specialist Travel Medicine Clinic in Ireland

BACKGROUND Patients with complex medical comorbidities travel for protracted periods to remote destinations, often with limited access to medical care. Few descriptions are available of their preexisting health burden. This study aimed to characterize preexisting medical conditions and medications of travelers seeking pre-travel health advice at a specialized travel medicine clinic. METHODS Records of travelers attending the Galway Tropical Medical Bureau clinic between 2008 and 2014 were examined and information relating to past medical history was entered into a database. Data were recorded only where the traveler had a documented medical history and/or was taking medications. RESULTS Of the 4,817 records available, 56% had a documented medical history and 24% listed medications. The majority of travelers with preexisting conditions were female. The mean age of the cohort was 31.68 years. The mean period remaining before the planned trip was 40 days. Southeast Asia was the most popular single destination, and 17% of travelers with medical conditions were traveling alone. The most frequently reported conditions were allergies (20%), insect bite sensitivity (15%), asthma (11%), psychiatric conditions (4%), and hypertension (3%). Of the 30 diabetic travelers, 14 required insulin; 4.5% of travelers were taking immunosuppressant drugs, including corticosteroids. Half of the female travelers were taking the oral contraceptive pill while 11 travelers were pregnant at the time of their pre-travel consultation. CONCLUSIONS This study provides an insight into the medical profile of travelers attending a travel health clinic. The diverse range of diseases reported highlights the importance of educating physicians and nurses about the specific travel health risks associated with particular conditions. Knowledge of the effects of travel on underlying medical conditions will inform the pre-travel health consultation.