Peter A. Leggat

An international review of tobacco smoking among medical students

We conducted a systematic international review of tobacco smoking habits among medical students. Particular attention was paid to countries where smoking rates have been historically well-documented in local journals, but were less often included in larger international review articles. The methodology involved a search of relevant medical subject headings, after which the reference lists of journal papers were also examined to find additional publications. A total of 66 manuscripts met the inclusion criteria. The most common countries previously studied included India, the United States, Australia, Japan, Pakistan, Turkey and the United Kingdom. Overall, our review suggests that the prevalence of smoking among medical students varies widely amongst different countries and also between male and female students within the same areas. Consistently low smoking rates were found in Australia and the United States, while generally high rates were reported in Spain and Turkey. Given their important future role as exemplars, more effective measures to help reduce tobacco smoking among medical students are clearly needed worldwide.

Travel Insurance Claims Made by Travelers from Australia

BACKGROUND Little is known about travel insurance claims made by travelers returning from abroad. This study was designed to investigate travel insurance claims made by travelers from Australia, particularly examining demographic factors, type of travel insurance coverage, nature and duration of travel, when treatment was sought during travel or when the problem arose, use of emergency assistance, nature of claim, and claim outcome, including cost. METHODS A random sample of approximately one in five claims reported during the period 1996 to 1998 to a major Australian travel insurance company were examined. RESULTS A total of 855 claims were examined, of which 42.6% (356/836) were made by male travelers and 57.1% (477/836) were made by female travelers. The majority of claimants were in the 55 years and over age groups (445/836, 53.2%). Medical and dental conditions accounted for 66.6% of claims (569/854), with the remainder associated with loss, theft, and damage (285/854, 33.4%). The most common medical conditions were respiratory (110/539, 20.4%), musculoskeletal (90/539, 16.7%), gastrointestinal (75/539, 13.9%), ear, nose, and throat (67/539, 12.4%), and dental conditions (39/539, 7.2%). Only one case of venous thrombosis was reported, secondary to a lower limb infection. Use of the travel insurance companys emergency telephone service was reported in 17.1% of claims (146/853). Almost two-thirds (559/853, 65.5%) of claims were fully accepted. Those who claimed medical treatment, assault, and theft were significantly more likely to have their claims accepted compared to those claiming dental conditions, cancellation, curtailment, loss and damage (chi2 = 127.78, df = 40, p <.00001). The majority of medical and dental conditions did not require further medical investigations (427/569, 75.0%). The mean cost of claim refunds was Australian dollars (AUD)991.31 (standard deviation [SD] 6 AUD5400.76) for males and AUD508.90 (SD 6 AUD1446.10) for females. Claims for assault, cancellation, and curtailment were significantly more expensive than other types of claims (Kruskal-Wallis one way analysis of variance [ANOVA]; chi2 = 106.87, df = 8, p <.00001). Claims for treatment of gastrointestinal, cerebrovascular, cardiovascular, musculoskeletal conditions, and pyrexias of unknown origin were significantly more expensive than other medical and dental claims (Kruskal-Wallis one way ANOVA; x2 = 61.68, df = 15, p <.00001). CONCLUSIONS This explorative study highlights the importance of travelers taking out appropriate travel insurance. Claims for medical and dental conditions represent the majority of travel insurance claims made by Australian travelers returning from abroad, although travel insurance also covers against such contingencies as loss, theft, and cancellation. The most common medical conditions claimed were respiratory, musculoskeletal, and gastrointestinal disorders. Travelers should be advised to take out appropriate travel insurance before departure overseas and to take care with preexisting medical and dental conditions, which may not be able to be claimed against travel insurance.

Sources of health advice given to travelers

One of the biggest problems for health professionals and the travel industry has been getting travelers to present for pretravel health advice from a qualified source. Behrens1 stated that one of the most important factors in whether travelers seek health advice at all was the perceived risk and severity of tropical diseases. Travelers may obtain this health advice from the travel industry itself, or from health professionals in travel clinics, hospitals, public health units, general practices or other centers. They may also obtain advice by telephone directly from these areas. It is likely however that travel agents and the travel industry, especially various publications, are an important source of preliminary information on health and safety for travelers.

Surgical Applications of Methyl Methacrylate: A Review of Toxicity

ABSTRACT Methyl methacrylate (MMA) is a monomer of acrylic resin widely used in a variety of medical, dental, and industrial applications. Its extensive use in surgery, particularly for arthroplasties, has often raised concerns regarding potential human toxicity for orthopaedic surgeons, surgical nurses, and other operating-room staff who are occupationally exposed to the compound. The main toxic effects of MMA exposure appear to involve the cardiovascular system. When exposed to MMA in the work environment, surgical staff have been reported to suffer from hypersensitivity, asthmatic reactions, local neurological symptoms, irritations and local dermatological reactions. The integrity of latex gloves may also be compromised following exposure to MMA during surgical procedures. At present, MMA is not thought to be carcinogenic to humans under normal conditions of use. Nevertheless, sound occupational hygiene practices should still be used to help reduce workplace exposure to MMA during orthopaedic and other medical procedures. Surgical staff should avoid direct contact with MMA mixtures wherever possible, and room ventilation and adequate airflow should also be optimized. In the present article, the authors review studies relating to MMA toxicity in surgical practice, updating in part a previous literature review and expanding on the toxicity of MMA within the surgical setting.

Rabies Postexposure Management of Travelers Presenting to Travel Health Clinics in Auckland and Hamilton, New Zealand

BACKGROUND Rabies is a fatal disease, and travelers going to endemic areas need to take precautions. Little is known about the rabies postexposure management of travelers from New Zealand. METHODS A total of 459 post-travel records from October 1998 until February 2006 at two travel medicine clinics, in Auckland and Hamilton, were examined for those who reported postexposure management to animals while abroad. RESULTS Fifty-four patients were included, 48 (88.9%) were New Zealand residents and 52.0% were male. The mean age of exposed travelers was 30.4 years (SD = 15.5). There was an adult to child ratio of 5:1. The highest exposure risk group was those aged 16 to 30 years. South and Southeast Asia were the most prominent geographical regions where exposure occurred, with 45 (83.3%) of subjects being potentially exposed to rabies. Dogs were the commonest animals involved, accounting for two thirds of incidents (36; 66.7%). The commonest sites of animal exposure on the body were the thigh and lower leg (26; 48.1%) and the hand (10; 18.5%). Forty-six (85.2%) of the animal exposures were graded as World Health Organization (WHO) category III. Forty-nine (90.7%) of the travelers had not had preexposure prophylaxis. Once in New Zealand, the correct WHO postexposure prophylaxis regime was applied on 44 of 52 (84.6%) occasions. However, overall, only 25% of the sample received postexposure treatment consistent with WHO guidelines, reflecting inappropriate management abroad. CONCLUSIONS Post-travel consultations at two New Zealand travel clinics were analyzed for prophylactic rabies postexposure management. The majority were travelers aged 16 to 30 years, who sustained WHO category III exposures to the lower limb in Asia, predominantly from dogs. Few of these travelers had been immunized prior to travel, and only 25% of them received postexposure prophylaxis consistent with WHO guidelines. Thus, 75% of the study sample remains at theoretical risk of contracting rabies due to inappropriate management overseas.

Back pain in the young: a review of studies conducted among school children and university students

Back Pain [BP] represents one of the most common occupational disorders among human beings, with almost all people experiencing it at some stage during their life. Despite the well-known relationships between workplace factors and BP among adults, BP also affects younger people, such as school children and university students. Although some evidence suggests an increasing prevalence of BP throughout later childhood, it is difficult to ascertain whether this reflects a true increase in prevalence, or just greater recognition of the problem by researchers and research subjects. Nevertheless, various studies have begun to highlight a variety of BP risk factors in young people, such as classroom posture, backpacks, computer usage and psychosocial factors. As today’s school children and university students may be a generation increasingly burdened by BP, it is essential that clinicians in the paediatric field keep abreast of contemporary issues and risks, so that they may more effectively deal with this growing menace.

Hepatitis B risks and immunisation coverage amongst Australians travelling to Southeast Asia and East Asia

BACKGROUND Southeast Asia and East Asia are regarded as highly endemic regions for hepatitis B virus (HBV) and include many popular destinations for Australian travellers. The objectives of this survey were to evaluate the extent of pre-travel health advice, the prevalence of behaviours with HBV infection risks and the prevalence of HBV vaccination amongst Australian travellers to Southeast Asia and East Asia. METHODS In 2004, a telephone survey was conducted amongst Australians, who had travelled overseas to Southeast Asia and East Asia in the past three years for three nights or more. RESULTS Three hundred and nine travellers aged 14 years and over completed the interview, including 138 males (45%) and 171 females (55%). Respondents travelled for leisure (64%), business (20%), and visiting friends and relatives (VFR) (16%). The most common destinations were Indonesia (34%), Thailand (32%), and China (27%). About half of the travellers (54%) sought vaccination specific health advice before travel of which about half (56%) had sought this advice more than six weeks before travel. Just over one quarter of travellers reported receiving HBV vaccination (28%) of whom most (70%) were vaccinated at least three weeks before travel. About half of the travellers (49%) had participated in at least one activity with HBV risk during their last overseas trip. Of those travellers aged 18 years and over who either had no HBV vaccination or who were unsure, about half (49%) had participated in at least one activity with HBV risk during their last overseas trip. CONCLUSIONS Australian travellers to Southeast Asia and East Asia commonly undertake activities with a risk of exposure to HBV. Hepatitis B vaccination coverage amongst this group remains low. It is important that travellers to this region seek travel health advice from a qualified source, which will include a risk assessment for hepatitis B vaccination.

Musculoskeletal disorders and psychosocial risk factors among veterinarians in Queensland, Australia

OBJECTIVE Although musculoskeletal disorders (MSD) represent one of the most important occupational health issues in contemporary society, few studies have specifically investigated this problem among veterinarians. DESIGN An anonymous questionnaire survey mailed to all veterinarians registered with the Veterinary Surgeons Board of Queensland during 2006. RESULTS Almost two-thirds of respondents (63%) had experienced MSD of the lower back, 57% had experienced neck-related MSD, 52% had experienced shoulder-related MSD and 34% had experienced MSD of the upper back during the previous 12 months. MSD was statistically correlated with a range of psychosocial factors, including stress associated with career structure, time pressures, clients attitude, lack of recognition by the public, lack of recognition by colleagues, lack of understanding from family or partners and work stress because of insufficient holidays each year. CONCLUSION Overall, this study has demonstrated significant correlations between MSD and psychosocial risk factors among a large cohort of veterinarians, apparently for the first time in the published literature. The results also suggest that personal and workplace issues may contribute more to the development of MSD among veterinarians than many of the previously recognised ergonomic risk factors.

Personal Safety Advice for Travelers Abroad

[Extract] Although many travelers are concerned about their personal safety when traveling abroad, it is an often neglected area in travel medicine. Personal safety is one of the most important areas for travel health advisers to cover when giving advice to travelers going to virtually any country. Individual responsibility is paramount, as fewer people are going on programmed package tours.1 Travelers should also be advised about important safety nets, such as health and travel insurance, and finding medical assistance abroad. Half of general practitioners (GPs) in a New Zealand study reported giving safety advice to travelers,2 but GPs who saw a greater proportion of travelers were more likely to give safety advice.2 Seventy percent of travel health advisers in travel clinics usually advised travelers about personal safety.3 A recent study of inflight magazines in Australia revealed a paucity of advice concerning personal safety of travelers.

Overseas Visitor Deaths in Australia, 2001 to 2003

BACKGROUND The health and safety of international visitors remain an important issue for Australia and other tourist destinations. The death of visitors remains an important indicator of safety. The aim of this study was to provide updated figures on deaths of overseas travelers in Australia. METHODS Data were sourced from the Australian Bureau of Statistics concerning deaths of overseas visitors for the years 2001 to 2003. RESULTS There were 1,068 overseas visitor deaths (701 males, 66%) during the study period 2001 to 2003. Death by natural causes increased with age, while deaths associated with accidents were more frequent among younger age groups. The majority of deaths were from natural causes (782, 73%), particularly ischemic heart diseases (26%). There were a total of 247 accidental deaths (23% of all deaths) with the main causes being transportation accidents (14% of all deaths) and accidental drowning/submersion (5% of all deaths). The countries contributing the most deaths were the UK (247, 23%), New Zealand (108, 10%) Melanesia/Micronesia (95, 9%), and the United States (57, 5%). CONCLUSIONS Australia remains a relatively safe destination for international travelers, at least in terms of fatalities, which appear to be declining. Most deaths of overseas tourists in Australia are due to natural causes with cardiovascular disease being the predominant cause of death in this group. Accidents remain the most common preventable cause of death of travelers, with road and water safety being the major issues. It is important that tourism and travel medicine groups continue to advocate for improved health and safety of international travelers visiting Australia.