Travel Health.

Travel and public health are inextricably linked: international travellers not only have a higher and well-recognized risk of illness and injury but also have the potential to either import non-endemic diseases into their country of origin or export non-endemic diseases to the country they visit. In 2003, severe acute respiratory syndrome (SARS) showed us how easily an outbreak could spread, and in this highly mobile world with its increasing pace and scale of travel, the interface between travel medicine and public health has never been more important

The March of measles - Can travel medicine halt the pace?

Measles was the subject of a recent episode of the US television drama Madam Secretary [1]; extremely timely given the current global measles outbreaks, the increase in vaccine hesitancy, and the rise in anti-vaccine misinformation on social media platform

Access to yellow fever travel vaccination centres in England, Wales, and Northern Ireland: A geographical study.

BACKGROUND: More than 700,000 trips were made by residents in England, Wales, and Northern Ireland (EWNI) in 2015 to tropical countries endemic for yellow fever, a potentially deadly, yet vaccine-preventable disease transmitted by mosquitoes. The aim of this study was to map the geographical accessibility of yellow fever vaccination centres (YFVC) in EWNI. METHODS: The location of 3208 YFVC were geocoded and the average geodetic distance to nearest YFVC was calculated for each population unit. Data on trips abroad and centres were obtained regionally for EWNI and nationally for the World Top20 countries in terms of travel. RESULTS: The mean distance to nearest YFVC was 2.4 km and only 1% of the population had to travel more than 16.1 km to their nearest centre. The number of vaccines administered regionally in EWNI was found correlated with the number of trips to yellow fever countries. The number of centres per 100,000 trips was 6.1 in EWNI, which was below United States (12.1) and above the rest of Top20 countries. CONCLUSIONS: The service availability was in line with demand regionally. With the exception of remote, rural areas, yellow fever vaccination services were widely available with only short distances to cover for the travelling public

Psychogenic Nonepileptic Seizures in Children and Adolescents

Though psychogenic non-epileptic seizures (PNES) are seen commonly during evaluation of children and adolescents with epilepsy, the literature regarding developmental changes in PNES is limited. Evidence Acquisition: Literature search was conducted in PubMed. Key search terms included: Pseudoseizure* OR PNES OR [(non-epileptic or nonepileptic or psychogenic or non-epileptic attack disorder) AND (seizure*)], resulting in 3,236 articles. Filters included human, ages 1-18 years, English language and last 15 years (2004-2019), resulting in 533 articles. We reviewed 33 articles, which included 19 articles that involved children (1-18 years), with 10 or more children with PNES in their study group. 21 articles obtained in cross references that were outside the filter setting (including time frame and age range) were also reviewed, for a total of 54 articles. Results: Majority of the studies were retrospective. We detail clinical features, predisposing factors and appropriate workup for children and adolescents with possible PNES. There is no consensus regarding frequency of psychiatric comorbidities in children with PNES. No controlled trials of treatment of PNES in children are available, but cognitive behavioral therapy is the consensus for adult PNES. Outcome appears to be better in children with PNES. Conclusions: There is a need for be long-term prospective studies to document various clinical features and outcome of pediatric and adolescent PNES, and also the comorbid conditions

Amplification of perceived risk among users of a national travel health Web site during the 2013-2016 West African Ebola virus outbreak.

Timely outbreak information was paramount to public health bodies issuing travel advisories during the 2013-2016 West Africa Ebola virus outbreak. This article explores the potential for a syndromic system/Shewhart control chart based on the online interaction with a national travel health Web site in comparison with searches on the Google UK search engine. The study showed an amplification of perceived risk among users of a national travel health Web site months before the World Health Organization declared the outbreak a Public Health Emergency of International Concern and the initial surge in public interest on Google UK in August 2014

A woman with cystic fibrosis, severe hypoxaemia, an atrial thrombus and a patent foramen ovale: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cystic fibrosis is usually associated with chronic pulmonary sepsis and frequent infective exacerbations. We report a very unusual cause of severe hypoxaemia in a woman with cystic fibrosis caused by thrombus formation in the right atrium.</p> <p>Case presentation</p> <p>A 21-year-old Caucasian woman with cystic fibrosis and a totally implantable venous access device presented with severe hypoxaemia. This was initially treated with antibiotics but her oxygen levels did not improve significantly. Subsequently, a transient ischaemic attack occurred. Further investigations, including a contrast echocardiogram and a cardiac magnetic resonance scan, revealed the presence of a large right atrial thrombus and right-to-left intracardiac shunt through a patent foramen ovale.</p> <p>Conclusion</p> <p>This case highlights the need to consider a right-to-left shunt in chronic respiratory diseases when hypoxaemia is out of proportion to the degree of lung function impairment. Totally implantable venous access devices should always be considered as a source of thrombus formation.</p

Impact of Demographic and Clinical Factors on Remote Patient Monitoring Acceptance

https://openworks.mdanderson.org/sumexp23/1128/thumbnail.jp

Early detection of perceived risk among users of a UK travel health website compared with internet search activity and media coverage during the 2015-2016 Zika virus outbreak: an observational study.

OBJECTIVES: The Zika virus (ZIKV) outbreak in the Americas in 2015-2016 posed a novel global threat due to the association with congenital malformations and its rapid spread. Timely information about the spread of the disease was paramount to public health bodies issuing travel advisories. This paper looks at the online interaction with a national travel health website during the outbreak and compares this to trends in internet searches and news media output. METHODS: Time trends were created for weekly views of ZIKV-related pages on a UK travel health website, relative search volumes for 'Zika' on Google UK, ZIKV-related items aggregated by Google UK News and rank of ZIKV travel advisories among all other pages between 15 November 2015 and 20 August 2016. RESULTS: Time trends in traffic to the travel health website corresponded with Google searches, but less so with media items due to intense coverage of the Rio Olympics. Travel advisories for pregnant women were issued from 7 December 2015 and began to increase in popularity (rank) from early January 2016, weeks before a surge in interest as measured by Google searches/news items at the end of January 2016. CONCLUSIONS: The study showed an amplification of perceived risk among users of a national travel health website weeks before the initial surge in public interest. This suggests a potential value for tools to detect changes in online information seeking behaviours for predicting periods of high demand where the routine capability of travel health services could be exceeded

Knowledge of the risk factors and symptons associated with endometrial cancer in British South Asian and British white women

ABSTRACT Objective: To explore differences in the background knowledge of Endometrial Cancer (EC), its risk factors, symptoms and prognosis of Endometrial Cancer (EC) between British White (BW) and British South Asian (BSA) women who had undergone treatment for stage I endometrial cancer within the past 3-years. Study design: Face-to-face, semi-structured interviews exploring knowledge; diagnosis; treatment; follow-up; and survivorship were undertaken and analysed using Thematic Analysis. Results: Twenty-one women were interviewed (13 BW and 8 BSA). BW and BSA women reported similar views, experiences and concerns with regards to EC. Knowledge appeared to differ amongst the two groups with BSA women reporting being more aware that unscheduled vaginal bleeding could be associated with a malignancy but having lower levels of knowledge of the risk factors that can lead to EC, compared to BW women. There was a lack of understanding of the difference between cervical cancer and EC and as a result, many women reported taking reassurance from negative cervical cytology as excluding EC and there was also the misconception amongst some of the women that there was a link between sexual behaviour and EC. Women from both groups used the lay healthcare system to discuss their situation/symptoms, however BSA women reported to have specifically sought out women within their social network who had previously undergone treatment for EC. Conclusions: Greater effort is needed to raise awareness in both the BW/BSA communities of the symptoms associated with EC that should prompt medical review. Educational efforts are required to overcome the reported perception that EC is synonymous with cervical cancer and cannot be detected by cervical screening