Pre-travel health care attendance among migrant travellers visiting friends and relatives (VFR): a 10-year retrospective analysis

Background: Travellers visiting friends and relatives (VFR) define a specific population of travellers exposed to higher risks for health and safety than tourists. The aim of this study was to assess differentials in pre-travel health care in VFR travellers compared to other travellers. Methods: A retrospective cohort study was performed including attendees of the Travel Medicine Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, between January 2007 and December 2017. Results: Over the 10-year period, 47,022 subjects presented to the travel clinic for pre-travel health care, 13.7% of whom were VFR travellers. These showed higher rates of vaccination against yellow fever and meningococcus, but lower rates for hepatitis A, hepatitis B, influenza, rabies, cholera, polio, typhoid IM vaccine and tetanus vaccine boosters. Regarding malaria prevention measures, results highlighted that VFR travellers, when compared with tourists, were more likely to be prescribed with chemoprophylaxis, particularly with mefloquine, than with atovaquone/proguanil. Conclusions: Findings from this large-scale study indicated differences in vaccination rates and completion, as well as in chemoprophylaxis for malaria, between VFR and non-VFR travellers, fostering specific interventions for promoting adherence to pre-travel health advice among migrant travellers

Non-Adherence to Malaria Chemo-Prophylaxis in Travelers: Mind to the Care Gap!

Background: Travelers are at risk of contracting malaria when moving to endemic areas. Yet, despite effective malaria chemoprophylaxis, imported cases of malaria still occur worldwide. Indeed, some studies have shown a varied adherence level; consequently, a traveler care gap could occur. Methods: A prospective cohort study was carried out in 2017 to evaluate the rate of malaria chemoprophylaxis adherence among Spanish travelers. Results: A post-travel questionnaire was completed by 402 travelers to malaria endemic areas that were prescribed chemoprophylaxis: 67 (16.7%) did not take any dose of chemoprophylaxis and 41 (10.2%) had not even carried it while travelling abroad. The adherence of chemoprophylaxis was 68,7% of travelers, being statistically different according to travel duration, onset of adverse events and type of drug prescribed. The non-adherent travelers reported not continuing with administration mainly because of forgetfulness, fear of side effects and low perceived risk because itinerary changes. Regarding the onset of the medication's secondary adverse events, one in three (35.2%) reported at least one, being more frequent among patients that took mefloquine than atovaquone-proguanil (p=0.01). The main adverse events reported by chemoprophylaxis users were gastrointestinal or sleeping disorders. Conclusions: The suboptimal compliance of chemoprophylaxis is a major lost opportunity to achieve malaria prevention, so it is an important contributor to the traveler care gap

Stand-by emergency treatment (SBET) of malaria in Spanish travellers: a cohort study

Background: Among strategies for malaria prevention, stand-by emergency treatment (SBET) is a possible approach, but scarce evidences exists investigating travellers' adherence and behaviours toward its use; therefore, the presented study aimed to determine travellers' compliance toward the SBET when prescribed in travel clinics. Methods: A prospective cohort study was performed at the Travel Health Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, during 2017. The research was planned on survey-based design, using pre- and post-travel questionnaires. Results: In the study period, of 5436 subjects who attended the HUB Travel Medicine Clinic, 145 travellers to malariaendemic areas were prescribed SBET, and all patients agreed to participate in the study by completing the pre-travel questionnaire. Approximately half the participants were women (n=75, 51.7%), and the median age of all travellers was 29 years (range 13-57), mainly travelling to South-East Asia (n=69, 47.6%), with Indonesia and the Philippines as the most popular destinations. The length of travels had a median duration of 29 days (range 10-213). Of the recruited participants, 98 replied to the online post-travel survey, reaching a response rate of 67.6%. A total of 62.2% of travellers to which SBET was prescribed did not buy and carry drugs while travelling abroad. No participants' baseline or travel characteristic was shown to be signifcantly associated (p>0.05) with this behaviour. Four women (4.1%) experienced fever and self-administered SBET, without seeking medical attention. No malaria cases were observed. Conclusions: This cohort study addressed travellers' adherence and behaviour toward SBET, highlighting an incorrect use of the emergency treatment in case of presumptive malaria symptoms. This should be taken into account during pre-travel consultation, since the success of this strategy for malaria prevention depends on travellers' strong adher‑ ence to it

Combining varenicline and nicotine patches: a randomized controlled trial study in smoking cessation

Background: Some smokers may benefit from a therapy that combines different nicotine replacement therapies (NRT) or drugs with different mechanisms of action. The aim of this study was to determine the efficacy of the combined therapy of varenicline and nicotine patches versus varenicline monotherapy. Methods: Three hundred forty-one smokers who smoked 20 or more cigarettes per day were recruited from a smoking cessation clinic between February 2012 and June 2013. The participants were randomized to receive a varenicline plus nicotine patch of 21 mg every 24 hours (170) or varenicline plus a placebo patch (171). All of the smokers received a standard 12-week course of varenicline and an 11-week course of either the placebo patch or the active patch after the target quit day. Both groups received behavioral support. The primary outcome was continuous abstinence for weeks 2 through 12 confirmed by exhaled levels of carbon monoxide. Post hoc subgroup analyses were performed to evaluate the treatment effects for a specific endpoint in subgroups of smokers. Results: The combination of the nicotine patch with varenicline was not associated with higher rates of continuous abstinence at 12 weeks (39.1% versus 31.8%; odds ratio (OR) 1.24; 95% confidence interval (CI) 0.8 to 2.6) and 24 weeks (32.8% versus 28.2%; OR 1.17; 95% CI 0.4 to 1.9). When participants were analyzed by subgroups according to cigarette consumption, the abstinence rates among smokers who smoked more than 29 cigarettes per day at 12 weeks (OR 1.39; 95% CI 1.2 to 2.5) and 24 weeks (OR 1.46; 95% CI 1.2 to 2.8) were significantly higher in the combination group. Other post hoc analyses based on level of dependence and previous quit attempts did not show subgroup differences. No differences between the groups for the reported adverse events were observed (χ2 value 0.07; P 0.79). Conclusions: The combination of varenicline with the nicotine patch does not improve abstinence rates at 12 and 24 weeks compared with varenicline used as monotherapy when all smokers were analyzed as a whole, independent of consumption level

The relationship between the parenteral dose of fish oil supplementation and the variation of liver function tests in hospitalized adult patients

Background Hepatic dysfunction is a complication associated with parenteral nutrition (PN). Our primary objective was to study the relationship between doses of intravenous fish oil (FO) emulsion in PN and the variation in the main liver function tests (LFTs) in hospitalized PN-treated adults. As a secondary objective, we studied the safety of FO administration. Methods We conducted a retrospective study in adult patients receiving FO supplementation in PN. Demographic, nutritional and safety variables were collected. Variation of LFTs was defined as the difference between values just before the first administration of FO and values at the end of PN. A multiple linear regression was performed to study the association between PN-lipids (FO or vegetable) and the variation of each LFT; the following variables were used to adjust the effect of lipids: sepsis, length of stay in the intensive care unit and lipids dose. Student t-test was used to study safety variables. Data were analyzed using SPSS 19.0. Results Patients (53, median age 68 years (24-90); 62 % men) with the principal diagnosis of digestive neoplasm (42 %) received PN for a median of 19 (7-75) days. In the multivariate analysis, the amount of FO was related to a decrease in gamma-glutamyl transferase (GGT) (B = −2.23;CI95 % = −4.41/-0.05), a decrease in alkaline phosphatase (AP) (B = −1.23;CI95 % = −2.07/-0.37), and a decrease in alanine aminotransferase (ALT) (B = −0.82; CI95 % = −1.19/-0.44). No differences were found in safety variables. Conclusions GGT, AP and ALT improved with FO PN-supplementation. Moreover, the improvement was greater when the doses of FO were higher. FO administration in PN is safe

Relationship between smoking and acute mountain sickness: a meta-analysis of observational studies

Aims. Previous epidemiological investigations of the relationship between smoking and acutemountain sickness (AMS) risk yielded inconsistent findings.Therefore, a meta-analysis of observational studies was performed to determine whether smoking is related to the development of AMS. Methods. Searches were performed on PubMed, Scopus, Embase, and Web of Science for relevant studies that were published before November 2016 reporting smoking prevalence and AMS. Two evaluators independently selected studies, extracted data, and assessed study quality.Thepooled relative risks (RRs) and 95% confidence intervals (CIs) were obtained using random-effects models. Subgroup analyses were performed according to the type of participant, altitude, and study design. Results. A total of 11 observational studies involving 7,106 participants, 2,408 of which had AMS, were eligible for inclusion in this meta-analysis. The summary RR for AMS comparing smokers to nonsmokers was 1.02 (95% CI: 0.83 to 1.26). Specific analyses for altitude, type of participant, and study design yielded similar results.There was significant heterogeneity for all studies ( = 37.43; < 0.001; 2 = 73%, 95% CI: 51% to 85%). No publication bias was observed (Egger's test: = 0.548, Begg's test: = 0.418). Conclusions.The meta-analysis indicates that no difference was found in AMS risk with regard to smoking status

Cardiovascular risk factor prevalence among a smoking population starting treatment to quit smoking

Fundamento: la prevalencia de los factores de riesgo cardiovascular en población general es elevada. Sin embargo, se conoce menos esta tasa en una población fumadora. El objetivo del estudio es determinar la prevalencia de los factores de riesgo cardiovascular en una cohorte de fumadores que inicia tratamiento de deshabituación tabáquica. Métodos: se trata de un estudio descriptivo en una muestra de 1.887 sujetos (1.098 hombres y 789 mujeres) con edades comprendidas entre los 20 y 80 años de edad. A cada uno de ellos se le realizó una visita médica, la determinación de su tensión arterial, colesterol total, glucemia basal, talla y peso. Resultados: el factor más prevalente fue la hipertensión arterial (25%). La prevalencia de uno o más factores de riesgo asociado al consumo de cigarrillos fue de un 36.2% (45,3% en hombres y 23,7% en mujeres, siendo estadísticamente significativa la diferencia; c 2=91.4 p<0,0001). Independientemente del número de factores presentes, la prevalencia fue siempre superior en los hombres. Exceptuando el infarto de miocardio entre los hombres, la prevalencia del resto de factores mostraron un incremento significativo con la edad, tanto en hombres como en mujeres. Entre los hombres existió un incremento porcentual del infarto de miocardio respecto al consumo de cigarrillos; en cambio, la prevalencia de hipercolesterolemia disminuye a medida que aumenta el consumo. Conclusiones: la prevalencia de los factores de riesgo cardiovascular en una población fumadora que inicia tratamiento es alta. Este hecho condiciona la necesidad de establecer medidas de intervención para modificarlos

Long-term clinical outcome of paraneoplastic cerebellar degeneration and anti-Yo antibodies

The outcome of 34 women with anti-Yo-associated paraneoplastic cerebellar degeneration was reviewed. Three patients had not developed cancer after more than 4 years of follow-up. The only independent predictor for survival was the type of associated tumor (risk ratio, 1.79; 95% CI, 1.02 to 3.12). Median survival was 100 months for patients with breast cancer and 22 for those with gynecologic cancer. Although paraneoplastic cerebellar degeneration leads to the diagnosis of cancer in 63% of the patients, cancer progression was the cause of death in 52%

Relationship of altitude mountain sickness and smoking: a Catalan traveller's cohort study

Objectives: The aim of this study is to analyse the relationship between smoking and altitude mountain sickness in a cohort of travellers to 2500 metres above sea level (masl) or higher. Setting: Travel Health Clinic at the Hospital Universitari de Bellvitge, in Barcelona, Spain. Participants: A total of 302 adults seeking medical advice at the travel clinic, between July 2012 and August 2014, before travelling to 2500 masl or above, who agreed to participate in the study and to be contacted after the trip were included. Individuals who met the following criteria were excluded: younger than 18 years old, taking carbonic anhydrase inhibitors for chronic use, undergoing treatment with systemic corticosteroids and taking any medication that might prevent or treat altitude mountain sickness (AMS) prior to or during the trip. The majority of participants were women (n=156, 51.7%). The mean age was 37.7 years (SD 12.3). The studied cohort included 74 smokers (24.5%), 158 (52.3%) non-smokers and 70 (23.2%) ex-smokers. No statistical differences were observed between different sociodemographic characteristics, constitutional symptoms or drug use and smoking status. Outcomes: The main outcome was the development of AMS, which was defined according to the Lake Louise AMS criteria. Results: AMS, according to the Lake Louise score, was significantly lower in smokers; the value was 14.9%, 95% CI (6.8 to 23.0%) in smokers and 29.4%, 95% CI (23.5 to 35.3%) in non-smokers with an adjusted OR of 0.54, 95% CI (0.31 to 0.97) independent of gender, age and maximum altitude reached. Conclusions: These results suggest that smoking could reduce the risk of AMS in non-acclimated individuals. Further studies should be performed in larger cohorts of travellers to confirm these results. Despite the results, smoking must be strongly discouraged because it greatly increases the risk of cardiorespiratory diseases, cancer and other diseases

A randomised study on the clinical progress of high-risk elective major gastrointestinal surgery patients treated with olive oil-based parenteral nutrition with or without a fish oil supplement

n-3 Fatty acids have clinical benefits. The primary aim of the present study was the assessment of infection in patients who underwent major high-risk elective gastrointestinal surgery receiving postoperatively fish oil (FO)-supplemented parenteral nutrition (PN), compared with those receiving a standard olive oil (OO) emulsion. The secondary aims were the assessment of anti-inflammatory response and evaluation of tolerance and safety of these emulsions. A prospective, randomised, double-blind study was performed in patients requiring at least 5 d of PN. An isoenergetic and isoproteic formula was administered: group A received OO alone, while group B received OO that was partially replaced with FO (16.6 %, w/w). End points were outcome measures (mortality, sepsis, infection, hospitalisation days and PN duration), inflammatory response (C-reactive protein (CRP), prealbumin and leucocytes) and safety (TAG and glucose metabolism, and liver and kidney function). Statistical analysis was done using Student's t test and Fisher's exact test (P < 0.05). Twenty-seven patients were evaluated, with thirteen patients receiving FO. In this group, a significantly lower incidence of infections was found (23.1 v. 78.6 %, P = 0.007). CRP, prealbumin and leucocytes were not significantly different between the groups. There were no differences in safety parameters. We conclude that high-risk surgical patients receiving FO-supplemented PN for 5 d present a lower incidence of infection. Emulsions were safe and well tolerated