Health problems and risks encountered among healthy and vulnerable Dutch travelers

The results described in this thesis expand and deepen the knowledge of the disease burden that several groups of Dutch travelers can face while traveling abroad and after returning home, varying from young medical students to the older traveler⁠. One can think of communicable diseases (e⁠.g⁠. enteric- and respiratory infections), non-communicable diseases (e⁠.g⁠. exacerbation of cardiovascular diseases or mental disorders) and (road-traffic-related) injuries⁠. In addition, travelers can also face non-medical challenges such as culture shock and violence⁠. Travelers can also become colonized with resistant bacteria (e⁠.g⁠. ESBL-E) while staying abroad⁠. Active surveillance and contact isolation precautions may then be recommended when a traveler returns from a destination in Asia, and is admitted to the hospital in the home country⁠. The different studies provide more insights and practical advices regarding pre-travel information, which attributes both to practical tailored travel advice for Dutch travelers and will also be of interest for future research in the evolving world of travel medicine⁠.The printing of this thesis was partly financially supported by ChipSoft B.V.LUMC / Geneeskund

Travel preparation and health risks in Dutch and Belgian medical students during an elective in low- or middle-income countries: a prospective self-reporting cohort study

Background: Medical schools offer students the opportunity to perform international electives. This study aimed to assess health risks among medical students, to tailor institutional guidelines.Methods: Multicenter study at Dutch and Belgian universities, among medical students who visited low- or middle-income countries. Students completed four questionnaires: once before the elective and two weeks, three- and six months after return.Results: Data was complete for 479 students (follow-up rate 84%). Most traveled to Surinam (29%) and South-Africa (14%). Half of the students encountered difficulties in adapting to local culture. Almost 40% visited malaria endemic countries. Nearly all (87%) used chemoprophylaxis as prescribed. Definite needle-stick or splash injuries were reported by 7%. All were dealt with adequately in accordance with national guidelines. However, less than half of 24 possible incidents were handled adequately. Two-and-a-half percent had unprotected sex with a new partner. The incidence of travelers' diarrhea (TD) was 46%. In those with TD, the incidence of post-travel new-onset abdominal complaints was 3%. Three percent were involved in a minor traffic accident, 18% were injured during leisure activities, 5% were threatened or experienced physical violence. Only half of the students visiting a highly endemic country were screened for tuberculosis post-travel. For schistosomiasis this was 6%.Conclusions: Students abroad are exposed to medical and non-medical challenges, which should be addressed during pre-travel counseling. Contact details of a professional back home should be provided, so students can confer in case of problems while abroad. Lastly, we recommend a centrally organized post-travel health check.Nephrolog

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among travellers to Africa: destination-specific data pooled from three European prospective studies

Immunogenetics and cellular immunology of bacterial infectious disease

Predicting morbidity in older travellers during a short-term stay in the tropics: the ELDEST study

Background: Older persons may suffer more from travel-related health problems because of ageing and underlying chronic disorders. Knowledge on who is more likely to have these health problems helps to tailor travel health advice more specifically. This study aimed to determine predictors of travel-related morbidity in older travellers by assessing their pre-travel characteristics and performance using physical and cognitive functioning tests.Methods: Multicentre prospective cohort study among older travellers (>= 60 years) who consulted one of the participating Dutch travel clinics. Handgrip strength and cognitive performance were measured pre-travel. Participants completed questionnaires before departure and 1 and 4 weeks after return. A diary recorded health complaints during travel until 2-week post-travel.Results: In total, 477 travellers completed the study (follow-up rate of 97%). Participants' median age was 66 years. The most visited regions were South-East Asia (34%) and South Asia (14%). Median travel duration was 19 days. Polypharmacy (>= 5 medications per day) was not uncommon (16%). The median Charlson Comorbidity Index (CCI) score was 0. Self-reported travel-related infectious diseases concerned primarily respiratory tract infections (21%) and gastroenteritis (10%) whereas non-infectious complaints were injuries (13%), peripheral edema (12%) and dehydration (3%). Medical assistance was sought by 18%, mostly post-travel from their general practitioner (87%). Self-reported physical and mental health-related quality of life significantly improved during and after travel. Predictors for an increased risk of travel-related morbidity were higher CCI score, more travel experience, longer travel duration, higher number of daily medications, visiting northern Africa or South-East and East Asia, and phone and social media use.Conclusion: Older Dutch travellers are generally fit, well-prepared and suffer not only from common infectious health problems, but also from injuries. Travel improved their self-perceived health. The predictors could be used to identify the more at-risk older traveller and to decrease travel-related morbidity by optimizing pre-travel advice.Immunogenetics and cellular immunology of bacterial infectious disease

Predicting morbidity in older travellers during a short-term stay in the tropics: the ELDEST study

BACKGROUND: Older persons may suffer more from travel-related health problems because of ageing and underlying chronic disorders. Knowledge on who is more likely to have these health problems helps to tailor travel health advice more specifically. This study aimed to determine predictors of travel-related morbidity in older travellers by assessing their pre-travel characteristics and performance using physical and cognitive functioning tests. METHODS: Multicentre prospective cohort study among older travellers (≥60 years) who consulted one of the participating Dutch travel clinics. Handgrip strength and cognitive performance were measured pre-travel. Participants completed questionnaires before departure and 1 and 4 weeks after return. A diary recorded health complaints during travel until 2-week post-travel. RESULTS: In total, 477 travellers completed the study (follow-up rate of 97%). Participants' median age was 66 years. The most visited regions were South-East Asia (34%) and South Asia (14%). Median travel duration was 19 days. Polypharmacy (≥5 medications per day) was not uncommon (16%). The median Charlson Comorbidity Index (CCI) score was 0. Self-reported travel-related infectious diseases concerned primarily respiratory tract infections (21%) and gastroenteritis (10%) whereas non-infectious complaints were injuries (13%), peripheral edema (12%) and dehydration (3%). Medical assistance was sought by 18%, mostly post-travel from their general practitioner (87%). Self-reported physical and mental health-related quality of life significantly improved during and after travel. Predictors for an increased risk of travel-related morbidity were higher CCI score, more travel experience, longer travel duration, higher number of daily medications, visiting northern Africa or South-East and East Asia, and phone and social media use. CONCLUSION: Older Dutch travellers are generally fit, well-prepared and suffer not only from common infectious health problems, but also from injuries. Travel improved their self-perceived health. The predictors could be used to identify the more at-risk older traveller and to decrease travel-related morbidity by optimizing pre-travel advice

Asymptomatic carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in travelers returning from Southern Asia: trends over time

Immunogenetics and cellular immunology of bacterial infectious disease

Residual thermal stresses around bonded fibre metal laminate repair patches on an aircraft fuselage

Residual stresses are present after elevated temperature cure of adhesively bonded patches to cracked aircraft structures. These residual stresses will affect the performance and the durability of the repair. Strain and temperature measurements were taken on a real aircraft fuselage section during and after repair at three locations. Thermal buckling of the skin was observed and therefore a precuring at a lower temperature was employed. Also at a lower temperature a significant outward bending of the skin was observed which influences the residual stresses. The measured temperature field corresponded weil with the theoretical model of Rose.Aerospace Engineerin

Residual thermal stresses around bonded fibre metal laminate repair patches on an aircraft fuselage

Aerospace Engineerin

Hospital-based care and/or death followed by repatriation in Dutch travelers: The HAZARD study

Background: Travelers can experience health problems while abroad. This descriptive study aimed to quantify the disease burden leading to hospital-based care, repatriation or death in Dutch travelers during a stay in a foreign country, including Europe. Methods: Retrospective study of demographic and clinical data from three medical assistance centers (MACs) and the Dutch Ministry of Foreign Affairs on Dutch travelers receiving hospital-based care or who died abroad in the years 2010-2014. Diagnoses were coded according to the International Classification of Diseases (ICD) and classified using the Global Burden of Disease tool. Results: Data was available for 77,741 travelers' incidents: 75,385 medical consultations and 2,356 deaths. Four in five travelers received inpatient care, of which 36% concerned older travelers (65+) who had significantly longer hospital stays. Overall the top three diagnoses were: injuries (29%), infectious diseases (17%), and car-diovascular diseases (17%). Mental illness was reported in nearly 1.5% of the travelers. Incidence proportions were highest in South-Eastern Asia, with enteric infections as most common diagnosis. Injuries and communi-cable diseases occurred most often in South-Eastern Asia, while non-communicable diseases were mostly re-ported in South America. One in five travelers who consulted a physician was repatriated back home, mostly on a scheduled flight with or without medical escort. Cardiovascular diseases and injuries were the leading causes of death. Conclusions: Not only communicable diseases, but also injuries and chronic diseases (in particular cardiovascular diseases) frequently affected travelers' health while staying abroad and frequently necessitated hospital-based care. This should be addressed during the pre-travel counseling