Factors associated with the vaccination of international travelers: a multivariate analysis.

Travel medicine practice in the United States has not been extensively studied. This study included 1078 consecutive patients who presented to a university-based travel medicine clinic from 1990 through 1994. Analyses of patient demographics, clinic attendance, itineraries, and vaccinations were conducted. Mean patient age (+/- SD) was 37.4 +/- 16.2 years; 626 (58.1%) of the patients were male. Travel duration was 103.1 +/- 242.3 days (median, 21 days), and lead time (defined as the time between clinic presentation and departure for the purpose of this study) was 23.8 +/- 26.5 days (median, 16 days). Destination was the strongest independent factor affecting vaccination practices. A lead time of 31 or more days was associated with significantly elevated odds ratios for all immunobiologicals except immune globulin. These findings underscore the need to educate the traveling public, healthcare providers, and the travel industry about the benefits of seeking medical consultation at least 1 month prior to international travel.

Projected incidence of cardiovascular disease in male firefighters based on current risk factor prevalence.

The projected incidence of cardiovascular disease (CVD) in male firefighters was determined by the prevalence of current CVD risk factors and the use of the Framingham Study general cardiovascular risk profile in a probability sample of firefighters from two municipal fire departments. Hypercholesterolemia (60.9%) and obesity (56.0%) were the most prevalent risk factors. Significant age-related trends were observed for the prevalence of all CVD risk factors, except glucose intolerance (P = .21) and an abnormal resting electrocardiogram (P = .07). The projected incidence of CVD in firefighters did not differ from that of the general male population (relative risk, 1.0; 95% confidence interval, 0.7 to 1.4); similar risk estimates were observed in age-specific analyses. These findings are in accord with previous incidence and mortality studies that used circulatory diseases as an end point. The present method should be viewed primarily as a hypothesis-generating tool because of its limitations in assessing cause and effect.