The changing landscape of travel health services in Canada.

Canadians are increasingly travelling to areas that would necessitate a pre-travel consultation. Changes in professional regulations in Canada allow greater autonomy of nurses and pharmacists, resulting in shifts in provision of travel health services. We surveyed 824 Canadian travel clinics, 270 (33%) of whom responded. Private clinics were most common, and more likely to offer extended hours and drop-in appointments. In one province, pharmacies dominated. Half the services were relatively new and a similar proportion saw fewer than 10 patients weekly; 1/3 had a single provider. The increased spectrum of services may increase convenience for travellers but the large proportion seeing low numbers of clients will challenge providers to maintain competence.

Travelling abroad with cystic fibrosis: Assessment of risks and healthcare requirements.

There is limited information on the risks and healthcare requirements of patients with cystic fibrosis (CF) undertaking travel abroad. Of 100 patients (mean age 24.7 years, mean FEV1 57.3 %predicted) attending a UK adult CF Centre, 96% had travelled abroad but 14% now limited travel on medical advice. They travelled frequently and widely, often undertaking adventurous activities on holidays, but because of the costs involved, 18% travelled without travel insurance and 23% with insurance which did not cover CF. Of those who had ever had an illness abroad 10% had a CF-related illness (7 chest infection, 2 dehydration, 1 pancreatitis) and 12% a non-CF-related illness (4 sunburn, 3 gastroenteritis, 3 ear infection, 1 fall, 1 gastro-oesophageal reflux). There is a wide range of disease severity and assessment of the medical risks and the travel insurance premium to be charged should be based on the individual's health status rather than generically on the basis of a diagnosis of CF.

General practitioners' patterns of treatment of febrile travellers in north Queensland: an exploratory study.

In north Queensland, recurring epidemics of dengue fever are a public health concern. Each epidemic is initiated by an index case: an infected person arriving from an endemic country or region with dengue activity who then transmits the disease to local mosquitoes. A timely diagnosis of dengue in an index case and notification to public health services is essential to prevent epidemics. This qualitative study explores north Queensland general practitioners' experiences and patterns of treatment of febrile travellers. Individual, semi-structured interviews with 50 general practitioners working in north Queensland were conducted. Analysis of the data resulted in four themes for discussion: characteristics of febrile travellers presenting to local general practitioners, the cost of pathology tests as a barrier to diagnosis, appropriate pathology testing, and notifying tropical public health services. Recommendations from this study point to a need for ongoing education and training for general practitioners in best practice with regards pathology testing for suspected dengue fever cases. As well, there is a need to provide clearer guidelines to general practitioners on when to notify tropical public health services of suspicious diagnoses of dengue.