ABSTRACT
BACKGROUND: Recent years have seen unprecedented growth in international travel. Travellers are at high risk for acquiring infections while abroad and potentially bringing these infections back to their home country. There are many ways to mitigate this risk by seeking pre-travel advice (PTA), including receiving recommended vaccinations and chemoprophylaxis, however many travellers do not seek or adhere to PTA. We conducted a systematic review to further understand PTA-seeking behaviour with an ultimate aim to implement interventions that improve adherence to PTA and reduce morbidity and mortality in travellers. METHODS: We conducted a systematic review of published medical literature selecting studies that examined reasons for not seeking PTA and non-adherence to PTA over the last ten years. 4484 articles were screened of which 56 studies met our search criteria after full text review. RESULTS: The major reason for not seeking or non-adherence to PTA was perceived low risk of infection while travelling. Side effects played a significant role for lack of adherence specific to malaria prophylaxis. CONCLUSIONS: These data may help clinicians and public health providers to better understand reasons for non-adherence to PTA and target interventions to improve travellers understanding of potential and modifiable risks. Additionally, we discuss specific recommendations to increase public health education that may enable travellers to seek PTA.
Subject(s)
Health Behavior , Patient Compliance/statistics & numerical data , Travel Medicine/methods , Communicable Diseases, Imported/prevention & control , Communicable Diseases, Imported/psychology , Health Knowledge, Attitudes, Practice , Humans , Malaria/prevention & control , Patient Compliance/psychology , Risk Assessment , Travel , Vaccination/psychologyABSTRACT
OBJECTIVES: Point-of-care lung ultrasonography (US) is an alternative to chest radiography for imaging of suspected community-acquired pneumonia (CAP) in children. We compared pediatric emergency department (ED) time metrics between children who received point-of-care lung US versus chest radiography. Secondary objectives were comparisons of health system costs and other resources in these imaging groups. METHODS: This work was a retrospective matched cohort study of children aged 0 to 18 years in an academic urban pediatric ED who were imaged for suspected CAP with either point-of-care lung US or chest radiography. RESULTS: A total of 202 patients (101 in each group) were included in the study. The point-of-care lung US group spent a mean of 75.9 (SE, 14.3) minutes less from physician assessment to discharge (P < .0001) and 60.9 (SE, 18.1) minutes less in the overall ED length of stay (P = .0008). Physician billings and facility fees were both significantly lower (P < .0001) in the point-of-care lung US group, for a mean health systems savings of CAN$187.1 (SE, CAN$21.9). CONCLUSIONS: In children undergoing imaging for suspected CAP in our pediatric ED, point-of-care lung US by pediatric emergency medicine physicians was associated with decreased time and cost compared with chest radiography.