Travel-Related Behaviors and Health Outcomes of Adolescents Compared with Adults on Short-Term International Service Missions.

With an increasing number of adolescents participating in international travel, little is known about travel-related behaviors and health risks in this age group. In the years 2015-2016, we conducted an anonymous, posttravel, questionnaire-based survey with the aim to compare self-reported practices and travel-related symptoms between adolescents (< 18 years old, N = 87) and adults (≥ 18 years old, N = 149) who came to our travel clinic before their humanitarian missions. They had the same pretravel health education, and traveled together to perform similar activities. In univariate analysis, compared with adults, we found that adolescents reported less prior international travel (P < 0.001), more often wore long-sleeved clothing for malaria prevention (P < 0.001) but less often for sun protection (P = 0.009), more often used insect repellents (P = 0.011), and less often had diarrhea (P = 0.024). All other practices and health outcomes were similar between the groups. Multivariate analyses using Bayesian network show strong associations between adults and prior travel experience, and not wearing long-sleeve clothing for malaria prevention. We also found strong associations between prior international travel and sustaining an injury, and having jet lag, as well as between taking malaria prophylaxis and not having diarrhea. Overall, most practices and health outcomes were similar between age groups. Adolescent age and lack of prior international travel experience did not have significant impacts on practices and health outcomes. Our findings highlight the need for more effective strategies to improve the behaviors and health outcomes in both adolescents and adults.

Respiratory viruses in returning Hajj & Umrah pilgrims with acute respiratory illness in 2014-2015.

BACKGROUND & OBJECTIVES: Respiratory tract infections are common among Hajj and Umrah pilgrims which pose a public health risk of spread of respiratory infections. Influenza has been reported from Indian Hajj and Umrah returning pilgrims, but data on other respiratory pathogens are sparse in India. Here we report the presence of common respiratory viral pathogens in returning Hajj and Umrah pilgrims suffering from acute respiratory illness (ARI) in 2014-2015. METHODS: Respiratory specimens (nasopharyngeal and throat swabs) were collected from 300 consenting pilgrims with ARI in the past one week and tested for influenza and Middle East Respiratory Syndrome coronavirus (MERS-CoV) and other respiratory viruses using in-house standardized quantitative real-time reverse-transcription polymerase chain reaction. Clinical features among the pathogen positive and negative patients were compared. The patients received symptomatic treatment and antivirals where appropriate and were followed telephonically to collect data on illness outcome. RESULTS: Ninety seven (32.3%) of the 300 participants were tested positive for any virus, most common being influenza viruses (n=33, 11%). Other respiratory viruses that were detected included human coronaviruses [n=26, 8.7%; OC43 (n=19, 6.3%) and C229E (n=7, 2.3%)], rhinovirus (n=20, 6%), adenoviruses (n=8, 2.6%), parainfluenza viruses (n=7, 2.3%), respiratory syncytial virus (n=3, 1%) and bocaviruses (n=2, 0.6%). Clinical features observed in pathogen positive and pathogen negative patients did not differ significantly. Eighteen influenza positive patients were treated with oseltamivir. INTERPRETATION & CONCLUSIONS: Pilgrims returning from mass gatherings are often afflicted with respiratory pathogens with a potential to facilitate transmission of respiratory pathogens across international borders. The study reinforces the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene.

[Health and access to health care of 18-25 years old people not in employment, education or training (NEETs) attending the French 'missions locales']. / Santé et recours aux soins des jeunes en insertion âgés de 18 à 25 ans suivis en mission locale.

BACKGROUND: In France, "missions locales" are public assistance units for young people aged 16-25 years not in employment, education or training (NEET). The health status of the more than 1.5 million young adults attending these units annually is unknown. The purpose of this study was to describe the health status and health care use of this population in comparison with the general population of the same age. METHODS: The Presaje survey was conducted in 2011 on a randomized sample of 1453 young adults aged 18-25 years who attended five "missions locales" in mainland France. Data were analyzed and compared with those of participants of the same age interviewed in a French national health survey (Baromètre Santé 2010, n=2899) and in a regional cohort (SIRS, n=204) conducted in the Greater Paris area, both in 2010. RESULTS: The overall social profiles of this NEET population was diverse, but with globally more difficult living conditions than in the general population. Health-related vulnerability factors identified were: insufficient health insurance; low educational level; numerous adverse experiences during childhood and social isolation. Some of their health indicators were remarkably poor in comparison with participants in the Baromètre santé study: 19.2 % (CI95 %=[17.2-21.3]) had a chronic disease-versus 8.2 % (CI95 %=[7.0-9.4]) (P<0.001); 31.9 % (CI95 %=[26.8-37.4]) were overweight or obese-versus 17.9 % (CI95 %=[16.3-19.6]) (P<0.001) and 19.6 % (CI95 %=[15.2-23.9]) were depressed-versus 7.3 %(CI95 %=[3.8-10.9]) (P<0.001). Compared with participants of the SIRS survey, fewer (70.4 %) (CI95 %=[68.0-72.7]) had a family doctor-versus 79.7 % (CI95 %=[73.1-86.2]) (P<0.05). Among the women in the Presaje survey, 38.0 % [30.5-45.4] had a regular gynecological follow-up-versus 80.9 % (CI95 %=[71.5-90.4]) in the SIRS survey (P<0.001). CONCLUSION: Careful attention must be given to the young NEET population. Many of these youths are not familiar with health care services despite their important health care needs. Integrating health services into the "missions locales" may help detect health problems in this population, facilitating links to care.

Mind the gap: knowledge and practice of providers treating uncomplicated malaria at public and mission health facilities, pharmacies and drug stores in Cameroon and Nigeria.

BACKGROUND: Artemisinin combination therapy (ACT) has been the first-line treatment for uncomplicated malaria in Cameroon since 2004 and Nigeria since 2005, though many febrile patients receive less effective antimalarials. Patients often rely on providers to select treatment, and interventions are needed to improve providers' practice and encourage them to adhere to clinical guidelines. METHODS: Providers' adherence to malaria treatment guidelines was examined using data collected in Cameroon and Nigeria at public and mission facilities, pharmacies and drug stores. Providers' choice of antimalarial was investigated separately for each country. Multilevel logistic regression was used to determine whether providers were more likely to choose ACT if they knew it was the first-line antimalarial. Multiple imputation was used to impute missing data that arose when linking exit survey responses to details of the provider responsible for selecting treatment. RESULTS: There was a gap between providers' knowledge and their practice in both countries, as providers' decision to supply ACT was not significantly associated with knowledge of the first-line antimalarial. Providers were, however, more likely to supply ACT if it was the type of antimalarial they prefer. Other factors were country-specific, and indicated providers can be influenced by what they perceived their patients prefer or could afford, as well as information about their symptoms, previous treatment, the type of outlet and availability of ACT. CONCLUSIONS: Public health interventions to improve the treatment of uncomplicated malaria should strive to change what providers prefer, rather than focus on what they know. Interventions to improve adherence to malaria treatment guidelines should emphasize that ACT is the recommended antimalarial, and it should be used for all patients with uncomplicated malaria. Interventions should also be tailored to the local setting, as there were differences between the two countries in providers' choice of antimalarial, and who or what influenced their practice.

Pre-travel preparation of US travelers going abroad to provide humanitarian service, Global TravEpiNet 2009-2011.

We analyzed characteristics of humanitarian service workers (HSWs) seen pre-travel at Global TravEpiNet (GTEN) practices during 2009-2011. Of 23,264 travelers, 3,663 (16%) travelers were classified as HSWs. Among HSWs, 1,269 (35%) travelers were medical workers, 1,298 (35%) travelers were non-medical service workers, and 990 (27%) travelers were missionaries. Median age was 29 years, and 63% of travelers were female. Almost one-half (49%) traveled to 1 of 10 countries; the most frequent destinations were Haiti (14%), Honduras (8%), and Kenya (6%). Over 90% of travelers were vaccinated for or considered immune to hepatitis A, typhoid, and yellow fever. However, for hepatitis B, 292 (29%) of 990 missionaries, 228 (18%) of 1,298 non-medical service workers, and 76 (6%) of 1,269 medical workers were not vaccinated or considered immune. Of HSWs traveling to Haiti during 2010, 5% of travelers did not receive malaria chemoprophylaxis. Coordinated efforts from HSWs, HSW agencies, and clinicians could reduce vaccine coverage gaps and improve use of malaria chemoprophylaxis.

[Classification of mental disorders of soldiers participating in peace missions and warfare actions]. / Klasyfikacja zaburzen, psychicznych u zolnierzy w czasie misji pokojowych i dzialaniach wojennych.

Numerous media reports (press, radio, television) and several scientific publications on psychiatric disorders among Polish soldiers participating in peace missions in Iraq indicate that there is a serious threat caused by the disorders defined in the DSM-IV classification as: acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The authors analyzed psychiatric documentation and conducted their own researches, which revealed that adjustment disorders, especially with anxiety, are the main psychiatric problem among Polish soldiers in Iraq, while incidence of ASD and PTSD is very low. The aim of this publication is to present and compare mental disorders which occur during peace missions and welfare actions according to the international ICD-10 and American DSM-IV classifications. The authors paid attention to the role and significance of hitherto diagnosed impulsive disorders, which occur among the soldiers in Iraq as the intermittent explosive disorder, according to DSM-IV. The general and essential conclusions of the presented publication is that the guidelines of diagnosing mental disorders that occur during peace missions and welfare actions should be developed and introduced quickly.

Determinants of the choice of health care provider in Nigeria.

The study investigated the determinants of households' choice of health care provider in Nigeria. Individual and household based questionnaires were used for the study. Using a multinomial logit model, the findings revealed that both distance and money prices are significant factors in discouraging individuals from seeking modem health care services but money prices was less important as a determinant of the choice of health care provider. And from the descriptive analysis, money price was a major reason why many low income households opted for the self-care option. Furthermore, the study showed that older people tend to patronize public and private hospitals.

Exploring the pattern of complications of induced abortion in a rural mission tertiary hospital in the Niger Delta, Nigeria.

Unsafe abortion remains a major cause of maternal morbidity and mortality in developing countries including Nigeria. We report a 10-year descriptive review of 118 consecutive cases of complicated induced abortions. At our centre, complications of induced abortion constituted 2.3% of maternal admissions, 5.6% of gynaecological admissions and 22.6% of maternal deaths. Fifty-nine percent of the women were married and the mean age was 25.6 +/- 7.9 years. Doctors performed 51.7% of the induced abortion and nurses performed 13.9%. Of the mortalities, medical doctors did 61 of the abortions in which 18 died (29.5%); traditional medical practitioners were responsible for 13 of the abortions in which two died (15.4%); of the 16 abortions performed by nurses, two died (12.5%). Sepsis was the most common cause of death (73%). There is an urgent need to improve the knowledge and utilization of modern contraception by rural women in order to prevent unwanted pregnancies. Doctors need to be continuously trained inn the basic principles of postabortion care.

Traumatic events and posttraumatic stress in cross-cultural mission assignments.

In addition to cross-cultural and environmental stressors, aid workers and missionaries are frequently exposed to trauma. We explored the frequency of traumatic events, their mental health impact, and factors associated with posttraumatic stress in two groups of missionaries, one representing a predominantly stable setting (Europe) and the other an unstable setting (West Africa). The 256 participants completed self-report measures assessing lifetime traumatic events, current posttraumatic stress, depressive and anxiety symptoms, resilience, and functioning. The rate of traumatic events was significantly higher in the unstable setting. More-frequent traumatic events were associated with higher posttraumatic stress. Factors associated with the severity of posttraumatic stress were depression, functional impairment, subjective severity and number of traumatic events, and the level of resilience.

Promises and challenges of faith-based AIDS care and support in Mozambique.

OBJECTIVES: We sought to examine the role of religious organizations in the provision of HIV/AIDS-related assistance in Africa. METHODS: We used data collected from Christian religious organizations in southern Mozambique. Bivariate comparisons and logistic regression analysis of survey data were performed. We conducted an analysis of the qualitative data to complement the quantitative results. RESULTS: Our analysis revealed little involvement of religious organizations in provision of assistance. Most assistance was decentralized and consisted of psychological support and some personal care and household help. Material or financial help was rare. Assistance to nonmembers of congregations was reported more often than to members. Members of larger and better-secularly connected congregations were more likely to report assistance than were members of smaller and less-secularly engaged ones. Assistance was reported more in cities than in rural areas. Women were more likely than men to report providing assistance to congregation members, and the reverse was true for assistance provided to nonmembers. The cooperation of religious organizations in provision of assistance was hindered by financial constraints and institutional rivalry. CONCLUSIONS: Policy efforts to involve religious organizations in provision of HIV/AIDS-related assistance should take into account that organization's resources, institutional goals, and social characteristics.

Survey of rabies preexposure and postexposure prophylaxis among missionary personnel stationed outside the United States.

BACKGROUND: Of the 36 cases of human rabies that have occurred in the United States since 1980, 12 (33%) were presumed to have been acquired abroad. In the United States, it is recommended that international travelers likely to come in contact with animals in canine rabies-enzootic areas that lack immediate access to appropriate medical care, including vaccine and rabies immune globulin, should be considered for preexposure prophylaxis. In 1992, the death of an American missionary who had contracted rabies while stationed in Bangladesh highlighted this high-risk group. METHODS: To assess their knowledge of rabies risk, rabies exposures, and compliance with preventive recommendations, we asked 695 missionaries and their family members to complete questionnaires about their time stationed abroad. RESULTS: Of the 293 respondents stationed in countries where rabies is endemic, 37% reported prior knowledge of the presence of rabies in their country of service. Only 28% of the personnel stationed in rabies-endemic countries received preexposure prophylaxis. Having preexposure prophylaxis specifically recommended increased the likelihood of actually receiving it (O.R. 15.6, 95%CI 7.4 - 34.9). There were 38 reported exposures (dogs = 66%, another human = 20%), proven or presumed to be rabid. Three of the people exposed received rabies immune globulin and vaccine; 11 received vaccine alone; 8 received only basic first aid, and 16 received no treatment. CONCLUSIONS: Although American missionaries stationed abroad are at an increased risk for exposure to rabies, compliance with established preventive measures was low. Prior to being stationed abroad, an educational rabies-prevention briefing, including encouragement to receive preexposure prophylaxis, could be an effective intervention for missionaries to decrease their risk of rabies.

Asthma in Hawaii: a tradition of excess mortality.

Hawaii has the highest asthma mortality in the nation and clinically has always had high rates. In contrast, international consensus has it that deaths have been rare over the past two centuries to 1950. The objective of this study was to document Hawaii's asthma mortality over the centuries to 1950. Asthma mortality was examined from pre- and early European times through kahunas, aphorisms, historical libraries, and materia medica. In 1879, vital statistics became available locally and from 1901 from the federal government. Asthma deaths were not rare in ancient Hawaii. Vital statistics in 1879 revealed an asthma mortality of 83/100,000 which declined to 4.0 by 1950. U.S. and international mortality, at least to 1930, was almost unknown. Compared to U.S. and international rates, Hawaii's asthma mortality has been excessive since ancient days.

Mortality trends of American missionaries in Africa, 1945-1985.

Mortality trends of missionary staff serving in sub-Saharan Africa were tracked for the period 1945-1985. For 1945-1970, when more complete incidence data were available, the missionary death rate was approximately 40% lower, after adjustment, than would be expected in a comparable US population. This trend persisted through 1985. Between 1945 and 1970, the largest number of fatalities was attributable to malignancy, atherosclerosis, accidents, and infectious disease, and the greatest mortality risks, compared with the US experience, were from homicides, the complications of pregnancy, and infections, notably malaria, hepatitis, and polio. Beginning in the late 1950s, motor vehicle accidents became the leading cause of death. Since the 1960s, accidental causes of death have been approximately 50% higher than in the US, and homicides have been four times higher. During this same period, the infectious disease death rate decreased to approximately that within the US. Currently, the leading causes of mortality are motor vehicle accidents, malignancy, and atherosclerosis, followed by other accidental causes, notably aircraft mishaps and drownings. Viral hepatitis is presently the leading infectious disease cause of death. Other contemporary lethal infections include malaria, rabies, typhoid, Lassa fever, and retroviral infection. It was concluded that missionaries in sub-Saharan Africa had a death rate approximately half that expected in a comparable domestic control population. Preventive strategies, particularly relative to accident and infectious disease prevention, could effectively reduce mortality risk further.