ORIGINAL_ARTICLE
“HEXAL Model” How It Can Collaborate With Health Service Providers and Travel Medicine
Introduction: Nowadays the trend to travel abroad has extremely grown. This is while, paying attention to travelers’ health is an incredibly important issue. Many organizations try their best to provide health services during travelers’ trips. Meanwhile, the biggest and most effecting health care providers all around the world are hospitals. Regarding this fact, a theory has been presented to help these organizations coordinate and direct much more effectively in compared to the past. It is noticeable to mention that this theory can help health care providers to gain a more sustainable position in order to develop medical tourism in their centers.Methods: A theory has been presented in this research with different dimensions. The major aspects of this model have been designed according to the relationships which exist in families. These relationships include: parents, children and others. Each of these aspects have been divided into two segments which are female and male. These aspects play their roles in three different dimensions.Results: According to the results this study, it can be mentioned that there are 6 relationships in regards to the HEXAL Model in health service providers. These relationships include mother, father, sister, brother, step sister and other relationships. It can be also said that each of these dimensions have different responsibilities in both health care providers and travel medicine.Conclusion: By using this model, health service providers can collaborate much more effectively. As a result, medical tourists and even other tourists can experience much more satisfying trips throughout their lives.
https://www.ijtmgh.com/article_46735_81e1039010c9d3fadaa128bdd02562a0.pdf
2017-06-01
38
40
10.15171/ijtmgh.2017.08
Hexal Model
Health Services
Travel Medicine
Hospitals
Morteza
Izadi
morteza_izadi@yahoo.com
1
International Travel Medicine Center of Iran, Tehran, Iran
AUTHOR
Mohammadjavad
Hoseinpourfard
hpf.javad@gmail.com
2
International Travel Medicine Center of Iran, Tehran, Iran
LEAD_AUTHOR
Zahra
Farhangi
za_farhangi89@yahoo.com
3
International Travel Medicine Center of Iran, Tehran, Iran
AUTHOR
Ali
Ayoubian
ayoobian@hotmail.com
4
Department of Health Services Management, Islamic Azad University, Tehran North Branch, Tehran, Iran
AUTHOR
Whittaker A, Chee HL, Por HH. Regional circuits of international medical travel: prescriptions of trust, cultural affinity and history. Asia Pac Viewp. 2017. doi:10.1111/apv.12158.
1
Khan MJ, Chelliah S, Haron MS, Ahmed S. Push factors, risks, and types of visit intentions of international medical travelers–A conceptual model. Int J Healthc Manag. 2017;10(2):115-121. doi:10.1080/20479700.2017.1304345.
2
Samadbeik M, Asadi H, Mohseni M, Takbiri A, Moosavi A, Garavand A. Designing a medical tourism website: a qualitative study. Iran J Public Health. 2017;46(2):249-257.
3
Connell J. Transnational health care: global markets and local marginalisation in medical tourism. In: Parry B, Greenhough B, Dyck I, eds. Bodies Across Borders: The Global Circulation of Body Parts, Medical Tourists and Professionals. Farnham: Ashgate; 2015:75-93.
4
Loh CPA. Trends and structural shifts in health tourism: Evidence from seasonal time-series data on health-related travel spending by Canada during 1970-2010. Soc Sci Med. 2015;132:173-180. doi:10.1016/j.socscimed.2015.03.036.
5
Moghavvemi S, Ormond M, Musa G, et al. Connecting with prospective medical tourists online: a cross-sectional analysis of private hospital websites promoting medical tourism in India, Malaysia and Thailand. Tour Manag. 2017;58:154-163. doi:10.1016/j.tourman.2016.10.010.
6
Hoseinpourfard M, Ghanei M, Tofighi S, Ayoubian A, Izadi M. The emergence of Hajj stampedes: lessons for draw near in the Islamic values in Hajj Trauma centers accreditation. Trauma Mon. 2017; In Press. doi:10.5812/traumamon.39455.
7
Izad M, Hoseinpourfard M, Ayoubian A, Karbasi M, Jahangiri M, Jalali A. A Survey to the implementation of Islamic standards in the hospitals of Iran for attraction of muslim medical tourists. Int J Travel Med Glob Health. 2014;1(3):99-102.
8
Noree T, Hanefeld J, Smith R. Medical tourism in Thailand: a crosssectional study. Bull World Health Organiz. 2016;94(1):30-36.
9
Seow AN, Choong YO, Moorthy K, Chan LM. Intention to visit Malaysia for medical tourism using the antecedents of Theory of planned behaviour: a predictive model. International Journal of Tourism Research. 2017;19(3):383-393. doi:10.1002/jtr.2120.
10
Kangas B. Hope from abroad in the international medical travel of Yemeni patients. Anthropol Med. 2007;14(3):293-305.
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Connell J, Fara X. Medical tourism in the Caribbean islands: a cure for economies in crisis. Island Stud J. 2013;8(1):115-130.
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Glinos IA, Baeten R, Helble M, Maarse H. A typology of crossborder patient mobility. Health place. 2010;16(6):1145-1155.
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Kasemsap K. Facilitating hospitality and tourism management in global business. In: Pappas N, Bregoli I, eds. Global Dynamics in Travel, Tourism, and Hospitality. Hershey: IGI Global; 2016:283-305.
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Aydin G, Karamehmet B. Factors affecting health tourism and international health-care facility choice. Int J Pharm Healthc Mark. 2017;11(1):16-36. doi:10.1108/IJPHM-05-2015-0018.
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Ormond M, Sulianti D. More than medical tourism: lessons from Indonesia and Malaysia on South–South intra-regional medical travel. Current Issues in Tourism. 2017;20(1):94-110. doi:10.1080/13683500.2014.937324.
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Bolton S, Skountridaki L. The medical tourist and a political economy of care. Antipode. 2017;49(2):499-516. doi:10.1111/anti.12273.
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Pennings G. The ethical management of medical tourism. In: Botterill D, Pennings G, Mainil T, eds. Medical Tourism and Transnational Health Care. London, UK: Palgrave Macmillan; 2013:179-193.
18
American Hospital Association. Fast facts on US hospitals. http://www.aha.org/research/rc/stat-studies/fast-facts.shtml. Accessed May 2014.
19
Izadi M, Ayoubian A, Hoseinpourfard M. Health tourism: a comprehensive guide for tourism policy makers, health managers, travel agencies, insurance and investors. Tehran: Baqiyatallah University of Medical Sciences; 2016.
20
Dai Liyang ZF, Yunsheng K. The essence of hospital website construction and thinking of constructing outstanding hospital websites. China Medical Education Technology. 2010. 4: p. 020.
21
ORIGINAL_ARTICLE
Ocular Problems in High-Altitude Traveling: A Review With Focus on Management
Traveling to high altitudes can expose the eye to reduced ambient cold and low-pressure environments. These conditions can affect the physiology of the eye and may result in ocular problems and visual disturbances. In this paper, ocular disorders related to high altitudes are briefly reviewed. Then, high-altitude ocular disorders are categorized in three parts: those related to dry and cold environments, those related to low-pressure environments, and those in people with past ocular conditions. In every part, the signs and symptoms of related diseases are discussed. Up-to-date recommendations for the management and prevention of these disorders are presented. The main management for ocular disorders related to dry and cold environments includes the use of eye shields and artificial tear drops. Descending to low-altitude lands is the key to managing eye problems associated with low-pressure environments. Patients with past ocular problems or ocular surgery should consult their doctors before ascending to high altitudes.
https://www.ijtmgh.com/article_46490_93a5194d8196fd0ca71bb5b401b29a23.pdf
2017-06-01
41
45
10.15171/ijtmgh.2017.09
Eye
Altitude
Travel
Ocular disorders
Morteza
Izadi
morteza_izadi@yahoo.com
1
Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Mohsen
Pourazizi
m.pourazizi@yahoo.com
2
Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
AUTHOR
Mohammad-Hasan
Alemzadeh-Ansari
mh.aansari@gmail.com
3
Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
LEAD_AUTHOR
Ellerton JA, Zuljan I, Agazzi G, Boyd JJ. Eye problems in mountain and remote areas: prevention and onsite treatment—official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM. Wilderness Environ Med. 2009;20(2):169-175. doi:10.1580/08-WEME-REV-205R1.1.
1
Mader TH, Tabin G. Going to high altitude with preexisting ocular conditions. High Alt Med Biol. 2003;4(4):419-430. doi:10.1089/152702903322616173.
2
Karaküçük S, Mirza GE, Rul G. Ophthalmological effects of high altitude. Ophthalmic Res. 2000;32(1):30-40.
3
Jokela K, Leszczynski K, Visuri R. Effects of Arctic ozone depletion and snow on UV exposure in Finland. Photochem Photobiol. 1993;58(4):559-566.
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McKenzie RL, Johnston PV, Smale D, Bodhaine BA, Madronich S. Altitude effects on UV spectral irradiance deduced from measurements at Lauder, New Zealand, and at Mauna Loa Observatory, Hawaii. J Geophys Res. 2001;106(D19):22845-22860.
5
Meinander O, Kontu A, Asmi E, Sanchez R, Mei M, de Leeuw G. Bipolar high temporal resolution measurements of snow UV albedo in Sodankylä and Marambio. Paper presented at: EGU General Assembly Conference Abstracts; 2015.
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Schein OD. Phototoxicity and the cornea. J Natl Med Assoc. 1992;84(7):579.
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Willmann G. Ultraviolet Keratitis: from the pathophysiological basis to prevention and clinical management. High Alt Med Biol. 2015;16(4):277-282. doi:10.1089/ham.2015.0109.
8
Blumthaler M, Ambach W, Daxecker F. On the threshold radiant exposure for keratitis solaris. Invest Ophthalmol Vis Sci. 1987;28(10):1713-1716.
9
Patel M, Fraunfelder FW. Toxicity of topical ophthalmic anesthetics. Expert Opin Drug Metab Toxicol. 2013;9(8):983-988. doi:10.1517/17425255.2013.794219.
10
Morris DS, Evans S. Visual performance in extreme sports. In: Feletti F, ed. Extreme Sports Medicine. Springer; 2017:417-428.
11
Bartlett JD, Keith MS, Sudharshan L, Snedecor SJ. Associations between signs and symptoms of dry eye disease: a systematic review. Clin Ophthalmol. 2015;9:1719-1730. doi:10.2147/OPTH. S89700.
12
Gupta N, Prasad I, Himashree G, D’Souza P. Prevalence of dry eye at high altitude: a case controlled comparative study. High Alt Med Biol. 2008;9(4):327-334. doi:10.1089/ham.2007.1055.
13
Kangari H, Eftekhari MH, Sardari S, et al. Short-term consumption of oral omega-3 and dry eye syndrome. Ophthalmology. 2013;120(11):2191-2196. doi:10.1016/j.ophtha.2013.04.006.
14
Diez-Feijóo E, Grau AE, Abusleme EI, Durán JA. Clinical presentation and causes of recurrent corneal erosion syndrome: review of 100 patients. Cornea. 2014;33(6):571-575. doi:10.1097/ICO.0000000000000111.
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Basnyat B, Wu T, Gertsch JH. Neurological conditions at altitude that fall outside the usual definition of altitude sickness. High Alt Med Biol. 2004;5(2):171-179.
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Dickinson J. Transient monocular amaurosis at high altitude. High Alt Med Biol. 2001;2(1):75-75.
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Basnyat B, Cumbo TA, Edelman R. Acute medical problems in the Himalayas outside the setting of altitude sickness. High Alt Med Biol. 2000;1(3):167-174.
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Virués-Ortega J, Buela-Casal G, Garrido E, Alcázar B. Neuropsychological functioning associated with high-altitude exposure. Neuropsychol Rev. 2004;14(4):197-224.
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Dickinson JG. High altitude cerebral edema: Cerebral acute mountain sickness. Paper presented at: Seminars in Respiratory Medicine; 1983.
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Kramár PO, Drinkwater BL, Folinsbee LJ, Bedi JF. Ocular functions and incidence of acute mountain sickness in women at altitude. Aviat Space Environ Med. 1983;54(2):116-120.
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Frayser R, Houston CS, Bryan AC, Rennie ID, Gray G. Retinal hemorrhage at high altitude. N Engl J Med. 1970;282(21):1183-1184.
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Wiedman M. High altitude retinal hemorrhage. Arch Ophthalmol. 1975;93(6):401-403.
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Hanifudin A, Lim LT, Ah-Kee EY, El-Khashab T. High altitude subhyaloid hemorrhage. Oman J Ophthalmol. 2015;8(3):213.
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Morris DS, Severn PS, Smith J, Somner JE, Stannard KP, Cottrell DG. High altitude and retinal detachment. High Alt Med Biol. 2007;8(4):337-339.
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Bandyopadhyay S, Singh R, Gupta V, Gupta A. Anterior ischaemic optic neuropathy at high atitude. Indian J Ophthalmol. 2002;50(4):324.
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Arora R, Jha K, Sathian B. Retinal changes in various altitude illnesses. Singapore M J. 2011;52(9):685-688.
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Wiedman M, Tabin GC. High-altitude retinopathy and altitude illness. Ophthalmology. 1999;106(10):1924-1927.
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Clarke C, Duff J. Mountain sickness, retinal haemorrhages, and acclimatisation on Mount Everest in 1975. Br Med J. 1976;2(6034):495-497.
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Bosch MM, Barthelmes D, Merz TM, et al. High incidence of optic disc swelling at very high altitudes. Arch Ophthalmol. 2008;126(5):644-650. doi:10.1001/archopht.126.5.644.
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Willmann G, Fischer MD, Schatz A, et al. Quantification of optic disc edema during exposure to high altitude shows no correlation to acute mountain sickness. PLoS One. 2011;6(11):e27022. doi:10.1371/journal.pone.0027022.
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Morris DS, Somner J, Donald MJ, et al. The eye at altitude. Hypoxia and Exercise. Springer; 2006:249-270.
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Pavlidis M, Stupp T, Georgalas I, Georgiadou E, Moschos M, Thanos S. Intraocular pressure changes during highaltitude acclimatization. Graefes Arch Clin Exp Ophthalmol. 2006;244(3):298-304.
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Somner JE, Morris DS, Scott KM, MacCormick IJ, Aspinall P, Dhillon B. What happens to intraocular pressure at high altitude? Invest Ophthalmol Vis Sci. 2007;48(4):1622-1626. doi:10.1167/iovs.06-1238.
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Mieske K, Flaherty G, O’Brien T. Journeys to high altitude—risks and recommendations for travelers with preexisting medical conditions. J Travel Med. 2010 n;17(3):214. doi:10.1111/j.1708-8305.2010.00414.x.
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Houston S, Graf J, Sharkey J. Commercial air travel after intraocular gas injection. Aviat Space Environ Med. 2012;83(8):809-810.
48
Levasseur SD, Rahhal FM. Travel to high mountain elevations following vitrectomy with intraocular gas. Retina. 2013;33(7):1456-1461. doi:10.1097/IAE.0b013e318280766f.
49
Kokame GT, Ing MR. Intraocular gas and low-altitude air flight. Retina. 1994;14(4):356-358.
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Lincoff H, Weinberger D, Reppucci V, Lincoff A. Air travel with intraocular gas: I. The mechanisms for compensation. Arch Ophthalmol. 1989;107(6):902-906.
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Lincoff H, Weinberger D, Stergiu P. Air travel with intraocular gas: II. Clinical considerations. Arch Ophthalmol. 1989;107(6):907-910.
53
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54
Leal C, Admetlla J, Viscor G, Ricart A. Diabetic retinopathy at high altitude. High Alt Med Biol. 2008;9(1):24-27.
55
ORIGINAL_ARTICLE
Vaccinations of International Travellers From Greece to Sub-Saharan Africa
Introduction: The number of travellers from Greece who travel to sub-Saharan Africa has increased during the last decade. Our aim in this research was to study vaccination patterns for travellers travelling to sub-Saharan Africa.Methods: A cross-sectional study was conducted from January 2011 until December 2014 in all (57) public health departments in Greece. Travellers over 18 years travelling to sub-Saharan Africa participated in this study. A standard form was used in order to collect data about travellers’ demographics, immunization history and travel information.Results: During the study period, 1768 travellers (median age: 39.2 years) travelling to sub-Saharan Africa participated. Among them, 69.2% of them were male and 95.4% of them had a Greek nationality. Nigeria was their most common destination (15.7%). Among all the travellers, 56.7% stayed in urban areas, 57.9% travelled for less than one month, 58.5% for work, 29% for vacation, and 5.8% for visiting friends and relatives. Furthermore, 79.7%, 30.9%, 19.7%, 16.8%, and 14.1% received the yellow fever, typhoid fever, tetanus-diphtheria, hepatitis A, and meningococcal vaccines, respectively. The purpose of travelling was statistically significantly associated with gender, nationality, and the duration of travel. Tetanus, hepatitis A & B, poliomyelitis, rabies and meningococcal vaccines were more commonly recommended for recreational travel, whereas tetanus, hepatitis A, and poliomyelitis vaccines for short-term travellers and typhoid vaccine for long-term travellers.Conclusion: It can be concluded that vaccination rrecommendations should be improved for the travellers to sub-Saharan Africa. Individualized and more selective pre-travel recommendations are needed taking in consideration the purpose and duration of travel, the area and place of stay.
https://www.ijtmgh.com/article_46491_5056a39ece0f40aface5b8bb918f900f.pdf
2017-06-01
46
52
10.15171/ijtmgh.2017.10
Travellers
Sub-Saharan Africa
Vaccinations
Recommendations
Androula
Pavli
androulapavli@yahoo.com
1
Travel Medicine Office, Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
AUTHOR
Paraskevi
Smeti
smeti@keelpno.gr
2
Travel Medicine Office, Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
AUTHOR
Fotini
Antoniadou
antoniadou@keelpno.gr
3
Regional Department of Public Health of Attica, Athens, Greece
AUTHOR
Panos
Katerelos
panos.katerelos@gmail.com
4
Travel Medicine Office, Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
AUTHOR
Helena
Maltezou
helen-maltezou@ath.forthnet.gr
5
Travel Medicine Office, Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
LEAD_AUTHOR
World Tourism Organization. Annual report 2014. http://dtxtq4w60xqpw.cloudfront.net/sites/all/files/pdf/unwto_annual_report_2014.pdf. Accessed November 26, 2016.
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Khan K, Arino J, HuW, et al. Spread of a novel influenza A (H1N1) virus via global airline transportation. N Engl J Med. 2009;361:212-214. doi:10.1056/NEJMc0904559.
2
Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. 2006;354()2):119–30. doi:10.1056/NEJMoa051331.
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Leder K, Torresi J, Libman MD, et al. GeoSentinel Surveillance Network. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med. 2013;158(6):456-468. doi:10.7326/0003-4819-158-6-201303190-00005.
4
Boggild AK, Castelli F, Gautret P, et al. Vaccine-preventable diseases in returned international travelers: results from the GeoSentinel Surveillance Network. Vaccine 2010;28(46):7389-7395. doi:10.1016/j.vaccine.2010.09.009.
5
Maltezou HC, Patrinos S, Veneti L, et al. Hepatitis A and enteric fever in Greece, 2004-2011: a cross-sectional analysis. Travel Med Infect Dis. 2014;12(2):143-148. doi:10.1016/j.tmaid.2013.10.004.
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Wilson ME, Weld LH, Boggild A, et al. Fever in returned travelers: results from the GeoSentinel Surveillance Network. Clin Infect Dis. 2007;44:1560-1568. doi:10.1086/518173.
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Hatz C, Chen LH. Pre-travel consultation. In: Keystone JS, Freedman DO, Kozarsky PE, Connor BA, Nothdurft HD, eds. Travel Medicine. 3rd ed. Spain: Mosby; 2013:77-101.
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Hellenic Centre for Disease Control and Prevention (KEELPNO). http://www.keelpno.gr/el. Accessed February 16, 2017.
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World Health Organization. International Travel and Health 2012. http://www.who.int/ith/ITH_chapter_6.pdf?ua=1. Accessed November 26, 2016.
10
Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/destinations/list/. Accessed February 16, 2017.
11
National Vaccination Program for Children and Adolescents (in Greek). https://diavgeia.gov.gr/. Accessed November 26, 2016. Published 2011.
12
Smeti P, Pavli A, Katerelos P, Maltezou HC. Typhoid vaccination for international travelers from Greece visiting developing countries. J Travel Med. 2014;21:99-103. doi:10.1111/jtm.12076.
13
Pavli A, Katerelos P, Smeti P, Maltezou HC. Meningococcal vaccination for international travelers from Greece visiting developing countries. Travel Med Infect Dis. 2016;14:261-266 .
14
Hellenic Statistical Authority. http://www.statistics.gr/statistics/-/publication/STO15/. Accessed 12 March, 2016.
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Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med 2004;11:23-26.
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Van Herck K, Van Damme P, Castelli F, et al. Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey. J Travel Med. 2004;11:3-8.
17
Wilder-Smith A, Khairullah NS, Song JH, et al. Travel health knowledge, attitudes and practices among Australasian travelers. J Travel Med. 2004;11:9-15.
18
Pavli A, Spilioti A, Smeti P, et al. Vaccination and malaria prevention among international travelers departing from Athens International Airport to African destinations. J Trop Med. 2014;2014:563030. doi:10.1155/2014/563030.
19
World Health Organization. Disease Outbreak News. http://www.who.int/csr/don/22-april-2016-yellow-fever-china/en/. Accessed February 16, 2017.
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Gunaratnam P, Tobin S, Seale H, McAnulty JM. Infectious diseases in returned travelers, NSW, 2010-2011. N S W Public Health Bull. 2014;24:171-175.
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Hellenic Centre for Disease Control and Prevention (KEELPNO). http://www.keelpno.gr/el. Accessed March 12, 2016.
22
Monge-Maillo B, Norman FF, Pérez-Molina JA, et al. Travelers visiting friends and relatives (VFRs) and imported infectious disease: travelers, immigrants or both? a comparative analysis. Travel Med Infect Dis. 2014;12(1):88-94. doi:10.1016/j.tmaid.2013.07.004.
23
Steinberg EB, Bishop R, Haber P, et al. Typhoid fever in travelers: who should be targeted for prevention? Clin Infect Dis. 2004;39:186-191.
24
Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/typhoid-paratyphoid-fever. Accessed March 12, 2015.
25
Larocque RC, Rao SR, Lee J, et al. Global TravEpiNet: a national consortium of clinics providing care to international travelers - analysis of demographic characteristics, travel destinations, and pre-travel healthcare of high-risk US international travelers, 2009-2011. Clin Infect Dis. 2012;54(4):455-462. doi:10.1093/cid/cir839.
26
Steffen R. Changing travel-related global epidemiology of hepatitis A. Am J Med. 2005;118(suppl 10A):S46-S49.
27
Mutsch M, Spicher VM, Gut C, Steffen R. Hepatitis A virus infections in travelers, 1988–2004. Clin Infect Dis. 2006;42:490–497.
28
Leggat PA, Zwar NA, Hudson BJ. Travel Health Advisory Group, Australia. Hepatitis B risks and immunisation coverage amongst Australians traveling to Southeast Asia and East Asia. Travel Med Infect Dis. 2009;7(6):344-349. doi:10.1016/j.tmaid.2009.03.008.
29
Zuckerman JN, Hoet B. Hepatitis B immunisation in travelers: poor risk perception and inadequate protection. Travel Med Infect Dis. 2008;6(5):315-320. doi:10.1016/j.tmaid.2008.05.001.
30
World Health Organization. International Travel and Health, http://www.who.int/ith/chapters/ith2012en_chap6.pdf. Accessed Accessed March 12, 2016.
31
Goodman AL, Masuet-Aumatell C, Halbert J, Zuckerman JN. Awareness of meningococcal disease among travelers from the United Kingdom to the meningitis belt in Africa. Am J Trop Med Hyg. 2014;91(2):281-286. doi:10.4269/ajtmh.13-0763.
32
Pavli A, Saroglou G, Hadjianastasiou S, et al. Knowledge and practices about rabies among travel medicine consultants in Greece. Travel Med Infect Dis. 2011;9(1):32-36. doi:10.1016/j.tmaid.2010.11.004.
33
Altmann M, Parola P, Delmont J, et al. Knowledge, attitudes, and practices of French travelers from Marseille regarding rabies risk and prevention. J Travel Med. 2009;16(2):107-111. doi:10.1111/j.1708-8305.2008.00283.x.
34
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35
ORIGINAL_ARTICLE
Pre-travel Health Care Utilization Among Travelers Who Visit Friends and Relatives
Introduction: Immigrants to the United States who return home to visit friends and relatives (VFRs) have high rates of travel-related infections. The data on VFR utilization of pre-travel health care is inadequate. The objective of this study was to describe the travel patterns and adherence to pre-travel recommendations of VFRs.Methods: This retrospective study compared pre-travel health care utilization between VFR and non-VFR patients in one travel clinic from 2012-2013. Study investigators reviewed patients’ electronic medical records for demographic data, travel characteristics, and rates of immunizations and preventive medication prescriptions (i.e. antimalarial prophylaxis and antibiotics for traveler’s diarrhea). Categorical variables were compared using chi-square tests. Multivariate logistic regression was used to model adjusted associations of VFR with completion of pre-travel recommendations.Results: VFRs (n = 393) were younger than non-VFRs (n = 1680), more often required interpreters for language translation, and more commonly had government insurance coverage than non-VFRs. VFRs were more likely to travel to lower-income countries in Africa, Asia, and the Middle East. VFRs had longer durations of travel: 51% for >4 weeks vs. 21% for non-VFRs (P < 0.0001). VFRs were less likely to complete tetanus, polio, and rabies vaccinations, but more likely to complete measles, mumps, and rubella vaccinations. Only the association with the rabies vaccination remained significant after adjustment (OR [95% CI] = 0.3 [0.1, 0.8]).Conclusion: VFRs had longer travel durations and lower rates of vaccine completion than non-VFRs. More research is needed to understand this disparity and to promote changes in practice.
https://www.ijtmgh.com/article_48066_d9ce0a2c7bcb061357e603cb2b21dcd6.pdf
2017-06-01
53
59
10.15171/ijtmgh.2017.11
Emigrants and Immigrants
Vaccination
Immunization
Travel Medicine
Eugene
Tan
etan.eugene@gmail.com
1
Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
LEAD_AUTHOR
Jane
Njeru
njeru.jane@mayo.edu
2
Division of Primary Care Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Debra
Jacobson
djacobsn@mayo.edu
3
Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Patrick
Wilson
wilson.patrick@mayo.edu
4
Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Chun
Fan
fan.chun@mayo.edu
5
Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Jasmine
Marcelin
marcelin.jasmine@mayo.edu
6
Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Donna
Springer
miller.donna2@mayo.edu
7
Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Mark
Wieland
wieland.mark@mayo.edu
8
Division of Primary Care Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Irene
Sia
sia.irene@mayo.edu
9
Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
AUTHOR
Francyne Harrigan F, Seo SM. 244 million international migrants living abroad worldwide, new UN statistics reveal. Sustainable Development; 2016. http://www.un.org/sustainabledevelopment/blog/2016/01/244-million-international-migrants-living-abroadworldwide-new-un-statistics-reveal/.
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Dews F. What Percentage of the U.S. Population is Foreign Born? Vol 2017. Washington DC: Brookings; 2013.
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Keystone JS. Immigrants Returning Home to Visit Friends & Relatives (VFRs). In: Brunette GW, ed. CDC Health Information for International Travel 2014. New York: Oxford University Press; 2013.
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Heywood AE, Zwar N, Forssman BL, et al. The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance. Epidemiology and infection. 2016. doi:10.1017/S0950268816001734.
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ORIGINAL_ARTICLE
A Progressive Multilevel Model for Selecting Medical Tourism Destinations: A Qualitative Study
Introduction: The overall objective of this study was to design a progressive multilevel model using the Delphi method for selecting a medical tourism destination which includes three levels of decision making: the destination country, then the destination city, and finally, the healthcare center in the selected city. This model can be used as a new area of research for further planning in Iran’s growing medical tourism industry. Methods: This study is a descriptive, practical research using a qualitative approach. In the preliminary stage, an extensive review of the literature was performed, and the Delphi method was used to identify factors influencing the selection of Iran as a medical tourism destination. Experts participating in the Delphi panel reached consensuses after applying three rounds. Analysis of the data from the Delphi panel resulted in the construction of a multilevel model for selecting a medical tourism destination. Results: The outcome of this research was a constructed multilevel model for selecting a medical tourism destination. The model indicates all factors influencing the selection of each level of destination. It also includes two stages of decision making (medical tourism and information search), which come before the selection of three levels of destination. Conclusion: Iran’s political and economic situations after the imposition of sanctions and its problems in providing banking services for medical tourists are among the factors influencing medical tourists not to choose Iran as their destination. Government support, planned promotional activities, and JCI accreditations could increase the attraction of medical tourists to Iran.
https://www.ijtmgh.com/article_48145_3fdcacb6d0e92a9e15ad8b44c6546b2e.pdf
2017-06-01
60
68
10.15171/ijtmgh.2017.12
Medical tourism
Multilevel model
Iran
Zohreh
Dehdashti Shahrokh
zdehdashti33@gmail.com
1
Marketing Management Department, Faculty of Management & Accounting, Allameh Tabataba'i University, Tehran, Iran
LEAD_AUTHOR
Hamid
Zargham Brojeni
zargham@atu.ac.ir
2
Tourism Management Department, Faculty of Management & Accounting, Allameh Tabataba'i University, Tehran, Iran
AUTHOR
Vahid
Nasehifar
vahidnasehifar@yahoo.com
3
Marketing Management Department, Faculty of Management & Accounting, Allameh Tabataba'i University, Tehran, Iran
AUTHOR
Hosnieh
Nakhaei Kamalabadi
hnakhai@gmail.com
4
Allameh Tabataba'i University, Tehran, Iran
AUTHOR
Kumar GS, Raj RK. Status, growth and impact of medical tourism in India. Int J Pharm Sci Rev Res. 2015;34(1):284-291.
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Connell J. Contemporary medical tourism: conceptualisation, culture and commodi. Tour Manag. 2013;34:1-13.
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Turner L. “Medical tourism” and the global marketplace in health services: U.S. patients, international hospitals, and the search for affordable health care. Int J Health Serv. 2010;40(3):443-467. doi:10.2190/HS.40.3.d.
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Moghimehfar F, Nasr-Esfahani MH. Decisive factors in medical tourism destination choice: a case study of Isfahan, Iran and fertility treatments. Tour Manag. 2011;32(6):1431-1434.
4
Gholami M, Jabbari A, Kavosi Z, Gholami M. Service quality in iran’s medical tourism: hospitals in Shiraz city. Int J Travle Med Glob Health. 2016;4(1):19-24. doi:10.20286/ijtmgh-040119.
5
Asadi R, Daryaei M. Strategies for development of Iran health tourism. Eur J Soc Sci. 2011;23(3):329-344.
6
Izadi M, Ayoobian A, Nasiri T, Joneidi N, Fazel M, Hosseinpourfard M. Situation of health tourism in Iran; opportunity or threat. Mil Med J. 2012;14(2):69-75.
7
Jabbari A, Zarchi MR, Kavosi Z, Shafaghat T, Keshtkaran A. The marketing mix and development of medical tourism in Shiraz. Mater Sociomed. 2013;25(1):32-36. doi:10.5455/msm.2013.25.32-36.
8
Smith P, Forgione DA. Global outsourcing of healthcare: a medical tourism decision model. Journal of Information Technology Case and Application Research. 2008;9(3):19-31. doi:10.1080/15228053.2007.10856117.
9
Heung VCS, Kucukusta D, Song H. A conceptual model of medical tourism: implications for future research. Journal of Travel and Tourism Marketing. 2010;27(3):236-251. doi:10.1080/10548401003744677.
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Hueng VCS, Kucukusta D, Song H. Medical tourism development in Hong Kong: an assessment of the barriers. Tour Manag. 2011;32:995-1005.
11
Dehdashti ZS, Nakhaei HK. An entropy (Shannon) based approach for determining importance weights of infuencing factors in selecting medical tourism destination. Int J Travel Med Glob Health. 2016;4(4):115-121. doi:10.21859/ijtmgh-040406.
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Fetscherin M, Stephano RM. The medical tourism index: Scale development and validation. Tour Manag. 2016;52:539-556.
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Manouchehri J, Farhangi AA, Someeh S, Shakibaei E. The challenges of Kish health tourism: A case study. Int J Basic Appl Sci. 2014;3(3):335-343.
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Hajinejad A, Eslamfard F. Formulating Strategies for the development of treatment tourism in Shiraz (Iran) using a strategic planning approach (SWOT). J Rafsanjan Univ Med Sci. 2013;12(8):641-654. [Persian].
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Ye BH, Yuen PP, Qui HZ, Zhang VH. Motivation of medical tourists: an exploratory case study of Hong Kong medical tourists. PTA Annual Conference; 2008; Bangkok, Thailand.
17
Leng CH. Medical tourism in Malaysia: international movement of healthcare consumers and the commodification of healthcare. Asia Research Institute Working Paper Series No. 83; 2007.
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Dwyer L, Kim C. Destination competitiveness: determinants and indicators. Current Issues in Tourism. 2008;6(5):369-414. doi:10.1080/13683500308667962.
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Alsharif M, Labonte R. Patients beyond borders: a study of medical tourists in four countries. Glob Soc Policy. 2010;10:315-335. doi:10.1177/1468018110380003.
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Yu JY, Ko TG. A cross-cultural study of perceptions of medical tourism among Chinese, Japenese and Korean tourists in Korea. Tour Manag. 2012;33:80-88. doi:10.1016/j.tourman.2011.02.002.
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