International Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Lagging Behind – The Emerging Influence of Jet Lag Symptoms on Road Safety39448618510.15171/ijtmgh.2019.09ENShang Yuin ChaiSchool of Medicine, National University of Ireland Galway, Galway, IrelandGerard ThomasFlahertySchool of Medicine, National University of Ireland Galway, Galway, IrelandSchool of Medicine, International Medical University, Kuala Lumpur, Malaysia0000-0002-5987-1658Journal Article20190222Road traffic accidents are the leading cause of death in international travelers. With the growth of international travel, the number of visitors who rent a vehicle upon arrival at their destination by air or by sea is expected to increase. Jet lag is a well-recognized maladaptation to international travel across multiple time zones. Little is known about the possible influence of jet lag symptoms on the risk of road traffic collisions. Lack of awareness or failure to recognize the debilitating effects of jet lag and driving immediately after a long-haul flight put the driver at risk of a fatal road traffic accident. This article summarizes the available evidence and suggests reasonable approaches which may serve to minimize the risk of jet lag-induced driver fatigue leading to road injuries and deaths. The future research agenda should focus on routinely recording whether jet lag was a co-factor in road traffic accidents, analyzing the effectiveness of public awareness campaigns to highlight this neglected issue, and investigating the impact of jet lag on pedestrian road safety.https://www.ijtmgh.com/article_86185_a47be53616d1a01ef85180109d7b28b3.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Initiatives in Medical Volunteerism Aimed at Reducing the Burden of Orthopedic Disease in Low- and Middle-Income Countries45478815610.15171/ijtmgh.2019.10ENAlbert ThomasAnastasioSchool of Medicine, Emory University, Atlanta, USAJournal Article20181201While infectious disease garners much attention and research funding globally, initiatives aimed at treating traumatic orthopedic injuries are underfunded despite such injuries accounting for a significant degree of morbidity worldwide. In recent years, a number of organizations have sought to alleviate this burden through treatment and educational initiatives in low- and middle-income countries (LMICs). Additionally, emerging developments in orthopedic technology are allowing for more expansive treatment options in resource-poor environments. Distribution of both used and surplus orthopedic implants and components in LMICs and programs intended to encourage resident involvement with overseas volunteerism have proved beneficial in reducing the global burden of orthopedic disease. The goal of this manuscript is to educate readers about current initiatives in orthopedic volunteerism.https://www.ijtmgh.com/article_88156_fbd63ee9a3790123b919dcb73ec18b8d.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Feasibility of Obtaining Sufficient Numbers of Responses to Questions About Travel Intentions, Thereby Facilitating Effective Health Messaging48529139710.15171/ijtmgh.2019.11ENNeil SeemanInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, CanadaDanielle GoldfarbRIWI Corporation, Toronto, CanadaEmily KuzanRIWI Corporation, Toronto, CanadaMary SeemanDepartment of Psychiatry, University of Toronto, Toronto, Canada0000-0001-6797-3382Journal Article20190301<strong>Introduction: </strong>The medical literature has identified a variety of health risks associated with travel. Risks depend on the susceptibility of the traveler, the specifics of the destination, the mode of transport, and on chance events. Ill-prepared travelers who underestimate travel risks may encounter a variety of health problems. In order to eventually increase the capability of travel risk prediction, the current study aimed to ascertain travel intent in China, a country traditionally difficult to penetrate through online survey.<br /> <strong>Methods: </strong>This pilot survey study used a reliable, anonymous, online survey method to determine the feasibility of obtaining a sufficient response in China to enable travel risk prediction.<br /> <strong>Results: </strong>The results are encouraging in that seven and a half thousand individuals in China responded over the course of one month. Most responders were from urban centers. Three to eleven percent of the respondents were over age 55 and planning to travel to potentially hazardous destinations.<br /> <strong>Conclusion: </strong>The combination of older age and geographic risk increases the chance of ill health during travel. Knowing who is planning to travel, where they are from, and where, when, and how they are planning to arrive at their destination opens a corridor to effective preventive public health programming and educational initiatives.https://www.ijtmgh.com/article_91397_7714e62f855c4b2bf584b99ff92354f2.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Epidemiology of Medical Events on a Commercial African National Airline Carrier Between 2009 and 201153569023610.15171/ijtmgh.2019.12ENSalim ParkerDivision of Medicine, Faculty of Medicine, University of Cape Town, South Africa0000-0003-3386-0974Ozayr MahomedDepartment of Public Health Medicine, University of KwaZulu Natal, Durban, South AfricaJournal Article20190113<strong>Introduction: </strong>An estimated 3.8 billion passengers traveled on commercial aircraft in 2016, of whom close to 1.5 billion crossed international boundaries. Modern commercial aircrafts can carry up to 800 passengers and can fly more than 18 hours. Although not very common, in-flight medical incidents can result in flight diversions that are costly and extremely inconvenient. The aim of the current study was to review in-flight medical incidents on a commercial African carrier between 2009 and 2011.<br /> <strong>Methods: </strong>A secondary analysis of data collected by air stewards during in-flight medical events that were recorded in a register were retrieved for the 3-year period 2009-2011. All medical documented data was evaluated.<br /> <strong>Results: </strong>A total of 3306 medical events equating to an average of 155 cases per million passengers per year were documented over the 3-year study period, of which 3279 were specified into medical categories. Cardiovascular cases (1124; 34.0%) gastrointestinal (727; 22.0%), muscular-skeletal (302; 9%), and respiratory (202; 6%) were the most common cases. Most incidents (74%) were managed by the cabin crew. Five of the medical incidents led to diversions. There were 9 deaths on board over the 3-year period.<br /> <strong>Conclusion: </strong>In-flight medical incidents are rare events. Comparisons with other airlines is difficult due to the non-standardization of recording methods. A global uniform reporting format across all airlines is necessary. Further research is required to determine the factors associated with medical incidents so that pre-emergency preparedness plans can be strengthened.https://www.ijtmgh.com/article_90236_f0624490bda72f25c82e796f36c165da.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Occult Hepatitis B in Patients Undergoing Chemotherapy57619023410.15171/ijtmgh.2019.13ENAlireza SaadatChemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IranGholam Ali GhorbaniBaqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IranYasser HossienzadehFaculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IranNematollah JonaidiHealth Research Center, Baqiyatallah University of Medical Sciences, Tehran, IranGholamreza ToogehThrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, IranMorteza IzadiInternational Travel Medicine Center of Iran, Tehran, Iran0000-0002-2046-6321Journal Article20190320<strong>Introduction: </strong>The hepatitis B virus (HBV) is one health problem in Iran. Occult hepatitis B (OBI) is diagnosed by the detection of HBV DNA in the serum or liver tissue of patients for whom other serology, especially HBsAg and HBcAg, are negative. The current study aimed to determine the prevalence of OBI in patients who refer for chemotherapy.<br /> <strong>Methods: </strong>All patients referring for chemotherapy to the oncology clinic of Baqiyatallah Hospital in Tehran, Iran from 2012 to 2013 were selected as the population of this cross-sectional study. Samples of 5 mL of blood were taken from each subject and assayed for HBsAg and HBcAb. If HBV markers were negative, a qualitative HBV DNA PCR was done to detect OBI. The data was analyzed using SPSS 17 software, and the frequency test was used to determine prevalence.<br /> <strong>Results: </strong>In this study, 251 candidates for chemotherapy were recruited. Of this number, 114 (45%) patients were women. Mean patient age was 52.6 years. A total of 149 (59%) study subjects were employed, and the others were housekeepers or self-employed. About 67 (26.6%) patients had a history of one dose and 40 (15.9%) patients had a history of complete HBV vaccination. HBsAg was positive in 6 (2.4%) and HBcAb was positive in 33 (13.1%) patients; qualatative HBV DNA PCR was positive in 2 (0.8%) patients.<br /> <strong>Conclusion: </strong>This study revealed that OBI infection has a low prevalence, but patients referring for chemotherapy are at risk for its reactivation. On the other hand, isolated HBcAb is also a risk factor; therefore, in addition to HBsAg, it is recommended that HBcAb be evaluated before chemotherapy.https://www.ijtmgh.com/article_90234_8a9cde576617b92e149f584dffecb234.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Impact of Proximate Determinants on Fertility Transition Behind the Socio-demographic Factors in Bangladesh: A Hierarchical Approach from the National Survey62689216110.15171/ijtmgh.2019.14ENIqramul HaqDepartment of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka-1207, Bangladeshhttps://orcid.org/00Sheikh Giash UddinDepartment of Statistics, Jagannath University, Dhaka -1100, BangladeshInjamul Haq MethunFaculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IranAminul IslamOffice of the Deputy Commissioner, Shariatpur, BangladeshSultana BetheDepartment of Statistics, Jagannath University, Dhaka -1100, BangladeshAbdul LatifDepartment of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka-1207, BangladeshMahabub AlamBangladesh Bureau of Statistics (BBS), Statistics and Informatics Division, Ministry of Planning, Dhaka, BangladeshJournal Article20190126<strong>Introduction: </strong>Fertility is a vital ingredient in measuring population fluctuation. Bangladesh is still above the level of transplantation of fertility. The target of this research was to determine the proximate factors on fertility rate reduction in Bangladesh.<br /> <strong>Methods: </strong>The 2014 Bangladesh Demographic and Health Survey (BDHS) was used as secondary data. The association between fertility and sociodemographic variables was determined by bivariate analysis. Multiple regression analysis in a hierarchical approach was applied to determine the impact of factors on fertility rate reduction.<br /> <strong>Results: </strong>In the 2014 BDHS, the mean fertility of women aged 15-49 years was 2.45, and 76.5% of women were married at an early age. Hierarchical multiple regression analysis revealed that education has a significant effect on fertility rate. Increasing the education status of women decreased fertility, while other variants of Model I were controlled. Women who accomplish a secondary or higher education are more likely to have fewer children than illiterate women.<br /> <strong>Conclusion: </strong>The findings of the current study strongly recommend that efforts be made to augment female education, to inform women of the negative impact of early marriage, and to enhance the quality of contraceptive use for all ever-married women, particularly those living in the eastern region. Such steps would be the largest contribution to a future reduction in fertility rates in Bangladesh.https://www.ijtmgh.com/article_92161_ffcd6b75c6de54aa77affdc2793c950e.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Objective Structured Knowledge Exchange: A Novel Instructional Approach in Travel Medicine Education69708597910.15171/ijtmgh.2019.15ENGerard ThomasFlahertySchool of Medicine, National University of Ireland Galway, IrelandSchool of Medicine, International Medical University, Kuala Lumpur, Malaysia0000-0002-5987-1658Conor MaguireGlencairn Medical Centre, Dublin, IrelandSimon CollinsTravel Health Clinic, Dublin, IrelandJournal Article20190129https://www.ijtmgh.com/article_85979_e57ef5dd4c21903598da5746c9589a62.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007220190601Cross Boundary Morbidity and Mortality: A Situation Analysis of Recent 2012 Diphtheria Outbreak in Thailand71718598010.15171/ijtmgh.2019.16ENViroj WiwanitkitDr. DY Patil University, Pune, India0000-0003-1039-3728Journal Article20180911https://www.ijtmgh.com/article_85980_36de74d484921bc54936bad3ce89ef52.pdf