International Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007420191201Influence of History, Geography, and Economics on the Elimination of Malaria: A Perspective on Disease Persistence in Rural Areas of Zambia1131179902310.15171/ijtmgh.2019.24ENMukumbutaNawaUniversity of Zambia, School of Public Health, Department of Policy and Management, Lusaka, Zambia0000-0003-2360-2752Journal Article20190711The fight against malaria is currently ongoing in many countries where the disease is still endemic. The overall target is to eliminate malaria in all nations, regardless of their malaria burden, by 2030. Currently, the disease has been eliminated mainly in low-burden and unstable malaria areas globally. However, in high-burden countries, particularly in Africa, the disease is still not eliminated; some countries are even recording increases in incidence. This paper discusses why the disease is currently being eliminated in some countries and not in others using a historical and geo-economic perspective. It identifies gaps in the primary contemporary interventions in high endemic areas, particularly in rural constituencies where incidence of the disease is even higher. The key discussion point is that poor housing and behavioral patterns predispose rural dwellers to more malaria. Other risk factors include agricultural occupations, livestock keeping, and the fact that mosquito vectors in Africa thrive more in rural than urban areas. Combating malaria in rural African areas, therefore, requires radical transformative action to address the unique situations that currently enable the persistence of malaria beyond the contemporary, mainly indoor, and health facility-based interventions. Improving housing structures in rural Africa, which are mainly mud and thatched huts, to at least insect-proof standards is the recommended transformative action. Moreover, behavioral patterns, such as cooking outdoors in the evenings, must be modified to cooking in improvised insect-proof kitchens.https://www.ijtmgh.com/article_99023_dc492df7d610815d2cc854bd42049ef8.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007420191201Familial Mediterranean Fever (FMF): Mysterious Presentations and Challenging Points From Diagnosis to Management in Acute Care Settings; A Literature Review1181229921210.15171/ijtmgh.2019.25ENSoleymanHeydariDepartment of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IranTrauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IranHoseinNamdarCardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, IranMohammad JavadBehzadniaTrauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IranDepartment of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran0000-0002-3062-0839Journal Article20190714<strong>Introduction:</strong> Familial Mediterranean fever (FMF) is an autosomal recessive disease considered to be the most common entity of a rare group of disorders known as auto-inflammatory syndromes which have acute presentations in emergency settings.<br /> <strong>Methods:</strong> A search of Web of Science, Google Scholar, Cochrane, and PubMed databases for articles published before January 2019 was performed using relevant keywords. Full-text English articles, including review articles, case series, and experimental studies, were evaluated. Unrelated studies were excluded. Based on the selected keywords, 440 studies were selected for review. Ultimately, 60 met the study criteria for final assessment.<br /> <strong>Results:</strong> Given the various symptoms and the multiplicity of differential diagnoses, physicians may easily miss diagnosing FMF. Accordingly, emergency medical staff must be trained in order to significantly reduce the number of medical errors and economic costs and to improve the quality of life of involved patients.<br /> <strong>Conclusion:</strong> Although FMF is already known to be an inflammatory entity, more study and investigation of it is required. There is an educational gap in both medical and general populations that should be filled by using new genetic testing and providing appropriate social and medical education.https://www.ijtmgh.com/article_99212_735f01fb302c9b13dfe28f8b22d8a47e.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007420191201Better Late Than Never - An Analysis of Last-Minute Travelers Attending a Specialist Travel Medicine Clinic in Ireland1231289965210.15171/ijtmgh.2019.26ENGerard ThomasFlahertySchool of Medicine, National University of Ireland Galway, Galway, IrelandSchool of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia0000-0002-5987-1658Muhammad HaziqHasnolSchool of Medicine, National University of Ireland Galway, Galway, IrelandLokman HakimSulaimanInstitute for Research, Development and Innovation, International Medical University, Kuala Lumpur, MalaysiaDepartment of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, MalaysiaJournal Article20190803<strong>Introduction:</strong> Last-minute travelers (LMTs) are a vulnerable group, because it may not be possible to adequately vaccinate them against exposure to infectious diseases. The purpose of this retrospective cross-sectional study was to describe the characteristics of LMTs attending a travel health clinic.<br /> <strong>Methods:</strong> The following data was extracted from records of travelers attending the Tropical Medical Bureau (Galway, Ireland) over a 6-year period with less than 2 weeks remaining before their departure: gender, age, occupation, destination(s), purpose of travel, departure date, travel duration, travel group size, accommodation, past medical history, medications, and vaccination history.<br /> <strong>Results:</strong> Of 7555 traveler records, 1296 (17.2%) were of LMTs, of whom 45 (3.5%) were recurrent LMTs. LMTs were equally likely to be male or female. The mean age of this cohort was 32.2 years. The most common travel destination was Asia, and holiday was the most frequent purpose of travel. The mean interval before departure was 7.54 ± 3.65 days, and the mean travel duration was 7.36 ± 2.3 weeks. The majority (n=454, 35.1%) of LMTs traveled in pairs. Approximately 2 in 5 (n=497, 38.4%) travelers reported a past medical history; over half (n=674, 52.0%) had previously received travel vaccinations. The majority (n=1202, 92.8%) of LMTs were unable to complete a scheduled course of pre-travel vaccines.<br /> <strong>Conclusion:</strong> This study provides insight into the characteristics and travel patterns of LMTs. A large proportion of LMTs have pre-existing medical conditions. Further research should focus on the travel health risk-taking behavior of these individuals.https://www.ijtmgh.com/article_99652_d4a29bda9763789e6806e0a700a056b7.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007420191201Halogenation as a Strategy to Improve Antiplasmodial Activity: A Report of New 3-Alkylpyridine Marine Alkaloid Analogs1291349902610.15171/ijtmgh.2019.27ENCamila De SouzaBarbosaNúcleo de Pesquisa em Química Biológica, Universidade Federal de São João Del-Rei, Campus Centro Oeste, Divinópolis, MG 35501-296, BrazilDaniel Silqueira MartinsGuimarãesInstituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG 30190-009, BrazilJuliana Da CostaAlvesNúcleo de Pesquisa em Química Biológica, Universidade Federal de São João Del-Rei, Campus Centro Oeste, Divinópolis, MG 35501-296, BrazilCristiana Ferreira AlvesDe BritoInstituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG 30190-009, BrazilRenato MárcioRibeiro-VianaDepartamento Acadêmico de Química (DAQUI), Universidade Tecnológica Federal do Paraná, 86036-370 Londrina, Paraná, BrazilFernando De PillaVarottiNúcleo de Pesquisa em Química Biológica, Universidade Federal de São João Del-Rei, Campus Centro Oeste, Divinópolis, MG 35501-296, Brazil0000-0002-2939-7780Gustavo Henrique RibeiroVianaNúcleo de Pesquisa em Química Biológica, Universidade Federal de São João Del-Rei, Campus Centro Oeste, Divinópolis, MG 35501-296, Brazil0000-0002-1521-7486Journal Article20190818<strong>Introduction:</strong> Due to the emergence of resistance to antimalarial drugs as well as the lack of vaccination for malaria, there is an urgent demand for the development of new antimalarial alternatives. Recently, our research group developed a new set of 3-alkylpyridine marine alkaloid analogs, of which a compound known as compound 5 was found to be inactive against <em>Plasmodium falciparum</em>.<br /> <strong>Methods:</strong> Herein, we report a successful halogenation strategy to improve the antiplasmodial activity of compound 5 through the replacement of a hydroxyl group by chlorine (compound 6) and fluorine (compound 7) atoms.<br /> <strong>Results:</strong> Compounds 6 and 7 showed improved antiplasmodial activities (IC<sub>50</sub> = 7.2 and 8.3 μM, respectively) 20 times higher than that of their precursor, compound 5 (IC<sub>50</sub> = 210.7 μM). Ultraviolet-visible titration experiments demonstrated that halogenation of compound 5 did not alter its ability to bind its target, hematin.<br /> <strong>Conclusion:</strong> Halogenation can enhance the antiplasmodial activity of a compound without altering its mechanism of action.https://www.ijtmgh.com/article_99026_d2ff95d3bd0fa1a5023a778247ffc193.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007420191201Second-Hand Smoke Exposure at Home in the United States; Minorities’ Diminished Returns1351419597110.15171/ijtmgh.2019.28ENShervinAssariDepartment of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA0000-0002-5054-6250MohsenBazarganDepartment of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA0000-0001-6153-7870Journal Article20190606<strong>Introduction: </strong>Educational attainment and poverty status are two strong socioeconomic status (SES) indicators that protect individuals against exposure to second-hand smoke. <em>Minorities’ Diminished Returns </em>(MDRs), however, refer to smaller protective effects of SES indicators among ethnic minority groups such as Hispanics and Blacks, compared to non-Hispanic Whites. This study explored ethnic differences in the effects of educational attainment and poverty status on second-hand smoke exposure in the homes of American adults.<br /> <strong>Methods: </strong>This cross-sectional study included 18,274 non-smoking adults who had participated in the Population Assessment of Tobacco and Health (PATH; 2013). The independent variables were educational attainment and poverty status. The dependent variable was second-hand smoke exposure at home. Age and region of residence were the covariates. Ethnicity was the moderator.<br /> <strong>Results: </strong>Overall, individuals with a higher educational attainment (odds ratio [OR] = 0.76, 95% CI = 0.74-0.79) and those who lived out of poverty (OR = 0.56, 95% CI =0.51-0.62) had lower odds of second-hand smoke exposure at home. Hispanic ethnicity showed significant interactions with both SES indicators, suggesting that the protective effects of education and poverty on second-hand smoke exposure at home are smaller for Hispanics (ORs for interaction with education and poverty status = 1.30 and 1.26, <em>P </em>< 0.05) than for Non-Hispanics.<br /> <strong>Conclusion: </strong>In the US, high SES Hispanics remain at high risk of exposure to second-hand smoke at home despite a high education and income. High SES better reduces environmental exposures for non-Hispanic than for Hispanic individuals.https://www.ijtmgh.com/article_95971_3dc6029e9916359104b1f98a146ce122.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007420191201Assessment of Knowledge, Attitude and Adherence to Treatment in Patients With Heart Disease in Iran14214610214910.15171/ijtmgh.2019.29ENMasoudKhodaveisiDepartment of Community Health Nursing, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran0000-0002-4635-175XShahlaFakhreaziziDepartment of Community Health Nursing, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran0000-0002-5138-2120NahidMohammadiDepartment of Community Health Nursing, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran0000-0003-0111-9655LeiliTapakDepartment of Epidemiology, School of Public Health, Hamedan University of Medical Sciences, Hamedan, Iran0000-0002-4378-3143Journal Article20190517<strong>Introduction:</strong> Adherence to treatment is essential in heart disease. This study was conducted to evaluate the nutritional awareness of hypertensive patients and their dietary intake in heart disease.<br /> <strong>Methods:</strong> This is a descriptive-analytical study that was performed on hypertensive patients referred to Farshchian Cardiovascular Clinic in Iran, using the available random sampling method. Data collection tools included demographic information questionnaire and three questionnaires of nutritional awareness, illness perception, and dietary follow-up of patients with hypertension. Data were analyzed using SPSS software version 16 and descriptive statistics.<br /> <strong>Results:</strong> The mean score of knowledge was 4.73±1.55. Fifty-eight percent of patients were unaware of high-fat diet, 56% of them did not eat red meat and 63% of them did not eat sweets. The mean score of perception was 29.58±3.94 of which 38% of the patients were uncontrollable and 43% strongly opposed their illnesses which could lead to premature death and 56% were against dietary restriction.<br /> <strong>Conclusion:</strong> There is a need for interventions to improve the knowledge and attitude of patients with heart disease.https://www.ijtmgh.com/article_102149_ca859bc3d1011f2c4ddd841ec759b687.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11007420191201Serendipitous Detection of Asymptomatic Lesions in International Travellers1471489902410.15171/ijtmgh.2019.30ENWilliam WenOhSchool 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 Article20190927https://www.ijtmgh.com/article_99024_8090b4910f46ab0270d1a32bfc7cf120.pdf