International Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201Health Risks and Benefits of International Travel for Adult Patients With Asthma14915413891310.34172/ijtmgh.2021.25ENSinead M.WalshSchool of Medicine, National University of Ireland, Galway, IrelandDepartment of Respiratory and Sleep Medicine, University Hospital Galway, Galway, Ireland0000-0003-1104-8985Gerard ThomasFlahertySchool of Medicine, National University of Ireland, Galway, IrelandSchool of Medicine, International Medical University, Kuala Lumpur, Malaysia0000-0002-5987-1658Journal Article20210121Asthma is a very prevalent condition. A significant proportion of patients with asthma will engage in travel for work or leisure purposes. Patients may be fearful of travel, especially during the current COVID-19 global pandemic. However, there are health benefits to be obtained, including leaving an area of high air pollution and travelling to an area of lower air pollution, travelling to high altitude, the beneficial effects of a low trigger environment and the psychological benefits associated with travel. Travel can be associated with improved diet and increased vitamin D exposure. Caution should be taken with alcohol consumption as it may worsen asthma. Whilst bariatric surgery has been shown to improve asthma symptoms and control, there are dangers associated with bariatric surgery tourism that the traveller should be made aware of. Travellers with asthma may experience jet lag and a worsening in their symptoms. Caution is required around exogenous melatonin use. Optimal asthma control pre‑travel is essential. The destination should be carefully considered, in terms of air pollution, altitude and possible environmental triggers. Pre-travel, written asthma management plans should be reviewed and updated if necessary. Patients should carry more asthma medications than they think is necessary, including oral corticosteroids and a pressurised metered dose inhaler via spacer. Travellers with asthma should have a self‑management plan in the event of exacerbations occurring during travel.https://www.ijtmgh.com/article_138913_d547e5b8973faeefe39a84c4a2886b25.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201Migrant-Health Inequity as a Consequence of Poor Siracusa Principles Implementation in the COVID-19 Era15516013891810.34172/ijtmgh.2021.26ENFerdinand C.MukumbangDepartment of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA0000-0003-1441-2172Journal Article20210713The Siracusa Principles dictate that restrictions on the rights of individuals or a group of individuals in the name of public health safety should be strictly necessary and be least intrusive to reach their objective. While social distancing measures have proven to abide by the Siracusa Principles to a more significant extent, they have failed to meet the distributive justice laws, which require limiting unfair or inequitably personal and economic burdens on the nation’s inhabitants. While employing social distancing measures, the principle of reciprocity also obliges governments to provide the people living within their borders with life necessities. Although asylum-seekers, refugees, and undocumented migrants already disproportionately bear the brunt of the coronavirus disease 2019 (COVID-19) pandemic, poor application of the Siracusa Principles in social distancing measures seems to intensify their vulnerabilities. We argue that while implementing public health measures that could potentially impact the lives and livelihoods of the people living within the nation, considerations should also be paid to minority groups such as asylum-seekers, refugees, and undocumented migrants. We propose that the application of the social distancing measures should be ‘migration aware, adapting interventions, policies, and setting systems that embed migration as a central concern in their design.https://www.ijtmgh.com/article_138918_8d1de503affe568a214e9d9b436497d6.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201Vaccine Passport Use and Travel Health Status Among Turkish Travelers at an International Airport16116914412810.34172/ijtmgh.2021.27ENMustafaKahramanDepartment of Physiology, School of Medicine, Istanbul University, Istanbul, TurkeyÇanakkale Onsekiz Mart University, School of Medicine, Çanakkale, Turkey0000-0002-5775-5928IremYukselSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0002-3023-7477Elif BeyzaBozSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0003-2759-3013Hasan EdizOzbekSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0002-1655-6412ElifMertSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0002-4216-1094AybikeReyhanliSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0001-5223-3517AslihanSariSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0003-0312-1935Enes MuhammedCanturkSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0003-4216-5180EbruCanSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0002-2129-3987AtaberkDemirkolSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0002-2099-5020Mustafa SencerToramanSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0003-2977-3624NiluferYildirimSchool of Medicine, Istanbul University, Istanbul, Turkey0000-0003-4738-9300Meryem MerveOrenDepartment of Public Health, School of Medicine, Istanbul University, Istanbul, Turkey0000-0002-3383-7830Sila HidayetBozdogan PolatDepartment of Physiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey0000-0002-3641-2002OsmanKanGeneral Directorate of Health for Border and Coastal Areas of Turkey, Ankara, Turkey0000-0002-6536-066XCemalAyazogluGeneral Directorate of Health for Border and Coastal Areas of Turkey, Ankara, Turkey0000-0003-1085-0415Fulya KahramanAydoganGeneral Directorate of Health for Border and Coastal Areas of Turkey, Ankara, Turkey0000-0003-3479-6548SukruOzturkDepartment of Internal Medicine, School of of Medicine, Istanbul University, Istanbul, Turkey0000-0002-8809-7462Mehmet AkifKaranDepartment of Internal Medicine, School of of Medicine, Istanbul University, Istanbul, Turkey0000-0002-9080-404XJournal Article20210926<strong>Introduction: </strong>Even though Istanbul is one of the centers of the world’s fastest-growing tourism and travel sector, there are limited statistics on the knowledge, attitudes, and practices (KAP) of travelers from this region regarding travel-related infectious diseases. This study aimed to determine the passengers’ KAP about contagious diseases and contribute to developing new solutions for the problems people face while traveling abroad.<br /><strong>Methods: </strong>A questionnaire was administered to 182 Turkish travelers planning on traveling abroad and applied to the Istanbul Travel Health Center and the Istanbul Airport Health Control Center between January and March 2019.<br /><strong>Results: </strong>The proportion of carrying a vaccination certificate was statistically higher in those who received healthcare services at international terminals (<em>P</em>=0.002), especially those who had yellow fever (<em>P</em><0.001) and meningococcal vaccine (<em>P</em>=0.011). More than half of the vaccinated passengers did not carry their vaccination certificates, while around half (53.8%) were traveling to Africa. When compared to travelers flying to Europe, vaccination checks were 6.7 times (95% CI: 2.5-17.9) higher in passengers traveling to Africa, 6.1 times (95% CI: 1.5-24.3) higher in passengers traveling to Asia, and 14.8 times (95% CI: 1.3-164.3) higher in passengers traveling to South America. In addition, the vaccination certificate carrying proportion was significantly higher in those with a travel duration of 15 days or more (<em>P</em>=0.028), those who received health services at international terminals (<em>P</em>=0.002), and those vaccinated (<em>P</em><0.001).<br /><strong>Conclusion: </strong>Improved knowledge of travel-related infectious diseases and increased adoption of pre-travel health advice and vaccines are urgently needed among Turkish travelers.https://www.ijtmgh.com/article_144128_af008003e80bb699dfac22d53ed6c5be.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201Hypertension and Diabetes Mellitus in Rural Haiti17017514365410.34172/ijtmgh.2021.28ENJohisOrtegaSchool of Nursing and Health Studies, University of Miami, Florida, USA0000-0003-1357-919XJuan M.GonzalezSchool of Nursing and Health Studies, University of Miami, Florida, USA0000-0002-7301-8741KenyaSnowdenSchool of Nursing and Health Studies, University of Miami, Florida, USA0000-0001-5755-9583AmauriQuintanaSchool of Nursing and Health Studies, University of Miami, Florida, USA0000-0002-4502-2305KarinaGattamortaSchool of Nursing and Health Studies, University of Miami, Florida, USA0000-0001-5827-1389Journal Article20211022<strong>Introduction: </strong>The problem of the prevailing occurrence of hypertension and diabetes cases quickly took the world by storm. Rural areas became even more exposed to the negative issues associated with these health conditions due to the lack of a skilled workforce and educational programs for patients. Within the framework of the current paper, the researcher utilized the data from two mission trips in Thomonde, Haiti, to gain more insight into chronic health issues among rural Haitian residents.<br /><strong>Methods</strong>: This study employed a retrospective analytical cross-sectional retrospective, descriptive design utilizing data obtained from two mission trips in Thomonde, Haiti in the areas of Palmay, Savane Plate, and La Hoye. The information was analyzed with the help of the SPSS software. A total of 403 adult patient visits across the three sites and two visits were included in the analysis.<br /><strong>Results</strong>: <em>Gastroesophageal reflux disease </em>(GERD) (25.8%) was the most common diagnosis found in the rural Haitian communes among adults in the total sample (N = 403), followed by Hypertension (16.8%) and Dehydration (13.9%). Among women, significant differences were found by location for pregnancy. The greatest number of pregnancies were observed in La Hoye (19.0%).<br /><strong>Conclusion</strong>: The core implication of these findings was the significance of disseminating knowledge across rural areas while conducting similar retrospective studies to check progress. Real-life application of relevant knowledge could be beneficial for both patients and care providers operating in rural locations that are the hardest to reach.https://www.ijtmgh.com/article_143654_9c01b6c64821ca4032460a05c5b33e7c.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211205Inequalities in Accessing Healthcare in the United States of America: A Major Contributor to the Increasing COVID-19 Morbidity and Mortality17618214064810.34172/ijtmgh.2021.29ENOlayinka StephenIlesanmiDepartment of Community Medicine, University of Ibadan, Ibadan, Oyo State, NigeriaDepartment of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria0000-0003-0827-6442Aanuoluwapo AdeyimikaAfolabiDepartment of Community Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria0000-0001-9928-2252OluwafunbiAwoniyiRollins School of Public Health, Emory University, Atlanta, GA, USA0000-0001-5323-3973Journal Article20210714<strong>Introduction: </strong>Many COVID-19 cases and deaths have been reported from the United States (US). This study aimed to assess the health system inequalities as a determinant of COVID-19 case morbidity and mortality in the US.<br /><strong>Methods: </strong>This study collected data on US COVID-19 cases and deaths as of the 27th of January 2021 from the Worldometer and COVID-19 Community Vulnerability Index. The strength of association between the social vulnerability index (SVI), total COVID-19 deaths and tests, and regional population in the US were determined using Pearson’s correlation. <em>P </em>values < 0.05 were statistically significant.<br /><strong>Results: </strong>New York has the highest SVI (0.94) in the North-Eastern region and the highest percentage of non-Whites. California has the highest SVI (0.90) in the Western region and the highest proportion of Asians. In the mid-Western region of the US, Illinois has the highest SVI (0.88) and the highest proportion of African Americans and Asians. North Carolina has the highest SVI of (1.00) in the Southern region and the highest proportion of African Americans. A strong positive correlation exists between the SVI and total COVID-19 tests (<em>P </em>= 0.001) in the North-eastern and Southern regions (<em>P </em>= 0.025). In addition, a positive correlation (<em>P </em>< 0.039) exists between SVI and the total population in the Western and mid-Western regions (<em>P </em>< 0.003).<br /><strong>Conclusion: </strong>Multi-sectoral collaboration should be encouraged to promote equity in accessing COVID-19 healthcare in the US, especially in States with high COVID-19 SVI.https://www.ijtmgh.com/article_140648_c2f16b1b281b052a8f04af5d6c78a222.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201High Economic Stress May Explain Worse-Than-Expected Health of Highly Educated Chinese Americans18319014118110.34172/ijtmgh.2021.30ENShervinAssariSchool of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USADepartment of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA0000-0002-5054-6250Journal Article20210919<strong>Introduction: </strong>Low stress is one of many plausible mechanisms that may explain the health effects of educational attainment. However, <em>Marginalization-related Diminished Returns (MDRs) </em>refer to the weaker health effects of educational attainment for marginalized, compared to privileged, groups. We are unaware of any previous studies that have compared Asian and non-Hispanic White Americans for the effects of educational attainment on perceived economic stress. The aim was to compare Chinese and non-Hispanic White Americans for the association between educational attainment and perceived economic stress in a national sample of American adults. This is important given stress is a risk factor for poor health.<br /><strong>Methods: </strong>This study analyzed cross-sectional data of 20,793 adults who participated in the National Health Interview Survey (NHIS 2015). From all participants, 403 individuals were Chinese Americans, and 20,390 were non-Hispanic Whites. Perceived economic stress was the outcome of interest. Years of education (educational attainment) was the predictor variable of interest. Gender, age, region, marital status, sexual orientation (i.e., lesbian, gay, bisexual, and transgender (LGBT)), and immigration status were covariates. Race/ethnicity was the effect modifier.<br /><strong>Results: </strong>Overall, higher educational attainment was associated with lower levels of perceived economic stress. A statistically significant interaction showed that the effect of educational attainment on reducing perceived economic stress is smaller for Chinese Americans than Non-Hispanic Whites.<br /><strong>Conclusion: </strong>Educational attainment is not similarly protective against perceived economic stress across all social groups. Thus, perceived economic stress may explain why ethnic minorities and immigrants gain decreased benefits from their educational attainment than the mainstream and privileged social group.https://www.ijtmgh.com/article_141181_574f0b0a2737041cfe4ba1db88e9ee5e.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201Bell’s Palsy Onboard: A Case Report of Widespread Disease in a Special Setting19119313891710.34172/ijtmgh.2021.31ENYoshihiroAokiDepartment of Emergency and Critical Care Medicine, Aizawa Hospital, Nagano, Japan0000-0003-2011-485XJournal Article20210720<strong>Introduction: </strong>Cruises are one of the major travel industries worldwide, and various medical issues can happen onboard. This is a case report of peripheral facial nerve palsy in an older man with diabetes treated onboard a world cruise ship.<br /><strong>Case Presentation: </strong>A 78-year-old man presented to the infirmary due to difficulty closing his left eye during a 105-day world voyage. The patient was in good general health and had a history of hypertension and diabetes mellitus (treated by dietary intervention). He was diagnosed with severe Bell’s palsy by history and physical examination and treated with prednisolone and valacyclovir without any complications and a near-complete recovery. The possibility of misdiagnosis and deterioration of diabetes mellitus due to the corticosteroid treatment was explained to the patient.<br /><strong>Conclusion: </strong>When it comes to medical management in a resource-limited setting like cruise ships, passenger physicians trained in a wide variety of illnesses are crucial. It is essential to explain to patients the prognosis and expected outcome of the medical condition. Emergency medical evacuation may be warranted in some instances.https://www.ijtmgh.com/article_138917_3e3258abc02f971d2b3673b5400e7d73.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201The Myth of the Para-Lockdown to Fight COVID-19 in Hong Kong19419513891610.34172/ijtmgh.2021.32ENFung KeiChengIndependent Researcher, Hong Kong, China0000-0002-8931-4860Journal Article20210611https://www.ijtmgh.com/article_138916_71368ddc383ea4b782c37fee03001169.pdfInternational Travel Medicine Center of IranInternational Journal of Travel Medicine and Global Health2322-11009420211201Traveling and Celebrating During Songkran as Super Spreading Events: A Potential Triggering Factor of the Surge of COVID-19 Cases in Thailand19619713891510.34172/ijtmgh.2021.33ENIan Christopher N.RochaSchool of Medicine, Centro Escolar University, Manila, PhilippinesBehavioral Sciences Department, De La Salle University, Manila, Philippines0000-0002-8775-6876Mary Grace A.PelayoBehavioral Sciences Department, De La Salle University, Manila, Philippines0000-0002-9817-8784ChaiyasomSammatidFaculty of Education, Silpakorn University, Nakhon Pathom, ThailandFaculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, ThailandJournal Article20210520https://www.ijtmgh.com/article_138915_f5b2441d5a9c09254cedc58cb2a9db36.pdf