Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2012 | Month : September | Volume : 6 | Issue : 7 | Page : 1324 - 1327 Full Version

Travellers Health Through “Emporiatrics


Published: September 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2448
Sushma .R, Nagabhushana .D

1. M.D.S, Lecturer, Department of Public Health Dentistry, J.S.S Dental College and Hospital, J.S.S University, Mysore, India. 2. M.D.S, Reader, Department of Oral Medicine and Radiology, J.S.S Dental College and Hospital, J.S.S University, Mysore, India.

Correspondence Address :
Dr. Sushma .R
#3/25 J.S.S Layout Mysore -570011, India.
Phone: 9844775196
E-mail: hisushhere@yahoo.co.in

Abstract

“Travel broadens the mind” and people have been extolling the merits of travel for a very long time.The general belief is that travel is good for travellers, mentally and physically. But while travel can indeed be interesting and exciting and good for the mental and physical wellbeing, all too often, it can be harmful to a traveller’s health (1).The increase in the numbers of travellers and the speed at which they travel, has not only had economic, cultural, and social repercussions, but medical, epidemiological, and medico-legal consequences as well (2). Travel Medicine seeks to prevent the illnesses and the injuries which occur in the travelers who go abroad and it manages the problems which arise in the travellers who come back or come from abroad. It is also concerned about the impact of tourism on health and it advocates for the improved health and safety services for tourists.

Keywords

Travel medicine, Travelers health, Travel hazards

Introduction Travel medicine or emporiatrics is the branch of medicine that deals with the prevention and the management of the health problems of international travelers. “The art of travel medicine is selecting the necessary prevention strategy without unnecessary adverse events, costs or inconvenience”(3). The necessity of Travel Medicine is a result of the rapid expansion in international and intercontinental travel, in the development of the means of the prevention of the risks which are linked to this increased travel, in the modifications which are made in the doctor-traveler relationship, and in the updating of the ever changing epidemiological data (2). There has been considerable growth in the interest in the field of travel medicine and in the intersection with Tourism Studies since the 1990s. Globalization facilitates the spread of diseases and it increases the number of travelers who will be exposed to different health environments. It has been estimated that about 80 million travelers go annually from the developed to the developing countries (3). The major content areas of travel medicine include the global epidemiology of the health risks to the traveler, vaccinology, malaria prevention, and pre-travel counseling, which were designed to maintain the health of the approximately 600 million international travelers (4). Yet, this interest from a medical perspective is not new. What is new, is the way in which the interest in travel medicine has developed across the science-social science divide and has now become one strand of a wider practitioner and academic interest in the tourists´ well-being. THE SPECTRUM OF TRAVEL HEALTH PROBLEMS (5),(6) It is worth looking at some figures to see how commonly health problems occurred among travellers, to look for the patterns in the sorts of problems they had, and to learn whether they sought any advice before their departure. Mortalitrtalitrtality and morbidity (7),(8) • Mortality studies have indicated that cardiovascular diseases account for most of the deaths during travel (50%-70%), while injuries and accidents follow (~25%).Infectious diseases account for about 2.8%-4% of the deaths during/from travel. • Morbidity studies have suggested that about half of the people from a developed country who stay for one month in a developing country will get sick. Traveller´s diarrhoea is the most common problem which is being encountered. The World´s 10 Worst Travel Diseases (9) 1. Traveler´s diarrhoea 2. Dengue fever 3. Malaria 4. Lyme disease 5. Hepatitis 6. Parasites 7. Typhoid 8. Yellow fever 9. Sexually transmitted diseases 10. Media disease of the week eg :Swine flu , SARS THE RISK ASSESSMENT IN TRAVEL MEDICINE (10) The risk assessment preferably starts before the traveller enters the consulting room. The risk assessment has to be undertaken as a part of the pre-travel consultation and the exact itinerary and the medical history of the traveller is required. Addressing the risk in travel medicine is generally all about trying to modify the risks which have been established from the travel health consultation. Establishing the risks includes: 1. The destination 2. The traveller´s medical history 3. Intervention 1. Risks of the destination • What countries and what parts of these countries are they visiting? • How long are they going to stay? •What time of the year are they visiting? • What are the living conditions? • What activities are they undertaking? • Is there anything special about the destination culturally or legally? • What is the traveller’s prior travel experience? • What access is there for an appropriate medical care? • Does the traveller know first aid? 2. Risks of the traveller´s medical history Some travellers may not meet the medical guidelines of travel or they may need special clearance to fly on commercial aircrafts, such as those with – Pre-existing illnesses – Pregnancy – Recent surgery or – Serious physical or mental incapacity 3. The risks of intervention All interventions have potential risks, including giving the wrong advice • Advice and education • Vaccination • Chemoprophylaxis • Screening and effective management PROVIDING TRAVEL HEALTH ADVICE AND SUPPORT More than 900 million international journeys are undertaken every year. The global travel on this scale exposes many people to a range of health risks which can be minimized by precautions which are taken before, during and after the travel. The 2012 edition of International Travel and Health provides updated information on vaccines and their requirements, malaria and yellow fever risks,2and new information for the last minute travellers (11). The travellers often give insufficient thought to their health needs prior to their travel, seldom considering the possibility of accidents or illnesses occurring while they are overseas. The travel agents who are involved may give some idea on the health-care needs of the traveller, but the commercial pressures which encourage the travel often conflict with the ensuring health protection provisions for travellers are adequate, and this aspect of the travel is consequently under-emphasized by the travel agents and the airlines alike (12). The travellers are advised when they book an international flight, to ensure that they have all the necessary travel documentation, and to consult their doctor about the immunization requirements (13). Vaccines are an important public health measure and they may be prompt remedies for the travellers to attend the pre-travel health advice sessions (14). Travel health advice is primarily aimed at prevention, and it is therefore offered before the travel. It includes the steps which are taken before and during the travel. There is also an aspect of travel health which is provided after the return from travel, which is usually diagnostic. Pre-Departure Advice Protecting the traveller's health and safety while they are overseas includes the following measures: 1. Medical examinations and screening – To ensure that the travellers will be fit if they are intending to live and work overseas, or to ensure that those travellers with current health issues are fit to travel. The Patient: 1. Medical Issues • Age-specific issues • Underlying illnesses, immunosuppression • Medical history • Medication use • Vaccination history • Allergies • Contraindications to vaccines and medications • Reproductive – Pregnant – Breastfeeding • Risk-taking behaviours Advice should be given about: • The general health measures while travelling, • Protective measures to avoid infection, immunization requirements, and health and accident insurance. • The patient and the doctor should also discuss about the certification for, and the use of medication while travelling. 2. Psychological preparation – To identify the potential sources of stress and personal difficulty while overseas, and to provide personal protection strategies against consequent problems. 3. Provision of a medical kit – To ensure that the travellers have first aid supplies and medications for personal use when adequate medical advice is not available. The travel emergency kit • A copy of the medical records and the prescription medications • Over-the counter medicines and supplies – Analgesics – Oral rehydration salts – Decongestants, cold medicines, cough suppressants – Antibiotics/antifungals/hydrocortisone creams – Pepto-Bismol tablets, antacids – Band-Aids, gauze bandages, tape, Ace wraps – Insect repellants, sunscreen, lip balm – Tweezers, scissors, thermometer A medical certificate to provide a written authority for the travellers to take this kit into any country on the itinerary should be provided, especially for those countries with strict drug smuggling prevention programmes and unpredictable legal systems. 4. First aid training - Encouraging travellers to remote locations to to equip themselves with the knowledge of basic first aid is useful, but in reality, most of the travellers do not bother to do this. First aid should also be promoted in relation to the use of traveller’s first aid kits. For those travellers in remote situations such as in climbing expeditions, ocean yachts, or military deployments, first aid training should be provided prior to their departure and a first aid/medical kit will be needed to be included in the traveler’s luggage and carried at all times. 5. Preventive measures for the prevention of thermal injuries – This includes the pre-travel acclimatization to heat, education, and dealing with travellers who are at a high risk of thermal stress. The doctor should give a general advice prior to the departure to hot environments. 1. Wear appropriate clothing. 2. Avoid direct sunlight 3. Try to be in shade 4. Maintain adequate fluid intake 5. Maintain adequate salt intake 6. Avoid excessive exercise, particularly during acclimatization The other aspect of thermal stress is protecting against cold, and this is especially important in adventure travel such as mountaineering and high altitude trekking, but also in connection with swimming and diving. 6. Insure and plan for aeromedical evacuation and repatriation if required- to ensure an expedited and a properly supported evacuation of any injured or severely ill person back home with advanced hospital stabilization locally if required. 7. Advice regarding accidents and related hazards – ensuring that the travellers are minimally disrupted by travel to/from their destination, and are advised regarding the avoidance of accidents and other health or safety hazards, for example, animal bites, while they are overseas. 8. Special provisions for specific travel hazards – this may include protection against altitude sickness for mountaineers and occupational health advice for people who are working overseas, for diving medicine, medical student electives, etc. 9. Protection against tropical diseases – to ensure that the travellers are advised, and where appropriate, vaccinated, against the many tropical diseases which may be a risk at their destination. In 2003, the International Society of Travel Medicine introduced a certificate of knowledge examination in travel medicine. We cannot make the travellers bullet-proof, but it is possible to make them bullet-resistant. The pre-travel visit should minimise the health risks which are specific to the journey, give travellers the capability to handle the most minor medical problems, and allow them to identify when to seek local care during the trip or on return (15). Post-Travel - After Return from the Travel Having concluded their journey, the patients may seek medical advice for three main reasons. They may complain of early post-flight symptoms of illnesses which are related to travel fatigue or the circadian rhythm disruption. • They may be experiencing persistent diarrhoea. • Thirdly, they may be experiencing symptoms such as fever, rashes, jaundice, or weight loss, which may suggest an exotic infectious disease. •Less commonly still, the passengers may also be named as the contacts of known cases of illnesses. • Essentially, all travellers should seek or be given advice before extensive travel. Yet, despite the available information and the resources, upto 70 percent of the travellers report some health problem, and approximately 8 percent will require medical care or pharmacotherapy during their journey or after they return. TRAVEL INSURANCE (16) Travel insurance is an insurance that is intended to cover the medical expenses and the financial (such as the money which has been invested in nonrefundable pre-payments) and other losses which are incurred while traveling, either within one’s own country, or internationally. A temporary travel insurance can usually be arranged at the time of the booking of a trip, to cover exactly the duration of that trip, or a more extensive, continuous insurance can be purchased from travel insurance companies, travel agents or directly from travel suppliers such as cruiselines or tour operators. However, the travel insurance which is purchased from the travel suppliers tends to be less inclusive than the insurance which is offered by insurance companies. The travel insurance often offers coverage for a variety of travellers. Student travel, business travel, leisure travel, adventure travel, cruise travel, and international travel are all various options that can be insured. The most common risks that are covered by travel insurance are: • Medical expenses • Emergency evacuation/repatriation • Overseas funeral expenses • Accidental death, injury or disablement benefits • Cancellation • Curtailment • Delayed departure • Loss, theft or damage to personal possessions and money (including travel documents) •Delayed baggage (and emergency replacement of essential items) • Legal assistance • Personal liability and rental car damage excess Some travel policies will also provide cover for additional costs, although these vary widely between the providers. In addition, often, a separate insurance can be purchased for specific costs such as: • pre-existing medical conditions (e.g. asthma, diabetes) • sports with an element of risk (e.g. skiing, scuba-diving) • travel to high risk countries (e.g. due to war or natural disasters or acts of terrorism) Usually, the insurers cover pregnancy related expenses, if the travel occurs within the first trimester. After that, the insurance coverage varies from insurer to insurer. The travel insurance can also provide helpful services, often 24 hours a day, 7 days a week, that can include concierge services and emergency travel assistance. Typically, the travel insurance for the duration of a journey costs approximately 5%-7% of the cost of the trip.

Conclusion

Giving adequate advice on travel health requires a good knowledge about the local health hazards overseas, the public health measures, and the effectiveness of immunization and prophylaxis. The traveller’s general practitioners are the most likely persons whom they approach for travel health advice, yet, the general practitioners receive very little, if any training in travel health, tropical health, or aviation medicine. In summary, travel medicine will be established as an interdisciplinary special discipline in the coming years and it will be characterized by new risks and on the other hand, by newer methods of therapy and prophylaxis.

References

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Schwartz E. Travel medicine: an emerging discipline in medicine. Harefuah. 2010 Sep; 149(9):556-8.
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Burchard GD. Travel medicine-the next 10 years. Eur J Med Res.1999 Sep 9;4(9):399-402.
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Page Stephen J. The evolution of travel medicine research: a new research agenda for tourism? Tourism Management 2009; 30 (2): 149-57.
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The International Society of Travel Medicine: www.istm.org.
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Cossar JH,Reid D. “The health hazards of international travel” .World Health Statistics quarterly 1989 ; 42: 61-69.
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Steffen R, et al. Travelers’ health risks. J Infect Dis 2004; 156:84- 91.
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Hargarten SW, Baker TD, Guptill K. Overseas fatalities of the United States citizen travelers: an analysis of the deaths which are related to international travel. Ann Emerg Med 1991; 20:622-26.
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McInnes RJ, Williamson LM, Morrison A. Unintentional injury during foreign travel: a review. J Travel Med. 2002 Nov-Dec; 9(6):297-307.
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Turner Wright, The World’s 10 Worst Travel Diseases,www.vagabondish. com/worlds-worst-travel-diseases/ 15 Oct 2009
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The CDC Travellers’ Health Website :www.cdc.gov/travel.
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The WHO Publication. Travel safely: protect yourself, protect others, international travel and health: new edition 2012.
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The World Health Organization :www.who.int/int.
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Leggat, Ross, Goldsmid. Travel vaccines: a guide to their appropriate use. Nurs Times. 2002.
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Wong C, Simons H. Travel health: the routine recommended and required vaccines. Br J Nurs. 2011 Aug 11-Sep 8; 20(15):914-8.
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Spira AM. Preparing the traveler. Lancet. 2003 Apr 19; 361(9366):1368-81.
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Zuckerman JN. Recent developments: Travel medicine. BMJ. 2002 Aug 3; 325(7358):260-4.

Tables and Figures
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DOI and Others

“Travel broadens the mind” and people have been extolling the merits of travel for a very long time.The general belief is that travel is good for travellers, mentally and physically. But while travel can indeed be interesting and exciting and good for the mental and physical wellbeing, all too often, it can be harmful to a traveller’s health (1).The increase in the numbers of travellers and the speed at which they travel, has not only had economic, cultural, and social repercussions, but medical, epidemiological, and medico-legal consequences as well (2). Travel Medicine seeks to prevent the illnesses and the injuries which occur in the travelers who go abroad and it manages the problems which arise in the travellers who come back or come from abroad. It is also concerned about the impact of tourism on health and it advocates for the improved health and safety services for tourists.

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