An analysis of the health risks associated with international travel
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This thesis, submitted for the award of a doctoral degree in Medicine, represents an attempt to collate all of my original research projects in travel medicine completed at NUI Galway. Chapter 1 presents four projects relating to the theme of knowledge, attitudes and practices in travel medicine, covering the travel health awareness of diverse groups including travel agents and university students. It also explores the issue of itinerary uncertainty and its influence on the pre-travel consultation. Results of a major airport survey conducted in Malaysia complete this chapter. I have a particular interest in the health needs of travellers with pre-existing medical conditions, and Chapter 2 highlights the burden of comorbidities in travellers attending a specialist travel medicine clinic, the risks associated with stem cell tourism, and pre-travel health advice for patients with diabetes mellitus. Chapter 3 is the most extensive chapter in this thesis and it reflects my passionate interest in high altitude medicine. In it I report on projects which examined the awareness of altitude-related health risks among travellers and the quality of advice available online, the issues of travelling with complex underlying medical problems, the pathogenesis of high altitude illness, and high altitude cerebral oedema in particular, the use of pulse oximetry to facilitate a safer ascent profile, and the importance of portable hyperbaric chambers at altitude. Chapter 4 reports the findings of four studies I completed relating to tropical infectious diseases relevant to travel medicine, specifically malaria in the VFR population, prevention of rabies and dengue infection, and the current practices of licensed yellow fever vaccination centres in Ireland. Chapter 5 focuses on issues affecting the returned traveller, including the quality of travel histories recorded when assessing patients with travel-related infectious diseases, and the ability of emergency physicians and nurses to recognise tropical infectious diseases. The pathophysiology and prevention of jet lag complete the chapter. My medical education background has informed my approach to teaching and learning in travel medicine, and Chapter 6 presents some of my educational innovations in this field. The final section of my thesis results from a collaboration with medical students from Brazil and compares travel medicine practice in the British Isles and Latin America.