Background: The primary prevention of periodontal disease is a global health concern due to its increasing incidence and evolving evidence of its role in cardiovascular disease (CVD). This study aimed to describe dentists' perceptions and practices regarding CVD prevention in practice. Study design and methods: A qualitative study design, using semi-structured interviews, was used to determine the perceptions, practices, barriers, and enablers of dentists towards the implementation of CVD prevention in practice. Interviews were analysed using a thematic analysis framework. NVivo 12 Pro software was utilised to support the data analysis. Results: Eleven participants (eight female) with a mean employment history of 17.45 years, were interviewed, at which point data saturation was reached. The semi-structured interviews ranged in duration from 45 to 86 min, with a mean duration of 62.5 min. All dentists interviewed were in private practice. Inductive thematic analysis revealed four major themes - dentists' current practices in relation to preventive cardiology in practice; professional identity and role expectations; barriers to preventive cardiology in practice; and facilitators of preventive cardiology in dental practice. Conclusions: This study highlights the current practices, perceptions and identified barriers and enablers to preventive cardiology in Irish dental practice. Future research should focus on educational interventions to improve the implementation of CVD prevention guidelines in dental practice.

Disorders of the ear, nose and throat may be the most commonly occurring pre-existing health condition in international travellers. Despite their high incidence, there is limited guidance for travellers and their clinicians on their prevention and management. This narrative review addresses this deficit by compiling and discussing available evidence on this neglected subject. A comprehensive review of the literature was undertaken using Medine and Scopus databases and multiple combinations of relevant MeSH search terms. Further references were obtained from focused searches on specific issues and manual review of the reference lists of articles obtained from the primary search. Nasal congestion or discharge are among the most common complaints amongst travellers and various causes are reviewed. Changes in elevation result in a pressure differential between the atmospheric pressure and the middle ear and paranasal sinuses. The effects of air travel, recreational high-altitude exposure and diving are considered. Various causes of epistaxis in travellers such as cold air exposure and recreational cocaine use are discussed. The aetiology of a discharging ear in travellers includes otitis externa. The most frequently described travel-specific aetiology of dizziness is motion sickness while mal de debarquement is a specific subtype which affects travellers and is most commonly associated with sea travel. Surgical tourism for treatment of ear, nose and throat pathology is well established and various precautions are presented for post-operative travel. Obstructive sleep apnoea is discussed from the perspective of international travel. The challenges facing travellers with hearing impairment are explored. This review critically discusses the prevention, diagnosis, and management of acute and chronic ENT conditions in the travelling population. Several areas of inquiry are highlighted that require further investigation. Close communication between ENT specialists and travel medicine practitioners is recommended in the preparation of selected patients for international travel.

A substantial number of travelers have pre-existing food allergies, which can put them at risk of exposure to allergens during transportation, e.g. on aircraft, and at travel destinations. This review aims to identify the characteristics of food-related allergic reactions among travelers. A literature search was conducted on PubMed, Embase and Scopus using keywords related to food allergies and travelers. Eligible studies were grouped into cohort/cross-sectional studies and case series/case reports. Data were extracted on prevalence (for cohort/cross-sectional studies), common allergens, locations where reactions occurred, and impact on travelers. Twenty-four articles were included. The prevalence of in-flight food-related allergic reactions ranged from 1.7-3.0

Methanol poisoning (MP) remains an overlooked yet critical travel-related health issue. The lack of reliable data, poor traveller awareness, and diagnostic challenges continue to place travellers at risk. This article explores current challenges and offers actionable strategies for travel health practitioners to address this preventable hazard.

BACKGROUND:The Dietary Approaches to Stop Hypertension (DASH) diet is designed to lower blood pressure and improve cardiovascular health by reducing sodium and unhealthy fats while increasing nutrients, including potassium, calcium, magnesium, and fibre. While evidence supports its benefits for managing cardiovascular risk factors, gaps remain in understanding its long-term impact on preventing cardiovascular disease (CVD), particularly in terms of hard clinical outcomes such as myocardial infarction and stroke. OBJECTIVES:To assess the effects of the DASH diet for the primary and secondary prevention of cardiovascular diseases. SEARCH METHODS:We used standard extensive Cochrane search methods. The latest search date was in May 2024. SELECTION CRITERIA:We included randomised controlled trials (RCTs) comparing a DASH diet intervention to no intervention (including usual care), minimal intervention, or other dietary interventions. In the context of this review, 'minimal intervention' includes brief dietary advice or informational leaflets provided during a medical consultation, without a structured dietary intervention. 'Other dietary interventions' include any other dietary programme besides the DASH diet. Participants were adults with or without CVD. The minimum duration of eligible interventions was eight weeks and the minimum follow-up was three months. DATA COLLECTION AND ANALYSIS:We used standard Cochrane methods. Primary outcomes were myocardial infarction, heart failure, and stroke. Secondary outcomes were the need for coronary revascularisation, carotid revascularisation, peripheral revascularisation, all-cause mortality, cardiovascular mortality, changes in blood pressure, blood lipids, the occurrence of type 2 diabetes, health-related quality of life, and adverse effects. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS:Five RCTs involving 1397 participants met our inclusion criteria and were included in this review. All five trials contributed at least one intervention arm to one or more of the three prespecified comparisons. In total, 1075 participants across eligible arms were included in the meta-analyses. The difference reflects trial arms that did not meet our prespecified intervention and comparison definitions, and were therefore not analysed, though all participants were randomised within eligible trials and are accounted for in the review total. The trials assessed the DASH diet in a primary prevention setting; none evaluated its effects in secondary prevention. Participants were generally healthy adults aged 18 years or older, without diagnosed cardiovascular disease. The intervention duration ranged from 16 weeks to 12 months, with follow-up periods between 16 weeks and 18 months (medium- and long-term). The trials were conducted in the USA and Poland, with funding from public institutions, including the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the Institute of Cardiology in Poland. DASH diet versus no intervention (including usual care) Myocardial infarction: one trial (144 participants) reported no myocardial infarctions in either group over a one-year follow-up. The GRADE certainty rating was low due to the high risk of performance bias and imprecision. Stroke: one trial (144 participants) reported no strokes in either group over the same follow-up period. The GRADE rating was low for similar reasons. All-cause mortality: one trial (90 participants) reported no deaths over a six-month follow-up. The GRADE rating was very low due to unclear risk of selection bias, high risk of performance bias, and imprecision. No data were available for heart failure or revascularisation needs (coronary, carotid, or peripheral) in this comparison. DASH diet versus minimal intervention Myocardial infarction: two trials (902 participants in total; 629 participants were in trial arms eligible for this comparison, based on our prespecified intervention and comparison definitions) reported limited events, with no clear differences between groups over one year (risk ratio (RR) 2.99, 95% confidence interval (CI) 0.12 to 73.04). The GRADE rating was low due to high risk of performance bias and imprecision. Stroke: two trials (reporting on the same 629 participants) reported no strokes in either group over follow-up periods ranging from six months to one year. The GRADE rating was low due to similar concerns. No data were available for heart failure, revascularisation needs (coronary, carotid, or peripheral), or all-cause mortality in this comparison. DASH diet versus another dietary intervention All-cause mortality: one trial (261 participants) reported no clear difference between the groups over one year (RR 2.98, 95% CI 0.12 to 72.42). The GRADE rating was very low due to multiple risks of bias and imprecision. No data were available for myocardial infarction, stroke, heart failure, or revascularisation needs in this comparison. AUTHORS' CONCLUSIONS:The effect of the DASH diet on major cardiovascular outcomes - including myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality - remains inconclusive due to a lack of robust long-term evidence. Additionally, no trials have assessed its impact on heart failure or the need for revascularisation procedures, such as coronary, carotid, or peripheral interventions. While the DASH diet may reduce blood pressure, total cholesterol, and triglyceride levels while increasing high-density lipoprotein (HDL) cholesterol compared to no intervention or usual care, it appears to have little to no effect on low-density lipoprotein (LDL) cholesterol. Evidence comparing the DASH diet to a minimal intervention or alternative dietary approaches remains limited. Although the DASH diet has minimal reported adverse effects, the absence of long-term safety data prevents definitive conclusions on its use in individuals with or without cardiovascular disease. The certainty of evidence is low to very low, primarily due to design limitations such as high risk of bias, small sample sizes, and short follow-up periods in the included trials. Most studies focused on cardiovascular risk factors rather than long-term clinical outcomes, and all eligible trials assessed primary prevention, with no data on secondary prevention. Given these uncertainties, well-designed, long-term randomised controlled trials are needed to evaluate the DASH diet's impact on major cardiovascular events, its effectiveness in secondary prevention, and its long-term safety.

BACKGROUND:Drug tourism reflects the expanding illicit drug market, posing health risks in unfamiliar travel settings. Existing knowledge specifically addressing substance use among international travellers is sparse and has not been reviewed to date. This review aimed to describe the recreational substance abuse in international travellers. METHODS:A literature search was conducted on PubMed, Google Scholar and Scopus using keywords related to recreational substances and international travellers. A total of 11 021 articles were reviewed, charted and summarized for the evidence on prevalence, patterns and characteristics of substance abuse and their health- and non-health-related problems on international travellers. RESULTS:A total of 58 articles were included. Most were cross-sectional studies and review articles. In total, 20 articles addressed the prevalence of substance abuse in travellers, 33 looked at characteristics and patterns of substance abuse in travellers and 39 investigated the health- and non-health-related problems from substance abuse. Estimated prevalence of recreational substances abuse varied from 0.7% to 55.0%. Rates of substances abuse were 9.45-34.5% for cannabis, 20.4-35.9% for alcohol intoxication, 2.82-40.5% for MDMA, 2-22.2% for cocaine, 2-15% for psychedelic agents and 2% for methamphetamine. The prevalence varied according to travellers' characteristics and travel destinations. Direct health problems included neuropsychiatric problems. Indirect problems included accident and unintentional injuries, crime and violence, risky sexual behaviours and sexual violence and blood-borne infections. Non-health-related problems included air rage, deportation and violation of local laws. CONCLUSION:Substance abuse among international travellers is an underestimated problem that requires intervention. These findings emphasize the importance of addressing this issue to mitigate both health and well-being problems among travellers whilst promoting safer and more responsible travel experiences. In the context of travel health practices, practitioners should counsel travellers whose itineraries may include substance abuse, informing them about associated risks and consequences.

The growing complexity of GeoSentinel surveillance data creates opportunities for novel data science-based outbreak detection methods. Challenges may be overcome by effective multidisciplinary collaboration. The early signals generated by outbreak detection methods using GeoSentinel data may influence policymaking, shape public health responses, and contribute to global disease control strategies.

An internet-based search identified 59 national and regional travel and tropical medicine societies across 193 UN member states. The analysis revealed diverse educational activities, with 61% hosting conferences and 32% publishing journals. Findings underscore the potential for ISTM to enhance global collaboration and support in travel medicine education.

Background: Knowledge of specific health-related events encountered by students studying abroad and the availability and use of pre-travel healthcare for these students is lacking. Methods: Anonymous web-based questionnaires were sent to study abroad offices, student health centers, and undergraduate students after studying abroad at eight institutions of higher education in the United States and Ireland from 2018–2021. Analyses were descriptive; relative risks and 95% confidence intervals were calculated for health-related events. Results: One study abroad office required a pre-travel consultation. All student health centers had pre-travel counseling available. Among 686 students, there were 307 infectious and 1,588 non-infectious health-related issues; 12 students (2%) were hospitalized. Duration of travel and timing of a pre-travel consultation impacted the risk of health-related events. Certain mental health conditions were associated with increased risk of alcohol and drug use. Conclusion: Future studies should address the optimal timing and best practices to optimize health for students studying abroad.

This perspective highlights the inconsistent integration of travel health education across medical, nursing and pharmacy educational programmes globally and calls for standardized travel health competencies based on the International Society of Travel Medicine's (ISTM) Body of Knowledge to help improve patient care outcomes as global travel returns to pre-pandemic levels.

BACKGROUND:Peripheral arterial disease (PAD) is the obstruction or narrowing of the large arteries of the lower limbs, which can result in impaired oxygen supply to the muscle and other tissues during exercise, or even at rest in more severe cases. PAD is classified into five categories (Fontaine classification). It may be asymptomatic or various levels of claudication pain may be present; at a later stage, there may be ulceration or gangrene of the limb, with amputation occasionally being required. About 20% of people with PAD suffer from intermittent claudication (IC), which is muscular discomfort in the lower extremities induced by exertion and relieved by rest within 10 minutes; IC causes restriction of movement in daily life. Treatment for people with IC involves addressing lifestyle risk factors. Exercise is an important part of treatment, but supervised exercise programmes for individuals with IC have low engagement levels and high attrition rates. The use of mobile technologies has been suggested as a new way to engage people with IC in walking exercise interventions. The novelty of the intervention, low cost for the user, automation, and ease of access are some of the advantages mobile health (mhealth) technologies provide that give them the potential to be effective in boosting physical activity in adults. OBJECTIVES:To assess the benefits and harms of mobile health (mhealth) technologies to improve walking distance in people with intermittent claudication. SEARCH METHODS:The Cochrane Vascular Information Specialist conducted systematic searches of the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL, and also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The most recent searches were carried out on 19 December 2022. SELECTION CRITERIA:We included randomised controlled trials (RCTs) in people aged 18 years or over with symptomatic PAD and a clinical diagnosis of IC. We included RCTs comparing mhealth interventions to improve walking distance versus usual care (no intervention or non-exercise advice), exercise advice, or supervised exercise programmes. We excluded people with chronic limb-threatening ischaemia (Fontaine III and IV). DATA COLLECTION AND ANALYSIS:We used standard Cochrane methods. Our primary outcomes were change in absolute walking distance from baseline, change in claudication distance from baseline, amputation-free survival, revascularisation-free survival. Our secondary outcomes were major adverse cardiovascular events, major adverse limb events, above-ankle amputation, quality of life, and adverse events. We used GRADE to assess the certainty of the evidence. MAIN RESULTS:We included four RCTs involving a total of 614 participants with a clinical diagnosis of IC. The duration of intervention of the four included RCTs ranged from 3 to 12 months. Participants were randomised to either mhealth or control (usual care or supervised exercise programme). All four studies had an unclear or high risk of bias in one or several domains. The most prevalent risk of bias was in the area of performance bias, which was rated high risk as it is not possible to blind participants and personnel in this type of trial. Based on GRADE criteria, we downgraded the certainty of the evidence to low, due to concerns about risk of bias, imprecision, and clinical inconsistency. Comparing mhealth with usual care, there was no clear evidence of an effect on absolute walking distance (mean difference 9.99 metres, 95% confidence interval (CI) -27.96 to 47.93; 2 studies, 503 participants; low-certainty evidence). None of the included studies reported on change in claudication walking distance, amputation-free survival, or revascularisation-free survival. Only one study reported on major adverse cardiovascular events (MACE) and found no clear difference between groups (risk ratio 1.37, 95% CI 0.07 to 28.17; 1 study, 305 participants; low-certainty evidence). None of the included studies reported on major adverse limb events (MALE) or above-ankle amputations. AUTHORS' CONCLUSIONS:Mobile health technologies can be used to provide lifestyle interventions for people with chronic conditions, such as IC. We identified a limited number of studies that met our inclusion criteria. We found no clear difference between mhealth and usual care in improving absolute walking distance in people with IC; however, we judged the evidence to be low certainty. Larger, well-designed RCTs are needed to provide adequate statistical power to reliably evaluate the effects of mhealth technologies on walking distance in people with IC.

Background Last-minute travelers (LMTs) present significant challenges for travel health services and are considered vulnerable due to their lack of health preparation. However, there is a lack of data to support this assumption. Methods The proportion of LMTs was investigated through a cross-sectional study involving all Thai travelers who visited the Thai Travel Clinic before their departure abroad. A prospective study was conducted by enrolling the travelers after the consultation, utilizing two online questionnaires. The first aimed to gather demographic data and categorize participants as either LMTs (if their departure date was ≤14 days) or non-LMTs, while the second assessed travel-related illnesses either upon their return or at the one-month point if their trip exceeded a month. Results A quarter (25.5 %) of 310 Thai travelers abroad were classified as LMTs. Both LMTs and non-LMTs showed similar gender distributions with mean ages of 35.8 and 35.7 years old, respectively, but LMTs were more likely to travel for tourism, travel in groups, visit countries within Asia and plan shorter stays abroad. Follow-up studies were conducted from July 2023 to February 2024. 452 departed respondents consisted of 150 LMTs and 302 non-LMTs. Although overall health problems were insignificantly higher in LMTs (32.0 % vs 22.0 %, AOR = 1.469, p = 0.107), gastrointestinal and neurological symptoms (primarily headache and dizziness) were significantly more common among LMTs. Conclusions LMTs represent a significant portion of Thai travelers, posing challenges for travel health specialists in Thailand. Intervention and education efforts may be necessary to address this issue.

Background The increasing prevalence of falsified and counterfeit medicines globally poses risks to international travellers. This narrative literature review examines the global challenge of falsified and counterfeit medicines, with a specific focus on risks for travellers. The aim is to provide a comprehensive understanding of this multidimensional issue, exploring potential solutions for effective intervention. Methods A comprehensive search of databases, including PubMed, MEDLINE, and Scopus, as well as relevant reports from international organisations, was undertaken. There was a focus on extracting information pertaining to the prevalence, types, and geographical patterns of falsified and counterfeit medicines encountered by international travellers. Synthesising this information helped to identify overarching trends and patterns. This narrative review utilised a thematic analysis approach to synthesise the findings. Results The findings revealed a diverse range of counterfeit drug categories, spanning from antibiotics to lifestyle medications, posing unique risks to travellers navigating the global pharmaceutical landscape. The review emphasises the geographical distribution of these drugs, with varying consequences for both high- and low-income nations. The inadequate formulations and inconsistent drug release arising from these practices pose severe threats to public health, especially for individuals travelling abroad. The review also highlights the significance of international collaboration in addressing this global challenge, as pharmaceutical supply chains seamlessly cross borders, necessitating a collaborative approach for effective regulation and enforcement. Conclusions This review underscores the need for targeted research, collaborative interventions, and technological innovations to address the complexities associated with falsified and counterfeit medicines, ensuring the safety and well-being of international travellers.

This paper discusses challenges in formulating and harmonizing malaria prevention recommendations for travellers. It explores diverse approaches used by advisory groups to assess malaria risk and shares insights from the 2023 International Expert Committee for Travel Medicine meeting. It also explores future prospects for enhancing malaria prevention recommendations for travellers.

This perspective article discusses the physical, mental and sociocultural benefits of international travel and considers the case for prescribing travel for therapeutic reasons. It also identifies priorities for further research in this neglected area.

Inadequate access to public bariatric surgical services has favoured the growth of bariatric tourism. This study analysed data extracted from bariatric surgical centres that care for patients travelling from abroad. The research highlights apparent deficits in accreditation, communication, perioperative care, and travel health advice. An international registry of accredited bariatric tourism providers and patient education may be indicated.

We read with great interest the systematic review by Wyler et al., published recently in this journal.1 This comprehensive review of literature pertaining to mortality arising from injuries in travellers highlighted the importance of discussing the hazards of road traffic collisions, drowning and homicide in the pre-travel consultation. While the review by Wyler et al.1 focuses on fatal injuries arising in these three settings, we wish to draw attention to an oft-overlooked category of travel-related traumatic injury. Sexual assault and rape during international travel, which may occur in isolation or in association with homicide, was the subject of an invited symposium presentation by one of the authors (A.H.) at the CISTM16 conference in Washington DC. While research in this area is sparse, a retrospective review of patients cared for at dedicated forensic medical services revealed that 9% of victims had experienced sexual violence while travelling outside the Republic of Ireland.2 A previous letter to this journal discussed the hidden phenomenon of in-flight sexual assaults and suggested ways in which the airline travel industry should prevent and respond to such distressing incidents.3 Kennedy and Flaherty4 pointed to the reluctance of individuals to disclose their experiences of sexual violence and suggested that this may be magnified in the context of international travel.

Context: Male amateur marathon runners represent a unique subset of the population who may be at increased risk of cardiovascular disease (CVD) due to their underlying risk factors and their involvement in vigorous exercise such as marathon running. Objective: To assess the modifiable risk factors (MRFs) of CVD in experienced male amateur marathon runners and health interventions on CVD risk factors. Data Sources: CINAHL, Cochrane Library, Embase, Medline, and SPORTDiscus. Study Selection: Studies selected according to the inclusion criteria. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: The publication dates included were from June 1, 2008 to February 29, 2020. Published primary epidemiological, observational, randomized controlled trial (RCT) and/or non-RCT studies assessing the MRFs of CVD and health interventions on CVD risk factors in male amateur marathon runners aged ≥18 years and written in the English language were included in the review. Results: Five studies met the inclusion criteria for analysis. These included male amateur marathon runners (n = 862), aged 42 to 77 years. Hypertension, hyperlipidemia, smoking, and alcohol use were MRFs positively associated with an increased risk of coronary atherosclerosis found in a subset of male marathon runners. No studies examined health interventions on CVD risk factors in any of the included studies. All 5 studies were of good quality from the National Heart, Lung, and Blood Institute quality assessment tools used. The risk of bias was low to moderate. Conclusion: There is a paucity of observational studies evaluating the CVD MRFs. Negative lifestyle behaviors exist within this population despite their engagement in physical exercise through marathon running. Marathon running does not negate the long-term effects caused by past negative lifestyle behaviors. This systematic review identifies that this population may not be aware of their possible risk of atherosclerosis and, consequently, CVD.

We have entered an exciting era where generative artificial intelligence is finding multiple applications in everyday life and scientific inquiry. This editorial explores the possibility of integrating this technology into the pre-travel consultation, but with careful consideration of its current capabilities, limitations and potential risks to patient safety.