Medical tourism continues

to grow, and the role of the travel medicine practitioner in preparing such patients has not been established.32 The most common health problems during travel include TD, skin problems, and respiratory symptoms.2,3,29 Many illnesses experienced are mild and resolve spontaneously, which complicates accurate etiological diagnoses, and reduces the feasibility and utility of further PR-171 in vitro research aimed in this area. Nevertheless, there are some practical questions that have been suggested as foci of possible future research. These involve noninfectious and infectious health problems that arise during travel, for which an improved evidence base regarding incidence and/or management would be welcome (Table 2). Travelers and travel medicine practitioners usually emphasize prevention of infectious diseases as the priority during the pre-travel encounter. However, the highest risks of death and disability for travelers arise from trauma. Typically, for selected travelers, brief reference to security issues is made (eg, terrorism and crime risk, children’s car seat use, the use of helmets when cycling during travel, and the use of life vests during water sports); however, novel approaches to improve security in travel should be explored.33 Data also suggest

that travelers are at risk for thromboembolism during long flights; however, questions remain about appropriate targets for prophylaxis and optimal therapeutic approaches to thromboembolic prevention. The risks of sexually transmitted Roxadustat datasheet infections are often not sufficiently emphasized during

pre-travel encounters, particularly given the high incidence of casual sex during travel.34,35 Effective strategies to Adenosine advise and promote adherence regarding safe sex practices are needed. In addition, medical volunteering is a common cause for travel that poses increased risk of transmission of blood-borne pathogens, such as HIV and hepatitis B and C. While vector avoidance is well recognized as an optimal approach to reduce the risks of many infectious diseases (including malaria), novel strategies to improve compliance with use of preventive measures such DEET (N,N-diethyl-m-toluamide) and permethrin should be explored. The GeoSentinel report has informed an evidence-based approach to the differential diagnosis of ill-returned travelers.29 The report showed significant regional differences in proportionate morbidity in most of the broad syndromic illness categories among travelers presenting to GeoSentinel sites. However, many questions remain about diagnostic and management approaches, particularly for diseases that have a diagnosis of exclusion such as post-infectious irritable bowel syndrome.