INTERNATIONAL TRAVEL WITH PRE-EXISTING MEDICAL ILLNESS

Abstract

This thesis describes a body of research investigating aspects of international travel health affecting individuals with pre-existing medical illnesses. To elucidate the travel experiences of obese individuals, semi-structured interviews were conducted. Principal emergent themes included obese air traveller embarrassment; physical discomfort on commercial flights; perceived weight bias; challenges in accessing hotel rooms; heat intolerance in warm climates; restricted leisure travel activities; and medical co-morbidities. The second study aimed to design and validate a questionnaire to examine the travel health knowledge, attitudes and practices of people living with type 1 diabetes, using exploratory and confirmatory factor analysis. A four-factor instrument emerged as follows: Pre-travel Preparation – Insect Bites; Pre-travel Preparation – Consultation; Insulin and Glycaemic Control; and Travel Risk Behaviour. The purpose of the study of last minute travellers (LMTs) was to describe the characteristics of LMTs attending a travel health clinic over a 6-year period. Of 7,555 traveller records, 1,296 (17.2%) were LMTs, of whom 45 (3.5%) were recurrent LMTs. Approximately two in five travellers reported a past medical history. It was evident from this study that a large proportion of LMTs have pre-existing medical conditions. The narrative review article analysed the issues faced by individuals with underlying medical conditions during the COVID-19 pandemic. This work identified that older patients are more likely to progress to severe COVID-19 disease requiring intensive care unit (ICU) admission. Patients with pre-existing hypertension and coronary heart disease are at greatly increased risk of developing severe and fatal COVID-19 disease. Obese COVID-19 patients are more likely to require complex ICU management. Multiple mechanisms of increased COVID-19 disease severity in diabetes were identified. The social isolation of patients with mental health disorders was compounded by the disruption of non-emergency care in hospitals. The final study focused on the development of a novel massive open online course (MOOC) in travel medicine for undergraduate healthcare students. Development of learning and assessment material and the pilot delivery phase were completed in December 2019. The MOOC was organised into five four-themed units: travel health risk assessment; pre-travel health advice; tropical infectious diseases; specialised travellers, including travellers with pre-existing conditions; and illness in returned travellers. Participant evaluation revealed very high levels of satisfaction with content and mode of delivery.