(see Appendix 2, available at [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.090313/-/DC1][1] for summary of recommendations and clinical considerations)









There are more than 200 million international migrants worldwide,[1][2] and this movement of people has implications for individual and

/pdf/evidence-based-clinical-guidelines-for-immigrants-and-200zq1p7iy.pdf

Evidence-based clinical guidelines for immigrants and refugees

David R. Hill, Charles D. Ericsson, Richard D. Pearson, Jay S. Keystone, David O. Freedman, Phyllis E. Kozarsky, Herbert L. DuPont, Frank J. Bia, Philip R. Fischer, and Edward T. Ryan National Travel Health Network and Centre and Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, England; Department of Medicine, University of Toronto, and Center for Travel and Tropical Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Department of Internal Medicine, Clinical Infectious Diseases, University of Texas Medical School at Houston, Department of Internal Medicine, St. Luke’s Hospital, and Center for Infectious Diseases, University of Texas at Houston School of Public Health, and Department of Medicine, Baylor College of Medicine, Houston, Texas; Departments of Medicine and Pathology, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia; Departments of Medicine and Epidemiology, Division of Geographic Medicine, University of Alabama at Birmingham, Birmingham; Department of Medicine, Infectious Diseases, Emory University School of Medicine, and 16 Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Medicine and Laboratory Medicine, Yale Medical School, New Haven, Connecticut; Department of Pediatrics, Division of General Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, and Mayo Eugenio Litta Children’s Hospital, Mayo Clinic, Rochester, Minnesota; and Department of Medicine, Division of Infectious Diseases, Harvard Medical School, Harvard School of Public Health, and Tropical and Geographic Medicine Center, Massachusetts General Hospital, Boston, Massachusetts

https://www.uphs.upenn.edu/bugdrug/antibiotic_manual/idsatravelmed.pdf

The practice of travel medicine: guidelines by the Infectious Diseases Society of America.

1. Introduction to Tourism and Global Environmental Change Part 1: Environments 2. Impacts of Global Environmental Change on Tourism in the Polar Regions 3. Global Environmental Change and Mountain Tourism 4. Lakes and Streams 5. Tourism and Forest Ecosystems 6. The Coastal and Marine Environment 7. Deserts and Savannah Regions 8. Tourism Urbanisation and Global Environmental Change Part 2: Global Issues 9. Tourism, Disease and Global Environmental Change 10. Tourism and Water 11. Extreme Weather Events 12. Biodiversity and Global Environmental Change Part 3: Stakeholder Adaptation and Perceptions 13. The Role of Climate Information in Tourist Destination Choice Decision-Making 14. Re-structuring the Tourist Industry 15. US Ski Industry Adaptation to Climate Change 16. The Example of the Avalanche Winter 1999 and the Storm Lothar in the Swiss Alps 17. Tourists and Global Environmental Change 18. Conclusion

Tourism and global environmental change : ecological, social, economic and political interrelationships

The implementation of real-time PCR for the diagnosis of malaria has been hampered by poor sensitivity for the detection of mixed infections. We have optimized a method that enhances the sensitivity of detection of minor species in mixed infections within a single multiplex reaction. Our assay uses species-specific forward primers in combination with a conserved reverse primer and largely overcomes primer competition for the minor species DNA. With a blind panel of clinical samples, we successfully identified the species in 13/16 mixed infections. This assay was further validated with 91 blood samples and demonstrated a specificity and sensitivity for single infections of 100% compared with nested PCR as the "gold standard." This test has been implemented for routine confirmation of malaria species in Alberta, Canada. In comparison with species identification by microscopy, the real-time PCR test demonstrated greater sensitivity for the identification of species causing low-level and mixed infections and for the discrimination of Plasmodium species other than Plasmodium falciparum. Our experience supports a role for real-time PCR in the identification of malarial species in conjunction with microscopy.

Multiplexed Real-Time PCR Assay for Discrimination of Plasmodium Species with Improved Sensitivity for Mixed Infections

Assessment of travellers who return home ill.

Over the last decade there has been a marked increase in cases of drug-resistant and severe malaria in Canadian travellers. We report 7 deaths due to falciparum malaria that occurred in Canada or in Canadian travellers. Risks for malaria infection include inappropriate recommendations for malaria prevention by health care providers and lack of knowledge about or adherence to appropriate recommendations by the travelling public. Risks for death include delays in seeking medical attention, delays in diagnosis and inadequate care by Canadian physicians and hospitals, and lack of access to parenteral therapy for severe malaria. Malaria infections and deaths are preventable. Better education of health care providers and travellers about the risks of malaria and appropriate prevention and treatment measures may decrease this unnecessary burden on the Canadian health care system.

/pdf/malaria-deaths-in-visitors-to-canada-and-in-canadian-35aof92nbx.pdf

Malaria deaths in visitors to Canada and in Canadian travellers: a case series

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Malaria deaths in visitors to Canada and in Canadian travellers: a case series