Archive for December, 2009

The Year, I mean, Decade In Review

Thursday, December 31st, 2009 by Andy Orr

I guess I drew the short straw.  Here it is the last day of the year, and I have been tasked with writing the pivotal year-end post.  Except that this year, it is the pivotal decade-ending post.  I realize that today is not the last day of the first decade of the third millennium.  As many others have pointed out, there was no year 0, so technically the year 2000 was the end of the second millennium, and we won’t complete the first decade of the third until the last day of 2010.  I will, however, go with the flow and cave in to the lower standard that seems to prevail in the mainstream media.

This decade was marked by many changes.  The Wall Street Journal’s article by Alan Murray titled “A 10-Year Dose of Reality” offered up a view focused on the economy and business with bubbles, scandals and global upheaval, but also highlighted that this decade saw the largest reduction in poverty ever, the emergence and growth of world-changing new technologies and the election of our first black president.  He also threw in Susan Boyle for good measure.

Given that the Healthy Travel Blog has somewhat of a focus (I have been accused of trying to derail this sometimes), I will address the advances we have seen in medicine in this decade.  I could also choose terrorism, travel security (somewhat in the news today), pandemics, climate change and natural disasters, but didn’t.

I am not going to reinvent the wheel when ABC News, in collaboration with MedPage Today, has already conducted a large survey and process to figure out the top 10 medical advances of the decade.  Their authoritative list is:

  1. Human Genome Mapping
  2. Doctors and Patients Harness Information Technology
  3. Anti-Smoking Laws and Campaigns Reduce Public Smoking
  4. Heart Disease Deaths Drop by 40 Percent
  5. Stem Cell Research: Laboratory Breakthroughs and Some Clinical Advances
  6. Targeted Therapies for Cancer Expand With New Drugs
  7. Combination Drug Therapy Extends HIV Survival
  8. Minimally Invasive Techniques Revolutionize Surgery
  9. Study Finds Heart, Cancer Risk With Hormone Replacement Therapy
  10. Scientists Peer Into Mind With Functional MRI

Items 1, 2, 5, 6 and 10 seem mostly focused on the future.  3, 4, 7 and 8 are in full force now, and 9 is really a finding that past practices had big unknown risks.  Number 7 stands out for me through a personal connection.  My brother-in-law, an internist in Philadelphia, has told me how great the change has been in the United States for patients with HIV/AIDS.  Instead of a ward filled with dying patients, he now treats patients with a chronic condition well-managed by a pharmaceutical cocktail.  Outside of the U.S. the biggest advances have been in the reduction of transmission rates.  New advances are being worked on with vaccines and gene therapy.

What do you think was the biggest advance in the last decade?  How about the biggest challenge for the future?  Let us know by leaving a comment, and we will follow up in more detail.

Here’s hoping that the next decade brings peace to the world and progress for all.  Happy New Year!

Photo: http://www.flickr.com/photos/wohinauswandern/4231050474CC BY 2.0

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More Happiness Data by Destination: Study Ranks States

Tuesday, December 22nd, 2009 by Mike Hartung

Louisiana is one of the happiest states in the U.S.The latest investigation into happiness by destination comes from Andrew Oswald of the University of Warwick (UK) and Stephen Wu of Hamilton College (NY) who have ranked all fifty states and DC using two data sets. One from the Centers for Disease Control compiles responses from 1.3 million Americans who were asked this: “How satisfied are you with your life?” The other is research conducted at the University of Southern California on indicators of quality of life such as sunshine, crime and environmental health. Surprisingly, Louisiana came out on top even in the aftermath of the Katrina disaster. And Mississippi is in the top six. At the bottom of the list? New York and Connecticut. There’s clearly little or no correlation with income per capita. The authors found a high degree of correlation between the subjective survey responses and the more objective indices. They speculate that “liberal angst” might be playing a role.

I’ve spent time in both New York City and New Orleans, and if we could measure the velocity of life, I think it would go a long way toward explaining these findings.

Photo: http://www.flickr.com/photos/philippeleroyer/ / CC BY-NC-ND 2.0
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Discover the Developing World’s Ten Best Ethical Destinations

Monday, December 21st, 2009 by Mike Hartung

The Earth Island Institute has published its 2010 Ethical Destinations Report at ethicaltraveler.org, shedding some light on the developing countries that have demonstrated the strongest commitment to environmental protection, social welfare and human rights. The report is a serious research effort to promote ethical travel: gaining an awareness of our impact and responsibilities as we explore the world. By all accounts it’s worth the trip. According to the authors, the countries cited represent “opportunities to experience nature at its most pristine, and to interact with local people and cultures in a meaningful, mutually enlightening way.” 

The authors have mined some of the best published data available to come up with this year’s Top Ten (see chart below). It’s interesting to find four South American countries, four African countries and two eastern European countries. Developing Asian nations did not make the list because of irresponsible development policies, human rights abuses and weak environmental policies. The comments we included in the chart are research findings measured against all countries of the world. These achievements are particularly impressive for nations without a long history of democracy. Though fledglings, these countries are ready to take flight as destinations for responsible travelers.

A handful of countries fell out of last year’s Top Ten: Costa Rica, Bolivia and Bulgaria have a growing reputation for child trafficking, and Nicaragua’s human rights record took a major step backward.

Do you have first-hand experience as an ethical traveler? The Healthy Travel Blog would like you contribute to this conversation.

ethicaltravelerchart

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The 787 Dreamliner – maybe not just in your dreams anymore

Wednesday, December 16th, 2009 by Andy Orr

787 DreamlinerToday is follow-up post day! 

Boeing’s hope for the future successfully completed its maiden flight yesterday.   The 787 Dreamliner, as mentioned here in November, has many new features that will improve passenger comfort.  We were most excited about the change in how it maintains cabin air pressure and how this benefits passengers through improved air quality.

Just as with the Fitbit Tracker, but infinitely more important to our economy, the Dreamliner has been beset by delay after delay during its development and testing period.  I hope that this first flight will help them get through the final testing phase and into ramped-up production.   They have a backlog of 865 on order – that’s equivalent to a little over 1.5 billion Fitbits (in dollars) and will definitely help put some people back to work.

Photo by: marada http://www.flickr.com/photos/marada/ / CC BY-ND 2.0

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Follow Up – Tracking the Fitbit Tracker

Wednesday, December 16th, 2009 by Andy Orr

Fitbit TrackerI saw that the New York Times had an article on the Fitbit Tracker last week and wanted to post a short follow up for our readers.

We first mentioned that the Fitbit Tracker was shipping back in September.   We were impressed by the device’s size, features and price (not to mention that is has no monthly fee after the purchase, unlike many of its competitors).

Unfortunately, we discovered late in October that their planned shipping date had slipped from the end of October to the end of January.  We also lamented back then that their initial openness with the development and production of the tracker had disappeared.  There have been no updates to their blog since September, and the last posted comment was in late October.

The NYT article, however, was confusing at best on this issue.  It seems that the company may be communicating with some of their pre-order customers directly, but one of these potential consumers stated that he hadn’t “heard anything yet” while maintaining “They’ve been really open and transparent about where they are in the process, and that’s made it easier to tolerate the wait.”  I’m hoping that the Fitbit is fit for prime time delivery soon and that it works as advertised.

As for consumer interest, there are eleven on sale at eBay today, with two featuring “Buy It Now” prices of around $250.  That is quite a bit more than the $99 price for someone with patience, but it speaks to the interest that people have in this device.  eBay lists twenty (20) having been sold for prices between $162.50 and $405.  Perhaps some of these are destined to sit under the trees of some lucky recipients.

On a bit of related news, I learned recently about Zeo, a “Personal Sleep Coach”, that made its debut back in June.  This seems to be much more comprehensive than the Fitbit in its sleep monitoring functionality but comes at a much steeper price – either $249 plus $7.95/month (or $79.95/year) for access to guided coaching or $349 with lifetime access built-in.  The $349 price makes sense if you plan to use this for a while, and if you think the company has staying power.

Photo by player x http://www.flickr.com/photos/playerx/ / CC BY 2.0
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The Lure of Easy Living

Wednesday, December 16th, 2009 by Brendan Sharkey

Island lifeIn my days of lecturing about global health care services to prospective expatriates, it was never a surprise to see scores of retirees stationed up front. They showed a high level of interest by nodding and taking copious notes. They had come to hear about health care services available around the globe.

Although many retirees love the idea of a personal maid, a driver, endless summer days, cheap eats and all around easy living, they also fear the limitations of health care in far-away places.  Their fear is not unfounded. It is a big world and the quality of healthcare can vary greatly from one city to the next.

Some of the most attractive retirement destinations lack the kind of health care infrastructure that someone chronically ill, or even someone perfectly healthy, needs access to. Is it reasonable to hope you can be airlifted from your island sanctuary anytime illness or injury comes calling? This may be impractical and could land you in a perilous situation.

A host of issues need to be considered when deciding what kind of insurance coverage you need for you and your family:  routine services, finding dependable medications, locating well trained English speaking doctors. For major surgeries there are even more concerns to address.  And whether you are healthier than you’ve ever been or have a chronic illness, there are other important questions. How will Medicare cover me overseas? Can I drop out of Medicare and purchase a local health plan and what are the pros and cons of doing so? 

Forbes recently covered several of the issues that a potential expat should consider including Insurance: Don’t Leave Home Without It, The 10 Best Retirement Havens, and The Globe’s Best Hospitals.  These articles provide you with a lot of things to think about and to help you make a sound decision.  Do your research, talk to the experts and remember this:  easy living requires peace of mind.

Photo by Just.looking http://www.flickr.com/photos/jonathanhercock/ / CC BY-ND 2.0
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Airline Safety for the Educated Consumer

Wednesday, December 16th, 2009 by Moira Bishop

airline safety2009 has not been a great year for air travel anywhere in the world.  Too often the headlines told of tragic accidents and not enough miracles.  This news is surely weighing on millions of global citizens booking flights for their holiday visits and vacations. 

We’ve offered perspective on travel associated risks in the past and the Book of Odds reminds us that the likelihood of being involved in any plane accident, let alone a fatal one, is extremely low.  However, the events of this year have even the most reasonable people wondering if there is something they should know before choosing their air carrier.

For those people, the Wall Street Journal recently published the results of the aviation safety reports published by the European Union (EU) and by the U.S. Federal Aviation Administration (FAA).  The data collection and evaluation processes are very different for each of these organizations. For instance the EU rates the safety of individual airlines, while the FAA evaluates countries as a whole. Overall, both reports take into account the history of accidents, policies and procedures, equipment and maintenance, but their criteria in each of these areas differ.

So if you want to feel like you have a little more control of your destiny, check the reports and book your flights accordingly. The Encyclopedia Britannica Blog reports, “airline safety declining, but still good.”  But it’s statistics like these that lead to the safety improvements necessary to create a safer product for everyone.  Remember that as you book your next trip.  By the way, if you happen to be planning a flight on British Airways for the holiday, you might want to monitor the status of the rumored strike set to take place December 22nd.

Photo by Tristan in Ottawa http://www.flickr.com/photos/tsmith22/ / CC BY-NC-ND 2.0
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DVT: What You Need to Know

Friday, December 11th, 2009 by Frank Gillingham, MD

Immobilization can lead to DVT.One thing that‘s most likely NOT on your holiday wish list this year is Deep Venous Thrombosis (DVT), but if you are going to be traveling for any significant periods of time, you are at risk for developing one.  Regardless of your age or physical health, you are susceptible to these blood clots that form in the large veins well below the skin’s surface.  The Quasi’s Bell Tower blog recounts the experiences of one young, healthy American student who suffered through DVT last year in Romania. 

Generally, DVT occurs in the leg and if it stays there, you should be ok. However, a DVT can break off, completely or in pieces, and travel through your body up to your lungs. Once in your lungs, this condition is identified as a pulmonary embolus (PE) and could result in death.

Immobilization of any kind raises your risk of developing DVT — this includes immobilization on an airplane, in a car, etc. Other factors that can raise the risk of DVT include regular smoking, obesity, pregnancy, use of birth control pills, dehydration, recent surgery or other medical problems requiring hospitalization, certain types of cancer or heart disease, and structural abnormalities of the veins. Some people are genetically predisposed to blood clots — so your family history is important–and senior travelers may also be at higher risk.

Symptoms of a DVT often include leg pain or tenderness, redness, or swelling.  Symptoms of a PE often include chest pain, shortness of breath, and cough (sometimes with blood tinged sputum).

If you are planning a long trip, follow these tips:

  • Get up, stretch and/or walk around every 60 minutes or so. Request an aisle seat so it’s easier to do so. Bulkheads and exit rows also provide more leg space and easier entry/exit. If you can, elevate your legs intermittently during the flight.
  • Drink plenty of fluids to avoid dehydration (coffee and alcoholic beverages don’t count!).
  • Move around and exercise in your seat, making sure the seat presses up against a different part of your legs every once in a while. Don’t cross your legs for prolonged periods of time.
  • Medical Grade support stockings can be helpful and don’t require a lot of effort to either obtain or to use — ask your doctor or pharmacist.

If you develop any symptoms of a DVT, persistent leg pain, redness or swelling, or symptoms of a PE, shortness of breath, cough or chest discomfort, seek immediate medical attention.  If you’ve had a DVT or a PE in the past you’re more likely to get one again in the future.  And, keep in mind — the longer the flight or the car trip, the higher the risk.

Image by: exonumia  http://www.flickr.com/photos/exonumia/ / CC BY-NC-SA 2.0

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Review: Culture Shock! A Survival Guide to Medical Safety

Friday, December 11th, 2009 by Moira Bishop

Culture Shock! A Survival Guide to Medical SafetyIn our post, Show Your Respect and Savoir Faire: Learn the Local Customs, we introduced the Culture Shock series as a useful source for you to consult before taking a journey overseas.   Recently, one of our contracted physicians, Dr. Paul E. Zakowich, published a new title in that series: Culture Shock! A Survival Guide to Medical Safety.  This addition to the series covers the medical topics you need to consider when traveling anywhere in the world.  

What makes this guide particularly useful is its clear organization which makes it easy to navigate through the contents quickly to find the information you need.  It takes you from the early stages of planning for your trip in terms of medical examinations and vaccinations, to diseases and environmental hazards that you could encounter in specific destinations.

Dr. Zakowich, a former medical advisor to the U.S. Embassy in Singapore, currently treats patients from all over the globe. This experience enables him to provide you with an answer for the “what ifs” before you even think to ask the question.  In addition to addressing the physical needs of a traveler, he addresses the mental ones through topics such as managing stress, securing travel medical insurance and even handling children on a long flight.

This guide is thorough and easy to read.  Pick up a copy as a holiday gift for that special global traveler in your life!

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Traveling Responsibly: Plan for the Unexpected

Wednesday, December 9th, 2009 by Moira Bishop

Crime can happen anywhereAs we pointed out in an earlier post crime can happen anywhere.  Criminals don’t spare you because you’re on vacation or traveling for business; in fact, they often target out-of-towners.   Even the beautiful islands known for their “no worries” attitude are now worried about getting their crime rates under control.  While our previous post focused on being aware of and taking steps to avoid being the victim of a crime, you need to have a plan in case you can’t avoid it.

In a recent article in the New York Times, the Practical Traveler details some tragic crimes against Americans abroad including the death of a young man struck by a speeding car.  These sobering events are a good reason to assess how much focus you put on the “what if” when preparing for a trip.

What if you are injured in an accident? What if you are the victim of a crime? If you are expecting to be able to quickly call 911 and get the help you need, you will be unpleasantly surprised. Do you know how to contact the local law enforcement? Can they be trusted? Who can you contact if you don’t feel like you are getting the support you need? Is there an American embassy close by?  You may need to contact someone back home to reach out to a local or state legislator who can advocate on your behalf.

On a more mundane level, what if your wallet or purse is stolen? Do you have photocopies of your driver’s license, credit cards and passport secured safely back in the safe of your hotel room? Do you have a separate credit card in the safe in case you lose the one in your wallet?

Regardless of where you are going, minimally you should arm yourself with the support documents and information that you will need in the event that something unexpected happens during your carefully planned trip or vacation.  Keep copies of important documents in a safe place, know how to call for help if you need it, and have access to the contact information for the closest American embassy or consulate.

Ideally, you won’t have to worry about any of these things on your trip, but take a few minutes to plan for the “just in case.”

 

Photo by kafka4prez: http://www.flickr.com/photos/kafka4prez/ / CC BY-SA 2.0

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