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Feasibility study on small cars as an alternative to conventional fleets due to low occupancy: case study in Indonesia

Setiyo M, Widodo EM, Rosyidi MI, Waluyo B, Pambuko ZB, Tamaldin N

Heliyon, 2020 Jan;6(1):e03318.
PMID: 32051877 DOI: 10.1016/j.heliyon.2020.e03318

Consumer interest in privately managed urban transport services in Indonesia are showing a declining trend. On the other hand, the presence of Transportation on Demand (ToD) based on Internet of Things (IoT) has attracted the majority of conventional fleet customers which contribute to the declining trend of occupancy. Therefore, this study aims to present a feasibility study of a small car RE60 Three Passenger and One Driver (3P+1D) four-wheeler as an alternative to replace conventional fleets. The Break-Even Point (BEP), Net Present Value (NPV), Internal Rate of Return (IRR), and Payback Period (PP) are analyzed based on vehicle operating data. The analysis shows that there is an additional monthly income flow of IDR 1,533,122 and IDR 2,536,946 from RE60 operations compared to the high and low consumption of fuel from existing fleets, respectively. In conclusion, it is feasible to invest in small car RE60 as a replacement for the existing fleets since the fundamental indicators (BEP, NPV, IRR, and PP) showed positive results before the specified instalment period. Sensitivity analysis also shows good results, NPV shows positive results (>0) although the input conditions are made pessimistic to -30% from NPV base case. The BEP of RE60 will cut distance travelled at 190,670 km and 115,225 km, respectively. NPV of IDR 33,088,000 and IDR 80,841,000 will be obtained at the 60th month after the operation and IRR also enabled good scores, at 2.24% and 4.17%.

Matched MeSH terms: Travel
Fever and rash in a returning traveller

Kumar N, Lewis DJ

BMJ, 2012;344:e2400.
PMID: 22496299 DOI: 10.1136/bmj.e2400
Matched MeSH terms: Travel*
Final journeys: exploring the realities of suicide tourism

Zhi GYJ, Flaherty GT, Hallahan B

J Travel Med, 2019 May 10;26(3).
PMID: 30860264 DOI: 10.1093/jtm/taz016
Matched MeSH terms: Travel*
Fulltext First case of Plasmodium knowlesi infection in a Japanese traveller returning from Malaysia

Tanizaki R, Ujiie M, Kato Y, Iwagami M, Hashimoto A, Kutsuna S, et al.

Malar J, 2013;12:128.
PMID: 23587117 DOI: 10.1186/1475-2875-12-128

This is the first case of Plasmodium knowlesi infection in a Japanese traveller returning from Malaysia. In September 2012, a previously healthy 35-year-old Japanese man presented to National Center for Global Health and Medicine in Tokyo with a two-day history of daily fever, mild headaches and mild arthralgia. Malaria parasites were found in the Giemsa-stained thin blood smear, which showed band forms similar to Plasmodium malariae. Although a nested PCR showed the amplification of the primer of Plasmodium vivax and Plasmodium knowlesi, he was finally diagnosed with P. knowlesi mono-infection by DNA sequencing. He was treated with mefloquine, and recovered without any complications. DNA sequencing of the PCR products is indispensable to confirm P. knowlesi infection, however there is limited access to DNA sequencing procedures in endemic areas. The extent of P. knowlesi transmission in Asia has not been clearly defined. There is limited availability of diagnostic tests and routine surveillance system for reporting an accurate diagnosis in the Asian endemic regions. Thus, reporting accurately diagnosed cases of P. knowlesi infection in travellers would be important for assessing the true nature of this emerging human infection.

Matched MeSH terms: Travel*
Fulltext First case of detection of Plasmodium knowlesi in Spain by Real Time PCR in a traveller from Southeast Asia

Ta TT, Salas A, Ali-Tammam M, Martínez Mdel C, Lanza M, Arroyo E, et al.

Malar J, 2010;9:219.
PMID: 20663184 DOI: 10.1186/1475-2875-9-219

Previously, Plasmodium knowlesi was not considered as a species of Plasmodium that could cause malaria in human beings, as it is parasite of long-tailed (Macaca fascicularis) and pig-tailed (Macaca nemestrina) macaques found in Southeast Asia. A case of infection by P. knowlesi is described in a Spanish traveller, who came back to Spain with daily fever after his last overseas travel, which was a six-month holiday in forested areas of Southeast Asia between 2008 and 2009. His P. knowlesi infection was detected by multiplex Real time quantitative PCR and confirmed by sequencing the amplified fragment. Using nested multiplex malaria PCR (reference method in Spain) and a rapid diagnostic test, the P. knowlesi infection was negative. This patient was discharged and asymptomatic when the positive result to P. knowlesi was reported. Prior to this case, there have been two more reports of European travellers with malaria caused by P. knowlesi, a Finnish man who travelled to Peninsular Malaysia during four weeks in March 2007, and a Swedish man who did a short visit to Malaysian Borneo in October 2006. Taken together with this report of P. knowlesi infection in a Spanish traveller returning from Southeast Asia, this is the third case of P. knowlesi infection in Europe, indicating that this simian parasite can infect visitors to endemic areas in Southeast Asia. This last European case is quite surprising, given that it is an untreated-symptomatic P. knowlesi in human, in contrast to what is currently known about P. knowlesi infection. Most previous reports of human P. knowlesi malaria infections were in adults, often with symptoms and relatively high parasite densities, up to the recent report in Ninh Thuan province, located in the southern part of central Vietnam, inhabited mainly by the Ra-glai ethnic minority, in which all P. knowlesi infections were asymptomatic, co-infected with P. malariae, with low parasite densities and two of the three identified cases were very young children under five years old.

Matched MeSH terms: Travel
Fulltext First molecular documented case of a rarely reported parasite: Plasmodium knowlesi infection in Denmark in a traveller returning from Malaysian Borneo

Aftab H, Kemp M, Stensvold CR, Nielsen HV, Jakobsen MM, Porskrog A, et al.

Travel Med Infect Dis, 2023;53:102580.
PMID: 37088361 DOI: 10.1016/j.tmaid.2023.102580

Plasmodium knowlesi has been reported as an emerging infection throughout the Southeast Asian region, especially in the Malaysian state of Sabah, where it accounts for the majority of the malaria cases reported. This is in contrast to Europe, where imported P. knowlesi is a rarely reported infection. We present a case of P. knowlesi infection in a Danish woman returning from a short trip to Malaysian Borneo. Microscopy of blood smears revealed 0.8% infected erythrocytes, but due to the atypical morphological presentation, a conclusive species identification was made by molecular methods. Plasmodium knowlesi is a potentially fatal infection and taking the increasing travel activity into consideration after the coronavirus disease 2019 (COVID-19) pandemic, P. knowlesi should be a differential diagnosis in patients with travel-associated illness returning from highly endemic Southeast Asian areas.

Matched MeSH terms: Travel
Follicular cutaneous larva migrans: a report of three cases and review of the literature

Veraldi S, Persico MC, Francia C, Nazzaro G, Gianotti R

Int J Dermatol, 2013 Mar;52(3):327-30.
PMID: 23414157 DOI: 10.1111/j.1365-4632.2012.05723.x

Hookworm-related cutaneous larva migrans (CLM) is characterized clinically by erythematous and slightly raised tracks, located especially on the feet. These tracks may be single or multiple, linear or serpiginous, more or less ramified and intertwined. The length is variable (up to many cm); the width ranges from 1 mm to 4 mm. Tracks are often accompanied by severe pruritus.

Matched MeSH terms: Travel*
Fulltext Food restrictions during pregnancy among Indigenous Temiar women in peninsular Malaysia

Sharifah Zahhura SA, Nilan P, Germov J

Malays J Nutr, 2012 Aug;18(2):243-53.
PMID: 24575670 MyJurnal

INTRODUCTION: A qualitative comparative case study was conducted to compare and contrast food taboos and avoidance practices during pregnancy among Orang Asli or indigenous Temiar women in four distinct locations that represent different lifestyle experiences and cultural practices.
METHODS: Through snowballing sampling, a total of 38 participants took part in five focus groups: one group each in Pos Simpor and Pos Tohoi in Kelantan state, one group in Batu 12, Gombak in Selangor state, and two groups in a regroupment scheme (RPSOA) in Kuala Betis, Kelantan. All the transcripts were coded, categorised and 'thematised' using the software package for handling qualitative data, NVivo 8.
RESULTS: Variant food prohibitions were recorded among the Temiar women residing in different locations, which differ in food sources and ways of obtaining food. Consumption of seventeen types of food items was prohibited for a pregnant Temiar woman and her husband during the prenatal period. Fear of difficulties during labour and delivery, convulsions or sawan, harming the baby (such as foetal malformation), and twin pregnancy seemed to trigger many food proscriptions for the pregnant Temiar women, most of which have been passed on from generation to generation.
CONCLUSION: The findings of this study confirm that beliefs about food restrictions are strong among those Temiar living a traditional lifestyle. However, those who have adopted a more modern lifestyle also preserve them to some extent.pregnancy among Orang Asli or indigenous Temiar women in four distinct locations that represent different lifestyle experiences and cultural practices.

Matched MeSH terms: Travel
Getting to the heart of influenza vaccination in winter travellers

Flaherty GT

J Travel Med, 2019 Jan 01;26(1).
PMID: 30590731 DOI: 10.1093/jtm/tay158
Matched MeSH terms: Travel*
Going viral: embracing the changing culture of social media in travel medicine

Flaherty GT, Walden LM

Travel Med Infect Dis, 2015 Mar-Apr;13(2):120-1.
PMID: 25812774 DOI: 10.1016/j.tmaid.2015.03.005
Matched MeSH terms: Travel Medicine*
Fulltext Health Education Intervention as an Effective Means for Prevention of Respiratory Infections Among Hajj Pilgrims: A Review

Goni MD, Hasan H, Wan-Arfah N, Naing NN, Deris ZZ, Arifin WN, et al.

Front Public Health, 2020;8:449.
PMID: 33014965 DOI: 10.3389/fpubh.2020.00449

The prevalence of respiratory illness has continued to surge among Hajj pilgrims from different countries despite having some practices of preventive measures. Respiratory illnesses during Hajj could be due to many reasons and many factors that promote disease spread. These factors include overcrowding, cigarette smoking, and direct contact with infectious agents particularly viruses promote the spread of respiratory infections. However, due to the longer duration of the pilgrimage, there are high chances of pilgrims contracting various respiratory illnesses due to exposure to respiratory pathogens. Hajj pilgrims' knowledge, attitudes, and practices toward respiratory tract infections are used as the determinant of the effectiveness of the health education interventions. Knowledge and application of basic hygiene principles, use of face masks, following cough etiquettes, engaging in social distancing, and engaging in other measures are highly important. In this paper, we reviewed the various effective intervention strategies implemented to help prevent respiratory tract infections during Hajj.

Matched MeSH terms: Travel*
Health care reform and changes: the Malaysian experience

Merican MI, bin Yon R

Asia Pac J Public Health, 2002;14(1):17-22.
PMID: 12597513

Health care reform is an intentional, sustained and systematic process of structural change to one or more health subsystems to improve efficiency, effectiveness, patient choices and equity. Health care all over the world is continuously reforming with time. Health care reform has become an increasingly important agenda for policy change in both developed and developing countries including Malaysia. This paper provides an overview of the Malaysian health care system, its achievements, and issues and challenges leading to ongoing reform towards a more efficient and equitable health care system that possess a better quality of life for the population.

Matched MeSH terms: Travel
Health problems among international travellers: from a subtropical region to tropical and non-tropical regions

Pai HH, Lai JL

Travel Med Infect Dis, 2008 Jul;6(4):201-4.
PMID: 18571109 DOI: 10.1016/j.tmaid.2008.03.001

International travel may be associated with the risk of a wide range of infectious diseases. This study was designed to obtain information on the health problems among international travellers from a subtropical region to the neighbouring tropical, subtropical, and temperate regions. Health problems among international travellers from Taiwan to the Philippines, Malaysia, Indonesia, Singapore, Vietnam, Thailand (tropical group), Hong Kong, Macao, China and Japan (non-tropical group) were surveyed through the telephone. Of 649 travellers surveyed, 8.2% had one or more health problems and insect bite (3.4%) and coughing or sore throats (3.2%) were the most important symptoms. The rate of coughing or sore throats was significantly higher among those returned from the non-tropical regions. However, no associations were found between health problems and the demographic factors, travel style or travelling duration of travel.

Matched MeSH terms: Travel*
Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers

Piyaphanee W, Stoney RJ, Asgeirsson H, Appiah GD, Díaz-Menéndez M, Barnett ED, et al.

J Travel Med, 2023 May 18;30(3).
PMID: 36637429 DOI: 10.1093/jtm/taad002

BACKGROUND: International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists.
METHODS: Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis.
RESULTS: From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9; 19%), expertise abroad (n = 9; 19%), lower cost (n = 8; 17%) and convenience (n = 7; 15%); a third (n = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter.
CONCLUSIONS: International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.

Matched MeSH terms: Travel; Travel Medicine
Hepatitis B vaccine

Wilkinson IE

Med J Aust, 1992 May 18;156(10):741.
PMID: 1535682
Matched MeSH terms: Travel
Fulltext High proportion of asymptomatic and presymptomatic COVID-19 infections in air passengers to Brunei

Wong J, Abdul Aziz ABZ, Chaw L, Mahamud A, Griffith MM, Lo YR, et al.

J Travel Med, 2020 08 20;27(5).
PMID: 32365178 DOI: 10.1093/jtm/taaa066
Matched MeSH terms: Air Travel*
Hotel fire safety for international travellers

Flaherty G, Hession M, Cuggy C

Travel Med Infect Dis, 2016 Sep-Oct;14(5):529-530.
PMID: 27238904 DOI: 10.1016/j.tmaid.2016.05.011
Matched MeSH terms: Travel*
Fulltext How many roads must a Malaysian walk down? Mapping the accessibility of radiotherapy facilities in Malaysia

Yahya N, Sukiman NK, Suhaimi NA, Azmi NA, Manan HA

PLoS One, 2019;14(3):e0213583.
PMID: 30897166 DOI: 10.1371/journal.pone.0213583

BACKGROUND: The accessibility to radiotherapy facilities may affect the willingness to undergo treatment. We sought to quantify the distance and travel time of Malaysian population to the closest radiotherapy centre and to estimate the megavoltage unit (MV)/million population based on the regions.
MATERIALS & METHODS: Data for subdistricts in Malaysia and radiotherapy services were extracted from Department of Statistics Malaysia and Directory of Radiotherapy Centres (DIRAC). Data from DIRAC were validated by direct communication with centres. Locations of radiotherapy centres, distance and travel time to the nearest radiotherapy were estimated using web mapping service, Google Map.
RESULTS: The average distance and travel time from Malaysian population to the closest radiotherapy centre were 82.5km and 83.4mins, respectively. The average distance and travel were not homogenous; East Malaysia (228.1km, 236.1mins), Central (14.4km, 20.1mins), East Coast (124.2km, 108.8mins), Northern (42.9km, 42.8mins) and Southern (36.0km, 39.8mins). The MV/million population for the country is 2.47, East Malaysia (1.76), Central (4.19), East Coast (0.54), Northern (2.40), Southern (2.36). About 25% of the population needs to travel >100 km to get to the closest radiotherapy facility.
CONCLUSION: On average, Malaysians need to travel far and long to reach radiotherapy facilities. The accessibility to radiotherapy facilities is not equitable. The disparity may be reduced by adding centres in East Malaysia and the East Coast.

Matched MeSH terms: Travel
Fulltext Human Invasive Muscular Sarcocystosis Induces Th2 Cytokine Polarization and Biphasic Cytokine Changes, Based on an Investigation among Travelers Returning from Tioman Island, Malaysia

Tappe D, Slesak G, Pérez-Girón JV, Schäfer J, Langeheinecke A, Just-Nübling G, et al.

Clin Vaccine Immunol, 2015 Jun;22(6):674-7.
PMID: 25903356 DOI: 10.1128/CVI.00042-15

Sarcocystis nesbitti is a parasite responsible for a biphasic eosinophilic febrile myositis syndrome in two recent outbreaks in Malaysia. We demonstrate Th2 cytokine polarization in infected travelers, an overall cytokine production decrease in the early phase of the disease suggestive of initial immunosuppression, and elevated levels of proinflammatory and chemotactic cytokines in the later myositic phase.

Matched MeSH terms: Travel
Fulltext Human infections with Sarcocystis species

Fayer R, Esposito DH, Dubey JP

Clin Microbiol Rev, 2015 Apr;28(2):295-311.
PMID: 25715644 DOI: 10.1128/CMR.00113-14

Recurrent outbreaks of muscular sarcocystosis among tourists visiting islands in Malaysia have focused international attention on sarcocystosis, a disease once considered rare in humans. Sarcocystis species require two hosts, definitive and intermediate, to complete their life cycle. Humans can serve as definitive hosts, with intestinal sarcocystosis for two species acquired from eating undercooked meat: Sarcocystis hominis, from beef, and Sarcocystis suihominis, from pork. Symptoms such as nausea, stomachache, and diarrhea vary widely depending on the number of cysts ingested but appear more severe with pork than with beef. Humans serve as intermediate hosts for Sarcocystis nesbitti, a species with a reptilian definitive host, and possibly other unidentified species, acquired by ingesting sporocysts from feces-contaminated food or water and the environment; infections have an early phase of development in vascular endothelium, with illness that is difficult to diagnose; clinical signs include fever, headache, and myalgia. Subsequent development of intramuscular cysts is characterized by myositis. Presumptive diagnosis based on travel history to tropical regions, elevated serum enzyme levels, and eosinophilia is confirmed by finding sarcocysts in muscle biopsy specimens. There is no vaccine or confirmed effective antiparasitic drug for muscular sarcocystosis, but anti-inflammatory drugs may reduce symptoms. Prevention strategies are also discussed.

Matched MeSH terms: Travel

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