01% to 0.1% require medical evacuation.1,2 Fortunately, the death rate is low. A number of studies have examined the death rate of their citizens abroad, mostly using national foreign affairs data3–18 or observational studies.19 Unlike many Western countries, there are no data available on the numbers and causes of death of Proteasome function Dutch citizens abroad, even

though countless of Dutch travelers visit destinations outside the Netherlands each year. This lack of information is mostly a result of the absence of a mandatory registration system of Dutch citizens who died abroad. Although the death rate of citizens abroad remains an important indicator of a country’s safety profile, it can—from an alternative point of view—also be Vadimezan solubility dmso considered as the end point of accumulation of personal risk factors, including traveler’s personal health and behavior, which may be preventable to a certain extent. Detailed knowledge on these causes of death of travelers abroad is needed to accurately estimate these health risks. Moreover, this information may also be used as an important feedback tool to improve the quality and focus of our current travel health consultation and preparation. The aim of this study is to provide more insight in the number and causes of death of Dutch citizens abroad in relation to their travel destination. In 2009, we performed a questionnaire-based

survey among all Dutch general physicians. The questionnaire dealt with the following six items: (1) Do you Selleckchem Hydroxychloroquine give pretravel advice and to how many persons? (2) How many of your clients in your practice died abroad in the years 2007 and 2008? (3) What was the country of death? (4) What was the cause of death? (5) What was the age and gender of the deceased?

and (6) Do you have any additional information on the cause of death? All countries were classified in regions, according to the designated six World Health Organization (WHO) regions (available at www.who.int/about/regions/en/). These six regions were the European region including Turkey, Russia, and Greenland; the region of the Americas, both North America and South America; the African region, the whole continent apart from Morocco, Tunisia, Sudan, Somalia, and Egypt; the Eastern Mediterranean region including the Middle East and Morocco, Tunisia, Sudan, Somalia, and Egypt; the Southeast Asian region with also India, Indonesia, Thailand, and Sri Lanka; and the Western Pacific region including countries like China, Japan, Malaysia, New Zealand, and Australia. Demographic data, numbers and causes of deaths, and the countries of death were statistically analyzed using SPSS (v.15.0) software (SPSS Inc., Chicago, IL, USA). The number of Dutch travelers to all countries and regions in the world was obtained from the World Tourist Organization (available at www.e-unwto.org/home/main.mpx).