After all, travelers play a central role in the global spread of STIs, especially travelers to tropical and subtropical regions with the highest worldwide prevalence of STIs including HIV.[38, 39] Accidents were the only risk perceived higher after travel but significantly lower by travelers than by experts (Figure 3). Injuries, particularly road traffic accidents, are the second most common cause of death abroad

after cardiovascular disease[40-43] and the leading cause of death of those aged 15 to 29 years worldwide.[44] Over 90% of road traffic fatalities occur in low- and middle-income countries,[44] including BIBW2992 price many tourist destinations in the tropics and subtropics. Higher mortality rates due to vehicle accidents have been found among travelers than among the local population.[45] Travelers are often not familiar with poor road conditions and different, partly insufficient or insufficiently enforced[44] road traffic laws, and they might engage in high-risk behavior during vacation. Despite their potential

for disability[44] and other complications, little is known about the incidence, type, and severity of nonfatal BMS-354825 manufacturer accidents among travelers. Injuries were reported by 6 to 16% of travelers in three different studies,[14, 46, 47] most of them due to road traffic accidents. The most vulnerable groups on the road are pedestrians, (motor) Avelestat (AZD9668) cyclists, and users of unsafe or overcrowded public transport.[44] Some studies suggest that (young) men are most likely to be involved in (fatal) vehicle crashes[43, 48] and engage in more

risk-taking activities than women.[14, 49] However, there were no gender- or age-related differences in the perception of accidents in this study (Figure 4). The post-travel increase in perception is most likely due to observed danger abroad. In other studies, accidents were also rated as a more important health problem during or after a stay abroad than before.[10, 50] In order to raise awareness of this potentially life-threatening risk before departure, information about accidents abroad including practical preventive measures needs to be an integral part of pre-travel health advice. PRISM has only been validated for the assessment of the subjective burden of a present illness, not for the perception of health risks in the near future and past. Nevertheless, a fast, nonverbal visual tool[16] may take into account the emotional quality of (risk) perception which is subjective among both travelers and experts. Statistical correlation of the perception of risks with their incidence was not an option as up-to-date, comparable data were not available or collected. However, the experts’ risk assessment, used as a reference point, proved to be consistent with current literature. Generalization of the results is limited owing to the single location of the study.