旅行医学课件英文版.ppt

Introduction to travel medicine,About the author,Dr Peter Leggat has co-ordinated the Australian postgraduate course in travel medicine since 1993.He has also been on the faculty of the South African travel medicine course,conducted since 2000,and the Worldwise New Zealand Travel Health update programs since 1998.Dr Leggat has assisted in the development of travel medicine programs in several countries and also the Certificate of Knowledge examination for the International Society of Travel Medicine.,Objectives,In this sessionDefine travel medicineExamine some figures for global and local migrationHopefully gain an appreciation of the importance of giving travel health adviceDiscuss some of components that are needed in order to give correct advice to traveller,What is travel medicine?,It is a science and an art,What is travel medicine?,It is that part of health professional practice that:seeks to prevent illnesses and injuries occurring to travellers going abroadmanages problems arising in travellers coming back or coming from abroadis concerned about the impact of tourism on health and also advocates for improved health and safety services for tourists is increasing concerned about refugee and migrant health(Primer of Travel Medicine 3rd Ed),“the art of travel medicine is selecting the necessary prevention strategy without unnecessary adverse events,cost or inconvenience”(Steffen,1994),Challenge of travel medicine,Sea of global migration of peopleMore people travellingPeople travelling further a fieldRapid movement of travellers,USA/Canada35.2 million,Europe25.0 million,Japan11.4 mio,AUS/NZ3.3 million,Travellers from industrialised areas to developing areas 1999(WTO),2.8,2.3,19,7.8,1.9,3.6,6.8,2.5,1.3,1.6,2.4,4.6,6.1,4.8,2.6,Total:,n million travelers,0.2-1 million travelers,80 million travelers,1.2,Globalization of health and safety,AffectsHealth of local populationsHealth determinantsSafety and securityResults inGlobal impactsEmerging and re-emerging infectious disease,Commerce and Health,Pathogens travel as fast as transportation:borders are not respected,Tsunami,SARS,Influenza,Terrorism,Travellers are exposed to a variety of hazards,The Importance of Travel Health Measures,100,000 travelers to the developing world for 1 month.50,000 will become ill8,000 will see a physician5,000 will stay in bed1 will die,Steffen,1994,The Importance of Travel Health Measures,Per 100,000 travellers that have travel insurance.8000 will make a claim(8%)2000 will use emergency assistance(2%)400 ER or clinic referrals(0.4%)200 Hospital admissions(0.2%)50 Aeromedical evacuations(0.05%),Leggat et al.Travel Med Inf Dis 2005;3:9-17.,The Importance of Travel Health Measures,MortalityCardiovascular Disease(50 to 70%)Accidents/Trauma(20-25%),esp.MVAsInfectious diseases(2.8-4%)(Reid and Cossar,BMBull.1993;257-268;Prociv,MJA.1995;163:27-30;Baker et al.,PHR 1992;107:155-159;MacPherson et al,JTM.2000;2000:227-233;Steffen,Trans RSTM85:156-162),Travel medicine is a continuum,Travellers do get sick or injured abroad or when they come backThe commitment to travel health can therefore be regarded as a continuum,The Continuum of Travel Medicine,During Travel,Preventive Medicine,Contingency Planning,Treatment&Rehabilitation,Visitors,Pre-Travel,Post-Travel,What do we need to do in order to be giving the correct advice to travellers?,Travel Health Advice needs Information,“Information is power in Travel Medicine”,Travel Health Advice needsTraining,Training gives you a framework for using that information,Travel Health Advice needsExperience,Experience helps put the information and training in perspective,Travel Health Advice needsto be Documented,Documentation is important for Quality assurance and reinforcing travel health advice,Travel Health Advice needsTravellers,Marketing is essential in travel health,whether in general practice or in specialist travel clinics,Giving the correct advice to travellers,Giving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellers,Travel Health Advice needs Information,GuidelinesPoliciesTextbooks,including an World AtlasJournalsProfessional organisationsStaff/colleaguesElectronic DatabasesWWW,International Guidelines,WHOInternational Health RegulationsInternational Travel and Healthwww.who.int/ithYellow fever requirements,“National Guidelines”,Travel Health GuidelinesMalaria GuidelinesImmunisation GuidelinesAntibiotic GuidelinesJournalsSeminars,You need access to www-sites,International Society of Travel Medicinewww.istm.org US Centers for Disease Control and Preventionwww.cdc.gov/travelUS GuidelinesSimilar government sites for UK and CanadaWorld Health Organizationhttp:/www.who.int/ith The former“yellow book”is now published as the“blue book”online,It is very useful to have access to a multicountry travel medical advisory service,CDC Travel Health,see http:/www.cdc.gov/travel/index.htmMASTA,see http:/www.masta.orgTRAVAX,see http:/www.travax.nhs.ukShorelands,see http:/,Professional Organisations,Local professional groups andTHE ISTM,ISTM,International Society of Travel MedicineInternational NetworkInternational Clinic DirectoryUseful for marketing/recognitionwww.istm.orgListserveOutbreak alertsJournalGeosentinelCertificate of Travel HealthGreat Conferences!,Journals,Weighing the Evidence,Weighing the evidence,“Travel medicine prevention should be based on epidemiological data.”Robert Steffen,1991What are the likely risks of a person travelling to particular destinations?What are the likely benefits of intervention?,Giving the correct advice to travellers,Giving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellers,Pre-Travel Health Advice needs Training,Helps give structure and consistencyProvides a framework for practiceDiscusses evidence for practicePolicy and Procedures ManualConsistent approach to travel health,Part of the commitment is to also have a consistent and structured approach to travel health advice,WHO Checklist(www.who.int/ith)Information on local conditionsPreventionAccident avoidanceMedical and dental check-upNZPHR-PreventionVaccinationsHealth AdvicePrescription,Source:http:/www.who.int/ith,VACCINATE(IHC),AlwaysNational scheduleOftenhepatitis ASometimesJapanese encephalitis meningococcal disease polio rabies yellow fever Influenza Pneumococcal disease Other vaccines(adapted*from NZPHR;1996;3(8):57-59),ADVISE AND DISCUSS,Insectsrepellents,nets,permethrinIngestionscare with food and waterdiet/teeth(including airlines/jetlag/DVT)*IndiscretionsSTIs,HIVInjuriesaccident avoidance,personal safetyImmersionschistosomiasisInsurance*health and travel insurance*finding medical assistance o/s*(adapted*from NZPHR;1996;3(8):57-59),PRESCRIBE(Script/Drs letter/bracelet),Alwaysregular medicationmedical kit(first aid)*Sometimesantimalarial medicationdiarrheal self-treatmentcondoms(NZPHR;1996;3(8):57-59),Courses,Increasing number of travel medicine academic programs globally(see educational opportunities at www.istm.org)Get relevant endorsementsAviation medical examinerDiving medical certification(SPUMS)Certificate of Travel Health(ISTM)Occupational health training,Courses,Weighing the evidenceContributing to the discipline through research(also through GeoSentinel)Despite training,still need to keep up to date and to keep seeing travellers to help build experience,Giving the correct advice to travellers,Giving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellers,Travel health advice needs experience,Lets just do it!Affiliation with a group with experience can be usefulTravel clinic groupTravel medical advisory group(eg MASTA,Worldwise,Travax etc)UniversityThose NZ GPs that were interested in travel medicine were significantly more likely to have had tropical medicine/developing country experience(Leggat et al.JTM 1999;7:55-58.),Travel is part of experience,Travel is part of experience,Professionals working in travel medicine need to travel and have that personal experience to communicate to travellersHelps to put travel health advice in context and helps to build a positive travel experience,Giving the correct advice to travellers,Giving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellers,Travel health advice needs to be documented,Standardised forms/questionnairesInformed consentInternational Health Certificate/Vaccination recordDoctors letter/copy of prescription/medialert braceletWritten advice/videos/Books/Health advisory documents,Correct advice is even better if the advice is actually followed by the traveller,DocumentationFollow-up Use staff resourcesReinforce health advice,Giving the correct advice to travellers,Giving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellers,Travel Health Advice needs Travellers,Inform own patients concerning the need for seeking travel health advice,and seeking this advice earlyMarket travel health adviceDirect,if possibleJoin group/affiliateLinks/promotion with traveller groups,travel agents,travel insurance,consulates etcJoin travellers health networks,such as ISTM,IAMAT etc,Take home points,More people are traveling to more destinations,becoming exposed to the health and safety of that destination and also having the potential to impact on the health and safety of that destination,especially through emerging infectious diseaseTravelers health is a continuum and includes the pre-travel health,contingency planning while abroad and caring the traveler after travelTravel health advice needs information(including a capacity to undertake a risk assessment),training,experience,documentation and travelers,