旅行医学 （英文版）课件

1、Introduction to travel medicineAbout the authorDr 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 prog

2、rams 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.ObjectivesIn this sessionDefine travel medicineExamine some figures for global and local migr

3、ationHopefully gain an appreciation of the importance of giving travel health adviceDiscuss some of components that are needed in order to give correct advice to travellerWhat is travel medicine?It is a science and an art“the art of travel medicine is selecting the necessary prevention strategy with

4、out unnecessary adverse events, cost or inconvenience” (Steffen, 1994)Challenge of travel medicineSea of global migration of peopleMore people travellingPeople travelling further a fieldRapid movement of travellers Globalization of health and safetyAffectsHealth of local populationsHealth determinan

5、tsSafety and securityResults inGlobal impactsEmerging and re-emerging infectious diseaseCommerce and HealthPathogens travel as fast as transportation: borders are not respectedTsunamiSARSInfluenzaTerrorismTravellers are exposed to a variety of hazardsThe Importance of Travel Health Measures100,000 t

6、ravelers to the developing world for 1 month.50,000 will become ill8,000 will see a physician5,000 will stay in bed1 will dieSteffen, 1994The Importance of Travel Health MeasuresPer 100,000 travellers that have travel insurance .8000 will make a claim (8%)2000 will use emergency assistance (2%)400 E

7、R 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 MeasuresMortalityCardiovascular Disease (50 to 70%)Accidents/Trauma (20-25%), esp. MVAsInfectious diseases (2.8-4%)(Reid and Cossar

8、, 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 RSTM&H 1991;85: 156-162 )Travel medicine is a continuumTravellers do get sick or injured abroad or when they come backThe commitment to travel health can

9、 therefore be regarded as a continuumWhat 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 needsExperienceExperience helps put the information and training in perspectiveTravel

10、Health Advice needsto be DocumentedDocumentation is important for Quality assurance and reinforcing travel health adviceTravel Health Advice needsTravellersMarketing is essential in travel health, whether in general practice or in specialist travel clinicsGiving the correct advice to travellersGivin

11、g the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellersTravel Health Advice needs InformationGuidelinesPoliciesTextbooks, including an World AtlasJournalsProfessional organisationsStaff/colleaguesElectronic DatabasesWWWInternational GuidelinesWHOInternati

12、onal Health RegulationsInternational Travel and Health/ithYellow fever requirements You need access to www-sitesInternational Society of Travel Medicine US Centers for Disease Control and Prevention/travel/travelUS GuidelinesSimilar government sites for UK and CanadaWorld Health Organization/ith The

13、 former “yellow book” is now published as the “blue book” onlineIt is very useful to have access to a multicountry travel medical advisory serviceCDC Travel Health, see /travel/index.htmMASTA, see TRAVAX, see http:/www.travax.nhs.ukShorelands, see ISTMInternational Society of Travel MedicineInternat

14、ional NetworkInternational Clinic DirectoryUseful for marketing/recognitionListserveOutbreak alertsJournalGeosentinelCertificate of Travel HealthGreat Conferences!JournalsWeighing the EvidenceWeighing the evidence“Travel medicine prevention should be based on epidemiological data.” Robert Steffen, 1

15、991What are the likely risks of a person travelling to particular destinations?What are the likely benefits of intervention?Giving the correct advice to travellersGiving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellersPre-Travel Health Advice needs T

16、rainingHelps give structure and consistencyProvides a framework for practiceDiscusses evidence for practicePolicy and Procedures ManualConsistent approach to travel healthPart of the commitment is to also have a consistent and structured approach to travel health adviceWHO Checklist (/ith)Informatio

17、n on local conditionsPreventionAccident avoidanceMedical and dental check-upNZPHR-PreventionVaccinationsHealth AdvicePrescriptionSource: /ithVACCINATE (IHC)AlwaysNational scheduleOftenhepatitis ASometimesJapanese encephalitis meningococcal disease polio rabies yellow fever Influenza Pneumococcal dis

18、ease Other vaccines(adapted* from NZPHR; 1996;3(8):57-59)ADVISE AND DISCUSSInsectsrepellents, nets, permethrinIngestionscare with food and waterdiet/teeth (including airlines/jetlag/DVT)*IndiscretionsSTIs, HIVInjuriesaccident avoidance, personal safetyImmersionschistosomiasisInsurance*health and tra

19、vel 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)CoursesIncreasing number of travel medicine

20、academic programs globally (see educational opportunities at )Get relevant endorsementsAviation medical examinerDiving medical certification (SPUMS)Certificate of Travel Health (ISTM)Occupational health trainingCoursesWeighing the evidenceContributing to the discipline through research (also through

21、 GeoSentinel)Despite training, still need to keep up to date and to keep seeing travellers to help build experienceGiving the correct advice to travellersGiving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellersTravel health advice needs experienceLets

22、 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 experien

23、ce (Leggat et al. JTM 1999; 7: 55-58.)Travel is part of experienceTravel is part of experienceProfessionals 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 experi

24、enceGiving the correct advice to travellersGiving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellersTravel health advice needs to be documentedStandardised forms/questionnairesInformed consentInternational Health Certificate/Vaccination recordDoctors l

25、etter/copy of prescription/medialert braceletWritten advice/videos/Books/Health advisory documentsCorrect advice is even better if the advice is actually followed by the travellerDocumentationFollow-up Use staff resourcesReinforce health adviceGiving the correct advice to travellersGiving the correct health advice to travellers needs:InformationTrainingExperienceDocumentationTravellersTravel Health Advice needs TravellersInf