旅行医学-课件(英文版)

IntroductiontotravelmedicineIntroductiontotravelmedicin1AbouttheauthorDrPeterLeggathasco-ordinatedtheAustralianpostgraduatecourseintravelmedicinesince1993.HehasalsobeenonthefacultyoftheSouthAfricantravelmedicinecourse,conductedsince2000,andtheWorldwiseNewZealandTravelHealthupdateprogramssince1998.DrLeggathasassistedinthedevelopmentoftravelmedicineprogramsinseveralcountriesandalsotheCertificateofKnowledgeexaminationfortheInternationalSocietyofTravelMedicine.AbouttheauthorDrPeterLegga2ObjectivesInthissessionDefinetravelmedicineExaminesomefiguresforglobalandlocalmigrationHopefullygainanappreciationoftheimportanceofgivingtravelhealthadviceDiscusssomeofcomponentsthatareneededinordertogivecorrectadvicetotravellerObjectivesInthissession3Whatistravelmedicine?ItisascienceandanartWhatistravelmedicine?Itis4Whatistravelmedicine?Itisthatpartofhealthprofessionalpracticethat:seekstopreventillnessesandinjuriesoccurringtotravellersgoingabroadmanagesproblemsarisingintravellerscomingbackorcomingfromabroadisconcernedabouttheimpactoftourismonhealthandalsoadvocatesforimprovedhealthandsafetyservicesfortourists

isincreasingconcernedaboutrefugeeandmigranthealth (PrimerofTravelMedicine3rdEd)Whatistravelmedicine?Itis5“theartoftravelmedicineisselectingthenecessarypreventionstrategywithoutunnecessaryadverseevents,costorinconvenience” (Steffen,1994)“theartoftravelmedicineis6ChallengeoftravelmedicineSeaofglobalmigrationofpeopleMorepeopletravellingPeopletravellingfurtherafieldRapidmovementoftravellersChallengeoftravelmedicineSe7USA/Canada35.2millionEurope25.0millionJapan11.4mioAUS/NZ3.3millionTravellersfromindustrialisedareas

todevelopingareas1999(WTO)2.82.3Total:nmilliontravelers0.2-1milliontravelers~80milliontravelers1.2USA/CanadaEuropeJapanAUS/N8GlobalizationofhealthandsafetyAffectsHealthoflocalpopulationsHealthdeterminantsSafetyandsecurityResultsinGlobalimpactsEmergingandre-emerginginfectiousdiseaseCommerceandHealthPathogenstravelasfastastransportation:bordersarenotrespectedTsunamiSARSInfluenzaTerrorismGlobalizationofhealthands9TravellersareexposedtoavarietyofhazardsTravellersareexposedtoava10TheImportanceofTravelHealthMeasures100,000travelerstothedevelopingworldfor1month…..50,000willbecomeill8,000willseeaphysician5,000willstayinbed1willdieSteffen,1994TheImportanceofTravelHealt11TheImportanceofTravelHealthMeasuresPer100,000travellersthathavetravelinsurance…..8000willmakeaclaim(8%)2000willuseemergencyassistance(2%)400ERorclinicreferrals(0.4%)200Hospitaladmissions(0.2%)50Aeromedicalevacuations(0.05%)Leggatetal.TravelMedInfDis2005;3:9-17.TheImportanceofTravelHealt12TheImportanceofTravelHealthMeasuresMortalityCardiovascularDisease(50to70%)Accidents/Trauma(20-25%),esp.MVAsInfectiousdiseases(2.8-4%)

(ReidandCossar,BMBull.1993;257-268;Prociv,MJA.1995;163:27-30;Bakeretal.,PHR1992;107:155-159;MacPhersonetal,JTM.2000;2000:227-233;Steffen,TransRSTM&H1991;85:156-162)TheImportanceofTravelHealt13TravelmedicineisacontinuumTravellersdogetsickorinjuredabroadorwhentheycomebackThecommitmenttotravelhealthcanthereforeberegardedasacontinuumTravelmedicineisacontinuum14TheContinuumofTravelMedicineDuringTravelPreventiveMedicineContingencyPlanningTreatment&RehabilitationVisitorsPre-TravelPost-TravelTheContinuumofTravelMedici15Whatdoweneedtodoinordertobegivingthecorrectadvicetotravellers?Whatdoweneedtodoinorder16TravelHealthAdviceneedsInformation“InformationispowerinTravelMedicine”TravelHealthAdviceneedsInf17TravelHealthAdviceneeds

TrainingTraininggivesyouaframeworkforusingthatinformationTravelHealthAdviceneeds

Tra18TravelHealthAdviceneeds

ExperienceExperiencehelpsputtheinformationandtraininginperspectiveTravelHealthAdviceneeds

Exp19TravelHealthAdviceneeds

tobeDocumentedDocumentationisimportantforQualityassuranceandreinforcingtravelhealthadviceTravelHealthAdviceneeds

to20TravelHealthAdviceneeds

TravellersMarketingisessentialintravelhealth,whetheringeneralpracticeorinspecialisttravelclinicsTravelHealthAdviceneeds

Tra21GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot22TravelHealthAdviceneedsInformationGuidelinesPoliciesTextbooks,includinganWorldAtlasJournalsProfessionalorganisationsStaff/colleaguesElectronicDatabasesWWWTravelHealthAdviceneedsInf23InternationalGuidelinesWHOInternationalHealthRegulationsInternationalTravelandHealth/ithYellowfeverrequirementsInternationalGuidelinesWHO24“NationalGuidelines”TravelHealthGuidelinesMalariaGuidelinesImmunisationGuidelinesAntibioticGuidelinesJournalsSeminars“NationalGuidelines”TravelHe25Youneedaccesstowww-sitesInternationalSocietyofTravelMedicine

USCentersforDiseaseControlandPrevention/travel/travelUSGuidelinesSimilargovernmentsitesforUKandCanadaWorldHealthOrganization/ith

Theformer“yellowbook”isnowpublishedasthe“bluebook”onlineYouneedaccesstowww-sitesIn26ItisveryusefultohaveaccesstoamulticountrytravelmedicaladvisoryserviceCDCTravelHealth,see/travel/index.htmMASTA,seeTRAVAX,seehttp://www.travax.nhs.ukShorelands,seeItisveryusefultohaveacce27ProfessionalOrganisationsLocalprofessionalgroupsandTHEISTMProfessionalOrganisationsLoca28ISTMInternationalSocietyofTravelMedicineInternationalNetworkInternationalClinicDirectoryUsefulformarketing/recognitionListserveOutbreakalertsJournalGeosentinelCertificateofTravelHealthGreatConferences!!ISTMInternationalSocietyofT29JournalsWeighingtheEvidenceJournalsWeighingtheEvidence30Weighingtheevidence“Travelmedicinepreventionshouldbebasedonepidemiologicaldata.” RobertSteffen,1991Whatarethelikelyrisksofapersontravellingtoparticulardestinations?Whatarethelikelybenefitsofintervention? Weighingtheevidence“Travelm31GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot32Pre-TravelHealthAdviceneedsTrainingHelpsgivestructureandconsistencyProvidesaframeworkforpracticeDiscussesevidenceforpracticePolicyandProceduresManualConsistentapproachtotravelhealthPre-TravelHealthAdviceneeds33PartofthecommitmentistoalsohaveaconsistentandstructuredapproachtotravelhealthadviceWHOChecklist(/ith)InformationonlocalconditionsPreventionAccidentavoidanceMedicalanddentalcheck-upNZPHR-PreventionVaccinationsHealthAdvicePrescriptionSource:/ithPartofthecommitmentistoa34VACCINATE(IHC)Always NationalscheduleOften hepatitisASometimes Japaneseencephalitis meningococcaldisease polio rabies yellowfever Influenza Pneumococcaldisease Othervaccines (adapted*fromNZPHR;1996;3(8):57-59)VACCINATE(IHC)Always Nationa35ADVISEANDDISCUSSInsects repellents,nets,permethrinIngestions carewithfoodandwater diet/teeth(including airlines/jetlag/DVT)*Indiscretions STI’s,HIVInjuries accidentavoidance,personal safetyImmersion schistosomiasisInsurance* healthandtravelinsurance* findingmedicalassistanceo/s*

(adapted*fromNZPHR;1996;3(8):57-59)ADVISEANDDISCUSSInsects rep36PRESCRIBE

(Script/Dr’sletter/bracelet)Always regularmedication medicalkit(firstaid)*Sometimes antimalarialmedication diarrhealself-treatment condoms (NZPHR;1996;3(8):57-59)PRESCRIBE37CoursesIncreasingnumberoftravelmedicineacademicprogramsglobally(seeeducationalopportunitiesat)GetrelevantendorsementsAviationmedicalexaminerDivingmedicalcertification(SPUMS)CertificateofTravelHealth(ISTM)OccupationalhealthtrainingCoursesIncreasingnumberoftr38CoursesWeighingtheevidenceContributingtothedisciplinethroughresearch(alsothroughGeoSentinel)Despitetraining,stillneedtokeepuptodateandtokeepseeingtravellerstohelpbuildexperienceCoursesWeighingtheevidence39GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot40TravelhealthadviceneedsexperienceLet’sjustdoit!AffiliationwithagroupwithexperiencecanbeusefulTravelclinicgroupTravelmedicaladvisorygroup(egMASTA,Worldwise,Travaxetc)UniversityThoseNZGPsthatwereinterestedintravelmedicineweresignificantlymorelikelytohavehadtropicalmedicine/developingcountryexperience (Leggatetal.JTM1999;7:55-58.)Travelhealthadviceneedsexp41TravelispartofexperienceTravelispartofexperience42TravelispartofexperienceProfessionalsworkingintravelmedicineneedtotravelandhavethatpersonalexperiencetocommunicatetotravellersHelpstoputtravelhealthadviceincontextandhelpstobuildapositivetravelexperienceTravelispartofexperiencePr43GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot44TravelhealthadviceneedstobedocumentedStandardisedforms/questionnairesInformedconsentInternationalHealthCertificate/VaccinationrecordDoctor’sletter/copyofprescription/medialertbraceletWrittenadvice/videos/Books/HealthadvisorydocumentsTravelhealthadviceneedsto45CorrectadviceisevenbetteriftheadviceisactuallyfollowedbythetravellerDocumentationFollow-upUsestaffresourcesReinforcehealthadviceCorrectadviceisevenbetter46GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot47TravelHealthAdviceneedsTravellersInformownpatientsconcerningtheneedforseekingtravelhealthadvice,andseekingthisadviceearlyMarkettravelhealthadviceDirect,ifpossibleJoingroup/affiliateLinks/promotionwithtravellergroups,travelagents,travelinsurance,consulatesetcJointravellershealthnetworks,suchasISTM,IAMATetcTravelHealthAdviceneedsTra48旅行医学--课件(英文版)49TakehomepointsMorepeoplearetravelingtomoredestinations,becomingexposedtothehealthandsafetyofthatdestinationandalsohavingthepotentialtoimpactonthehealthandsafetyofthatdestination,especiallythroughemerginginfectiousdiseaseTravelers’healthisacontinuumandincludesthepre-travelhealth,contingencyplanningwhileabroadandcaringthetraveleraftertravelTravelhealthadviceneedsinformation(includingacapacitytoundertakeariskassessment),training,experience,documentationandtravelersTakehomepointsMorepeoplear50IntroductiontotravelmedicineIntroductiontotravelmedicin51AbouttheauthorDrPeterLeggathasco-ordinatedtheAustralianpostgraduatecourseintravelmedicinesince1993.HehasalsobeenonthefacultyoftheSouthAfricantravelmedicinecourse,conductedsince2000,andtheWorldwiseNewZealandTravelHealthupdateprogramssince1998.DrLeggathasassistedinthedevelopmentoftravelmedicineprogramsinseveralcountriesandalsotheCertificateofKnowledgeexaminationfortheInternationalSocietyofTravelMedicine.AbouttheauthorDrPeterLegga52ObjectivesInthissessionDefinetravelmedicineExaminesomefiguresforglobalandlocalmigrationHopefullygainanappreciationoftheimportanceofgivingtravelhealthadviceDiscusssomeofcomponentsthatareneededinordertogivecorrectadvicetotravellerObjectivesInthissession53Whatistravelmedicine?ItisascienceandanartWhatistravelmedicine?Itis54Whatistravelmedicine?Itisthatpartofhealthprofessionalpracticethat:seekstopreventillnessesandinjuriesoccurringtotravellersgoingabroadmanagesproblemsarisingintravellerscomingbackorcomingfromabroadisconcernedabouttheimpactoftourismonhealthandalsoadvocatesforimprovedhealthandsafetyservicesfortourists

isincreasingconcernedaboutrefugeeandmigranthealth (PrimerofTravelMedicine3rdEd)Whatistravelmedicine?Itis55“theartoftravelmedicineisselectingthenecessarypreventionstrategywithoutunnecessaryadverseevents,costorinconvenience” (Steffen,1994)“theartoftravelmedicineis56ChallengeoftravelmedicineSeaofglobalmigrationofpeopleMorepeopletravellingPeopletravellingfurtherafieldRapidmovementoftravellersChallengeoftravelmedicineSe57USA/Canada35.2millionEurope25.0millionJapan11.4mioAUS/NZ3.3millionTravellersfromindustrialisedareas

todevelopingareas1999(WTO)2.82.3Total:nmilliontravelers0.2-1milliontravelers~80milliontravelers1.2USA/CanadaEuropeJapanAUS/N58GlobalizationofhealthandsafetyAffectsHealthoflocalpopulationsHealthdeterminantsSafetyandsecurityResultsinGlobalimpactsEmergingandre-emerginginfectiousdiseaseCommerceandHealthPathogenstravelasfastastransportation:bordersarenotrespectedTsunamiSARSInfluenzaTerrorismGlobalizationofhealthands59TravellersareexposedtoavarietyofhazardsTravellersareexposedtoava60TheImportanceofTravelHealthMeasures100,000travelerstothedevelopingworldfor1month…..50,000willbecomeill8,000willseeaphysician5,000willstayinbed1willdieSteffen,1994TheImportanceofTravelHealt61TheImportanceofTravelHealthMeasuresPer100,000travellersthathavetravelinsurance…..8000willmakeaclaim(8%)2000willuseemergencyassistance(2%)400ERorclinicreferrals(0.4%)200Hospitaladmissions(0.2%)50Aeromedicalevacuations(0.05%)Leggatetal.TravelMedInfDis2005;3:9-17.TheImportanceofTravelHealt62TheImportanceofTravelHealthMeasuresMortalityCardiovascularDisease(50to70%)Accidents/Trauma(20-25%),esp.MVAsInfectiousdiseases(2.8-4%)

(ReidandCossar,BMBull.1993;257-268;Prociv,MJA.1995;163:27-30;Bakeretal.,PHR1992;107:155-159;MacPhersonetal,JTM.2000;2000:227-233;Steffen,TransRSTM&H1991;85:156-162)TheImportanceofTravelHealt63TravelmedicineisacontinuumTravellersdogetsickorinjuredabroadorwhentheycomebackThecommitmenttotravelhealthcanthereforeberegardedasacontinuumTravelmedicineisacontinuum64TheContinuumofTravelMedicineDuringTravelPreventiveMedicineContingencyPlanningTreatment&RehabilitationVisitorsPre-TravelPost-TravelTheContinuumofTravelMedici65Whatdoweneedtodoinordertobegivingthecorrectadvicetotravellers?Whatdoweneedtodoinorder66TravelHealthAdviceneedsInformation“InformationispowerinTravelMedicine”TravelHealthAdviceneedsInf67TravelHealthAdviceneeds

TrainingTraininggivesyouaframeworkforusingthatinformationTravelHealthAdviceneeds

Tra68TravelHealthAdviceneeds

ExperienceExperiencehelpsputtheinformationandtraininginperspectiveTravelHealthAdviceneeds

Exp69TravelHealthAdviceneeds

tobeDocumentedDocumentationisimportantforQualityassuranceandreinforcingtravelhealthadviceTravelHealthAdviceneeds

to70TravelHealthAdviceneeds

TravellersMarketingisessentialintravelhealth,whetheringeneralpracticeorinspecialisttravelclinicsTravelHealthAdviceneeds

Tra71GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot72TravelHealthAdviceneedsInformationGuidelinesPoliciesTextbooks,includinganWorldAtlasJournalsProfessionalorganisationsStaff/colleaguesElectronicDatabasesWWWTravelHealthAdviceneedsInf73InternationalGuidelinesWHOInternationalHealthRegulationsInternationalTravelandHealth/ithYellowfeverrequirementsInternationalGuidelinesWHO74“NationalGuidelines”TravelHealthGuidelinesMalariaGuidelinesImmunisationGuidelinesAntibioticGuidelinesJournalsSeminars“NationalGuidelines”TravelHe75Youneedaccesstowww-sitesInternationalSocietyofTravelMedicine

USCentersforDiseaseControlandPrevention/travel/travelUSGuidelinesSimilargovernmentsitesforUKandCanadaWorldHealthOrganization/ith

Theformer“yellowbook”isnowpublishedasthe“bluebook”onlineYouneedaccesstowww-sitesIn76ItisveryusefultohaveaccesstoamulticountrytravelmedicaladvisoryserviceCDCTravelHealth,see/travel/index.htmMASTA,seeTRAVAX,seehttp://www.travax.nhs.ukShorelands,seeItisveryusefultohaveacce77ProfessionalOrganisationsLocalprofessionalgroupsandTHEISTMProfessionalOrganisationsLoca78ISTMInternationalSocietyofTravelMedicineInternationalNetworkInternationalClinicDirectoryUsefulformarketing/recognitionListserveOutbreakalertsJournalGeosentinelCertificateofTravelHealthGreatConferences!!ISTMInternationalSocietyofT79JournalsWeighingtheEvidenceJournalsWeighingtheEvidence80Weighingtheevidence“Travelmedicinepreventionshouldbebasedonepidemiologicaldata.” RobertSteffen,1991Whatarethelikelyrisksofapersontravellingtoparticulardestinations?Whatarethelikelybenefitsofintervention? Weighingtheevidence“Travelm81GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot82Pre-TravelHealthAdviceneedsTrainingHelpsgivestructureandconsistencyProvidesaframeworkforpracticeDiscussesevidenceforpracticePolicyandProceduresManualConsistentapproachtotravelhealthPre-TravelHealthAdviceneeds83PartofthecommitmentistoalsohaveaconsistentandstructuredapproachtotravelhealthadviceWHOChecklist(/ith)InformationonlocalconditionsPreventionAccidentavoidanceMedicalanddentalcheck-upNZPHR-PreventionVaccinationsHealthAdvicePrescriptionSource:/ithPartofthecommitmentistoa84VACCINATE(IHC)Always NationalscheduleOften hepatitisASometimes Japaneseencephalitis meningococcaldisease polio rabies yellowfever Influenza Pneumococcaldisease Othervaccines (adapted*fromNZPHR;1996;3(8):57-59)VACCINATE(IHC)Always Nationa85ADVISEANDDISCUSSInsects repellents,nets,permethrinIngestions carewithfoodandwater diet/teeth(including airlines/jetlag/DVT)*Indiscretions STI’s,HIVInjuries accidentavoidance,personal safetyImmersion schistosomiasisInsurance* healthandtravelinsurance* findingmedicalassistanceo/s*

(adapted*fromNZPHR;1996;3(8):57-59)ADVISEANDDISCUSSInsects rep86PRESCRIBE

(Script/Dr’sletter/bracelet)Always regularmedication medicalkit(firstaid)*Sometimes antimalarialmedication diarrhealself-treatment condoms (NZPHR;1996;3(8):57-59)PRESCRIBE87CoursesIncreasingnumberoftravelmedicineacademicprogramsglobally(seeeducationalopportunitiesat)GetrelevantendorsementsAviationmedicalexaminerDivingmedicalcertification(SPUMS)CertificateofTravelHealth(ISTM)OccupationalhealthtrainingCoursesIncreasingnumberoftr88CoursesWeighingtheevidenceContributingtothedisciplinethroughresearch(alsothroughGeoSentinel)Despitetraining,stillneedtokeepuptodateandtokeepseeingtravellerstohelpbuildexperienceCoursesWeighingtheevidence89GivingthecorrectadvicetotravellersGivingthecorrecthealthadvicetotravellersneeds:InformationTrainingExperienceDocumentationTravellersGivingthecorrectadvicetot90TravelhealthadviceneedsexperienceLet’sjustdoit!AffiliationwithagroupwithexperiencecanbeusefulTravelclinicgroupTravelmedicaladvisorygroup(egMASTA,Worldwise,Travaxetc)UniversityThos