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RISK ASSESSMENT IN TRAVEL MEDICINE.


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RISK ASSESSMENT IN TRAVEL MEDICINE. Dr Peter A. Leggat MD, PhD, DrPH, FAFPHM, FACTM, FFTM Associate Professor School of Public Health and Tropical Medicine James Cook University & Visiting Professor School of Public Health University of the Witwatersrand. About the author.
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Hazard ASSESSMENT IN TRAVEL MEDICINE Dr Peter A. Leggat MD, PhD, DrPH, FAFPHM, FACTM, FFTM Associate Professor School of Public Health and Tropical Medicine James Cook University & Visiting Professor School of Public Health University of the Witwatersrand

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About the creator Dr Peter Leggat has co-ordinated the Australian postgraduate course in travel prescription since 1993. He has additionally been on the staff of the South African travel drug course, directed subsequent to 2000, and the Worldwise New Zealand Travel Health redesign programs following 1998. Dr Leggat has helped with the improvement of travel medication programs in a few nations furthermore the Certificate of Knowledge examination for the International Society of Travel Medicine.

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Objectives In this address, we will Define the term hazard Gain an energy about its significance in giving pre-travel wellbeing counsel Develop a way to deal with undertaking a danger evaluation in travel solution Examine how hazard can be changed for explorers

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What is danger? "the probability of harm, infection, harm or misfortune from a genuine or potential peril" (CCH Australia)

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Balancing dangers Probability of mischief and the seriousness of conceivably results of travel Balance these with Probability and the seriousness of unfriendly results of any intercessions

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"the craft of travel solution is selecting the vital anticipation procedure without pointless unfavorable occasions, cost or bother" (Steffen, 1994)

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Risk observation is critical Travelers may perplex the probability and seriousness of results Familiarity, perceivability and controllability of a risk all impact the view of danger We have to comprehend the discernments and also the truth of the danger in travel

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Risk appraisal Needs to be embraced as a major aspect of the pre-travel interview Needs correct schedule and restorative history of the voyager Needs time: accentuate the need to get this data well before travel

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Risk evaluation Risk evaluation ideally begins before the explorer goes into the counseling room Document the danger appraisal

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Standardized poll www.who.int/ith

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Establish the dangers Destination Mode of travel Traveler's medicinal history Intervention

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Risks of the destination

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Risks of the destination What nations and what parts of these nations would they say they are going by? To what extent would they say they are going to sit tight? What time would they say they are going by? What are the living conditions? What are the present security concerns? What exercises would they say they are attempted? Do they require a plunging medicinal? What can the explorer let you know? Is there anything exceptional about the destination socially or legitimately?

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Risk of the destination CDC Travel Health, see http://www.cdc.gov/travel/index.htm MASTA, see http://www.masta.org TRAVAX, see http://www.travax.nhs.uk Shorelands, see http://www.tripprep.com

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World Health Organization www.who.int/ith

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Risks of the destination Are they voyaging alone or as a gathering? What is the voyager's earlier travel experience? What access is there to proper restorative consideration? Does the explorer know medical aid? Does the explorer have travel protection with full scope?

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Risks of the destination Categorize Living Conditions: Rural and remote regions and towns and/or close contact with neighborhood individuals, e.g. wellbeing specialists. Towns and urban areas, not provincial and remote and/or lower standard settlement and/or stay more than four weeks/month. Real urban communities and visitor resorts and/or medium to elevated requirement convenience and/or dependable water and nourishment sources and/or transient stays of under four weeks/month. In travel and not presented to nearby environment, eg staying in plane or fleeting stay in advanced airplane terminal.

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Disease or dangers might be related just with specific parts or ranges of a nation and not be a uniform danger all through a nation.

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Risks of the method of travel Modes of travel can show specific therapeutic issues of changing seriousness, e.g. movement infection, difficult ears, fears, DVT; Can they fly?

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Risks of the method of travel Some explorers may not meet therapeutic rules to travel or may require unique leeway to fly on business airplane, for example, with prior sickness, pregnancy, late surgery or genuine physical or mental inadequacy

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Risks of the method of travel Accidents and wounds Travelers may utilize methods of travel not regularly utilized, including at destination, e.g. 4WDing, engine bicycle riding, cycling, rollerblading, skiing, plane skiing, and so on

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Risks of the method of travel Cruise ship Vessel Sanitation Program http://www.cdc.gov/nceh/vsp/default.htm

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Risks of therapeutic history Past travel history, especially including any huge restorative issues, Past medicinal history, eg requirement for altering diabetic treatment, Past surgical history, eg late surgery, Most late dental examination Current solutions, including the oral preventative pill, Last menstrual period for females (would they say they are pregnant?), Smoking and liquor history, Allergies, including pharmaceuticals and sustenances, Any present ailments and normal drug, and Are they voyaging alone or with kids or with more established explorers? How fit would they say they are to embrace any proposed exertional exercises?

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Risks of medicinal history Asthma - Asthma administration arrangement; precipitants; natural concerns; consider flu immunization and anti-microbials for therapeutic unit. Diabetes - Consideration of time zone changes; control Ulcer administration - Reduced causticity may incline to diarrhoeal illness

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Risks of restorative history Psoriasis - May deteriorate with chloroquine Arthritis - May experience issues with treks, climbing (likewise broad wellness); may require standby NSAID treatment Hypertension - Caution in endorsing mefloquine and Beta blockers Immunosuppression - Immune reaction to immunization might be less; live antibodies may offer ascent to infection

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Risks of therapeutic history-hypersensitivities Sulphurs (Maloprim), Diamox & other sulphur based pharmaceuticals Egg allergies* Yellow fever antibody, influenza antibody, MMRII Neomycin, polymixin Measles, Mumps, Rubella Iodine iodine water refinement tabs Quinine Chloroquine Food sensitivities Various, including, seafood, peanuts Pets Cats

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Risks of intercession Addressing hazard in travel solution is for the most part about attempting to alter dangers set up from the travel wellbeing counsel All mediations have potential dangers, including giving the wrong exhortation

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Risks of mediation Advice and training Vaccination Chemoprophylaxis Screening and Effective administration

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Risks of the intercession Can the explorer endure the mediation? Does the danger of the introduction legitimize the intercession/cost? Can the voyager manage the cost of the intercession? What do you do in the event that you can't give ideal security in light of dangers from the medicinal history or different contemplations, for example, age of the voyager or expense?

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Risk evaluation Policies Guidelines Consensus proclamations Epidemiological confirmation (frail to solid)

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Risks can be further adjusted Safety nets travel protection & clearing administrations Access to great quality medicinal consideration Traveling with others, therapeutic group and so on Knowledge of emergency treatment Post-travel screening and mediation

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Conclusion Risk appraisal is a critical part of the travel wellbeing appraisal Risk evaluation should be archived Largely decides exhortation given inside the pertinent rules/proof utilized Risks can be changed