Study Guide Special Topic

Study Guide Special Topics

CONTENTS

Table of contents………..…………………………………………….………………………………. 1

Curriculum………………………………………...…………………………………………………… 2

Block Team…………………………………………………………………………….…...... 4

Facilitators………………………………………...…………………………………………………… 5

Time Table ………………….………………………………………………………………………… 6

Meeting of Students representatives ……………………………………………………………… 9

Meeting of The Facilitators………………………………..……………………………………….…9

Assessment method……………………………………..………………………………………….... 9

Student Project …………………………………………………………...... ………………………10

Learning Program………………………………………………………………………………….... 12

Abstract ……………………………………………………………………………………………….12

Learning Task ………………………………………….…………………………………………….22

Curriculum Mapping……………………………………………………………………………….... 31

CURRICULUM

AIM OF TRAVEL MEDICINE

To introduce the existence of Special Topics in the curriculum of the medical profession.
To know general perspective of Travel Medicine
To understand the science and it's practices of travelers medicine in the medical profession.
To describe etiology, patophysiology, clinical features, diagnosis, and management of travel related illness
To describe the 5 most common in travel related illness

LEARNING OUTCOMES

Know and can perform immunization and give chemoprophylaxis to prevent travel-related illness
Understand the management of primary care practice specific for traveler
Diagnose, treat, and prevent traveler`s diarrhea
Diagnose, treat, refer, and prevent DVT
Diagnose, treat, refer, and prevent ACS
Manage traveler with respiratory disease who undergo air travel
Diagnose, treat, refer, and prevent traveler with heat exhaustion and heat stroke
Diagnose, treat, refer, and prevent traveler with near drowning
Diagnose, treat, refer, and prevent traveler with decompression syndrome after dive

CURRICULLUM CONTENT

Know and can perform immunization and give chemoprophylaxis to prevent travel-related illness
Recognize the immunizations to prevent travel-related illness
Recognize the prophylaxis for malaria
Primary care practice for travel medicine
Understand the primary care practice specific for traveler
Recognize the management of primary care practice specific for traveler
Diagnose, treat, and prevent traveler`s diarrhea
Understand the definition of traveler`s diarrhea
Understand the etiology of traveler`s diarrhea
Describe the pathogenesis of traveler`s diarrhea
Recognize the clinical manifestation of traveler`s diarrhea
Recognize the management of traveler`s diarrhea
Understand the prevention of traveler`s diarrhea
Diagnose, treat, refer, and prevent DVT
Understand the predisposing factor of DVT
Describe the pathophysiology of DVT
Recognize the clinical presentation of DVT
Recognize the management of DVT
Understand the prevention of DVT
Diagnose, treat, refer, and prevent ACS
Understand the predisposing factor of ACS
Describe the pathophysiology of ACS
Recognize the clinical manifestation of ACS
Recognize the management of ACS
Understand the prevention of ACS
Manage traveler with respiratory disease who undergo air travel
Describe the flight environment
Recognize the physiological effects of exposure to altitude
Recognize the clinical pre-flight assessment
recognize fitness to flight condition
recognize respiratory disorders with potential complication for air travel
Diagnose, treat, refer, and prevent traveler heat exhaustion and heat stroke
Understand the definition of heat exhaustion and heat stroke
Describe the pathophysiology of heat exhaustion and heat stroke
Recognize the clinical manifestation of heat exhaustion and heat stroke
Recognize the complication of heat exhaustion and heat stroke
recognize the management of heat exhaustion and heat stroke
Diagnose, treat, refer, and prevent traveler with near drowning
Understand the definition of near drowning
Describe the pathogenesis of near drowning
Recognize the clinical manifestation of near drowning
Recognize the complication of near drowning
recognize the management of near drowning
Diagnose, treat, refer, and prevent traveler with decompression syndrome after dive
Understand the definition decompression syndrome after dive
Describe the pathogenesis decompression syndrome after dive
Recognize the clinical manifestation decompression syndrome after dive
Recognize the complication decompression syndrome after dive
recognize the management decompression syndrome after dive
Animal bite Objectives

To describe why rabies continues to be a feared zoonotic disease.
To describe how is rabies spread
To describe disease that Rabies most commonly mimic
To understand how Rabies is diagnosed
To describe the current recommendation for Rabies treatment
To describe pre and post exposure prophylaxis
To describe clinical presentation of Rabies
To describe the clinical management of snake bite envenoming
To describe the clinical management of scorpion sting envenoming

PLANNERS

No / Name / Department / Phone
1 / dr. Made Agus Hendrayana, M.Ked (Coordinator) / Microbiology / 08123921590
2 / Prof.Dr.dr. Tuti Parwati Merati, SpPD-KPTI / Internal Medicine / 08123806626
3 / dr. Ketut Agus Somia, SpPD-KPTI / Internal Medicine / 08123989353
4 / dr. Anita Devi,M.Si / Hyperbaric / 081805505911
5 / Dr. dr. Tjok Gde Agung Senapathi,Sp.An, KAR / Anesthesiology / 081337711220
6 / dr. I Made Ady Wirawan,MPH,PhD / Public Health / 081239394465

LECTURERS

No / Name / Department / Phone
1 / Prof. Dr. dr. Tuti Parwati Merati, SpPD-KPTI / Internal Medicine / 08123806626
2 / dr. Ketut Agus Somia, SpPD-KPTI / Internal Medicine / 08123989353
3 / dr.I Gusti Ngurah Bagus Artana,Sp.PD / Internal Medicine / 08123994203
4 / dr.Made Agus Hendrayana,M.Ked / Microbiology / 08123921590
5 / dr. Ketut Rina,SpJP(K)-FIHA / Cardiology / 0361-7800148
6 / dr. Anita Devi,M.Si / Hyperbaric / 081805505911
7 / dr. I Made Susila Utama,Sp.PD-KPTI / Internal Medicine / 08123815025
8 / Dr. dr. Tjok Gde Agung Senapathi,Sp.An, KAR / Anesthesiology / 081337711220
9 / dr. I Wayan Losen Adnyana, Sp.PD-KHOM / Internal Medicine / 08123995536
10 / dr.Anak Agung Ayu Yuli Gayatri,Sp.PD / Internal Medicine / 08123803985
11 / dr. Ni Made Dewi Dian Sukmawati,Sp.PD / Internal Medicine / 08123320380
12 / dr. I Made Ady Wirawan,MPH,PhD / Public Health / 081239394465
13 / dr.I Putu Adiartha Griadhi,M.Fis / Physiology / 081999636899

FACILITATORS

Regular Class (Class A)

No / Name / Group / Departement / Phone / Venue
(2nd floor)
1 / I.B.N Putra Dwija S.Si M.Biotech / A1 / Microbiology / 08179747502 / 2nd floor: R.2.09
2 / Dr. Ni Wayan Tianing S.Si M.Kes / A2 / Biochemistry / 08123982504 / 2nd floor: R.2.10
3 / Dr. LM Indah Sri HA S.Psi M.Erg / A3 / Phyisiology / 081337095870 / 2nd floor: R.2.11
4 / dr. Agung Nova Mahendra, M.Sc / A4 / Pharmacology / 087861030195 / 2nd floor: R.2.12
5 / dr. I Made Oka Negara, FIAS / A5 / Andrology / 085935054964 / 2nd floor: R.2.13
6 / Dr.dr. Susy Purnawati, M.KK / A6 / Physiology / 08123989891 / 2nd floor: R.2.14
7 / dr. Yukhi Kurniawan, Sp.And / A7 / Andrology / 08123473593 / 2nd floor: R.2.15
8 / dr. I G A A.Elis Indira,Sp.KK / A8 / Dermatology / 081338718384 / 2nd floor: R.2.16
9 / Dr.dr.I Nyoman Bayu Mahendra Sp.OG(K) / A9 / Obgyn / 081339550423 / 2nd floor: R.2.20
10 / Dr. dr. AAA Putri Laksmidewi Sp.S(K) / A10 / Neurology / 0811388818 / 2nd floor: R.2.23
11 / Dr.dr.I G A Sri Mahendra D Sp.PA(K) / A11 / Anatomy Patology / 081338763481 / 3nd floor: R.3.20
12 / Desak Gede Diah Dharma Santhi, S.Si, Apt. M.Kes / A12 / Clinical
Patology / 0817569021 / 3nd floor: R.3.23

English Class (Class B)

No / Name / Group / Departement / Phone / Venue
(2nd floor)
1 / Desak Ernawati, S.Si PGPharm M.Pharm.PhD / B1 / Pharmacology / 081236753646 / 2nd floor: R.2.09
2 / Dr. Luh Seri Ani SKM M.Kes / B2 / Public Health / 08123924326 / 2nd floor: R.2.10
3 / dr. I Wayan Eka Sutyawan Sp.M / B3 / Opthalmology / 081338538499 / 2nd floor: R.2.11
4 / dr. Yuliana, M.Biomed / B4 / Anatomy / 085792652363 / 2nd floor: R.2.12
5 / Dr.dr. Sianny Herawati, Sp.PK / B5 / Clinical
Patology / 081236172840 / 2nd floor: R.2.13
6 / dr. Ni Putu Wardani, Sp.An, M.Biomed / B6 / DME / 081337660988 / 2nd floor: R.2.14
7 / dr.Luh Nyoman Alit Aryani Sp.KJ / B7 / Psychiatry / 085737717244 / 2nd floor: R.2.15
8 / Dr dr Elysanti Dwi Martadiani Sp.Rad / B8 / Radiology / 081805673099 / 2nd floor: R.2.16
9 / Dr.IA Sri Wijayanti M.Biomed Sp.S / B9 / Neurology / 081337667939 / 2nd floor: R.2.20
10 / Dr.dr.IGA Putu Eka Pratiwi Sp.A M.Kes / B10 / Pediatry / 085101852244 / 2nd floor: R.2.23
11 / dr. I Made Sudipta, Sp. THT-KL / B11 / ENT / 08123837063 / 3nd floor: R.3.20
12 / Dr.dr. I Nyoman Wande, Sp.PK / B12 / Clinical
Patology / 08124686885 / 3nd floor: R.3.23

Time-Table

CLASS ROOM :4th FLOOR, room 4.01

no / days / topics / Time / learning Activity / Place / PIC
B Class / A Class
1 / Monday
Oct.10th
2016 / Introduction and general perspective of Travel Medicine.
- Pre travel assement
- Post travel illness / 08.00-09.00 / 09.00-10.00 / Lecture / Class room / Prof.Dr.dr. Tuti Parwati, SpPD-KPTI & Block Coordinator
09.00-10.30 / 12.00-13.30 / Individual Learning / Library / Facilitators
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room
12.00-12.30 / 11.30-12.00 / Break
12.30 - 14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
2 / Tuesday
Oct.11th
2016 / Traveler`s diarrhea / 08.00-08.30 / 09.00-09.30 / Lecture / Class room / dr.I Made Susila Utama,Sp.PD
Emerging Diseases Related Worldwide Travelling / 08.30-09.00 / 09.30-10.00 / Lecture / Class room / dr.Made Agus Hendrayana,M.Ked
09.00-10.30 / 12.00-13.30 / Individual learning / Library
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room / Facilitators
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
3 / Wednesday
Oct.12th
2016 / Air travel: thromboembolism / 08.00-09.00 / 09.00-10.00 / Lecture / Class room / dr. I Wayan Losen Adnyana, Sp.PD-KHOM
09.00-10.30 / 12.00-13.30 / Individual learning / Library
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room / Facilitators
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
4 / Thursday
Oct.13th
2016 / Medical evacuation / 08.00-09.00 / 09.00-10.00 / Lecture / Class room / Dr. Dr. Tjok GA Senapathi, Sp.An, KAR
09.00-10.30 / 12.00-13.30 / Individual learning / Library / Facilitators
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
5 / Friday
Oct.14th
2016 / High altitude / 08.00- 08.30 / 09.00-09.30 / Lecture / Class room / dr. I Putu Adiartha Griadhi,M.Fis
Air travel: respiratory disease related travel / 08.30 - 09.00 / 09.30 - 10.00 / Lecture / Class room / dr. I Gst.Ngr. Bagus Artana,Sp.PD
09.00-10.30 / 12.00-13.30 / Individual learning / Library / Facilitators
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
6 / Monday
Oct.17th
2016 / Heat exhaustion and heat stroke / 08.00- 08.30 / 09.00-09.30 / Lecture / Class room / dr. I Made Susila Utama,Sp.PD
Air travel: Fit to Flight / 08.30 - 09.00 / 09.30 - 10.00 / Lecture / Class room / dr.I Md.Ady Wirawan,MPH,PhD
09.00-10.30 / 12.00-13.30 / Individual learning / Library / Facilitators
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
7 / Tuesday
Oct.18th
2016 / Near drowning / 08.00- 08.30 / 09.00-09.30 / Lecture / Class room / Dr. Dr. Tjok GA Senapathi,Sp.An, KAR
Diving Decompression Syndrome / 08.30 - 09.00 / 09.30 - 10.00 / Lecture / Class room / dr. Anita Devi,M.Si
09.00-10.30 / 12.00-13.30 / Individual learning / Library / Facilitators
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
8 / Wednesday
Oct.19st
2016 / Immunization to prevent travel-related illness / 08.00 - 08.30 / 09.00-09.30 / Lecture / Class room / dr. K Agus Somia, SpPD-KPTI
Chemoprophylaxis for travel related illness / 08.30 – 09.00 / 09.30 – 10.00 / Lecture / Class room / dr. K Agus Somia, SpPD-KPTI
09.00-10.30 / 12.00-13.30 / Individual learning / Library
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room / Facilitators
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
9 / Thursday
Oct.20nd
2016 / Air travel: Acute Coronary Syndrome / 08.00-09.00 / 09.00-10.00 / Lecture / Class room / dr. K Rina SpJP(K)-FIHA
09.00-10.30 / 12.00-13.30 / Individual learning ( / Library / Facilitators
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
10 / Friday
Oct.21th
2016 / Animal Bite / 08.00- 08.30 / 09.00- 09.30 / Lecture / Class room / dr.A.A Ayu Yuli Gayatri,Sp.PD
Marine Envenomation / 08.30 - 09.00 / 09.30 - 10.00 / Lecture / Class room / dr.Dewi Dian Sukmawati,Sp.PD
09.00-10.30 / 12.00-13.30 / Individual learning / Library / Facilitators
10.30-12.00 / 13.30-15.00 / SGD / Disc. Room
12.00-12.30 / 11.30-12.00 / Break
12.30 -14.00 / 10.00-11.30 / Student Project
14.00-15.00 / 15.00-16.00 / Plenary / Class room / Team
12 / Saturday
Oct.22th
2016 / Preparation for final test
13 / Monday
Oct.24th
2016 / Assessment / Team

TIME Activity PIC

Oct.10th – Oct 21th,2016 Learning Activity Coordinator

Oct 22th ,2016 Preparation for final test

Oct 24th ,2016 Evaluation Teams

MEETING OF STUDENT REPRESENTATIVES

In the middle of block period a meeting is designed among the student representatives of every small group discussion, facilitators, and source person of the block. The meeting discuss about the ongoing teaching and learning process, quality of facilitators, and lecturers as the feedback to improve the next process.

This meeting is held on Saturday when the students are free from lecture.

MEETING OF THE FACILITATORS

All facilitators are invited to discuss all block activities with block contributors 1 week after meeting onf students representatives

ASSESMENT METHOD

Assessment will be held on end of the block period. The time provision is 100 minutes. The number of MCQ is 100 with passing point ≥ 70

STUDENT PROJECT

Format of the paper :

Cover Tittle

NameStudent Registration Number

Faculty of Medicine, Udayana University 2016

Introduction
Content
Conclusion
References (minimal 3 references)

Example :

Journal

Porrini M, Risso PL. 2011. Lymphocyte Lycopene Concentration and DNA Protection from Oxidative Damage is Increased in Woman. Am J Clin Nutr 11(1):79-84.

Textbook

Abbas AK, Lichtman AH, Pober JS. 2011. Cellular and Molecular Immunology. 4th ed. Pennysylvania: WB Saunders Co. Pp 1636-1642.

Note.

5-10 pages; 1,5 spasi; Times new roman 12

TOPIC

SGD
GROUP / TOPIC / Supervisor Student Project
A1 / Bug Bites / I.B.N Putra Dwija S.Si M.Biotech
A2 / Jet Lag / Dr. Ni Wayan Tianing S.Si M.Kes
A3 / Mental Health and Travel / Dr. LM Indah Sri HA S.Psi M.Erg
A4 / Road Safety / dr. Agung Nova Mahendra, M.Sc
A5 / Sex Tourism / dr. I Made Oka Negara, FIAS
A6 / Traveling with a Disability / Dr.dr. Susy Purnawati, M.KK
A7 / Humanitarian Aid Workers / dr. Yukhi Kurniawan, Sp.And
A8 / Last-Minute Travelers / dr. I G A A.Elis Indira,Sp.KK
A9 / Long-Term Travelers and Expatriates / Dr.dr.I Nyoman Bayu Mahendra Sp.OG(K)
A10 / Pregnant treveler / Dr. dr. AAA Putri Laksmidewi Sp.S(K)
A11 / Elderly traveler / Dr.dr.I G A Sri Mahendra D Sp.PA(K)
A12 / Travelling with children / Desak Gede Diah Dharma Santhi, S.Si, Apt. M.Kes
SGD
GROUP / TOPIC / Supervisor Student Project
B1 / Travelers with Weakened Immune Systems / Desak Ernawati, S.Si PGPharm M.Pharm.PhD
B2 / Travelers with Chronic Illnesses / Dr. Luh Seri Ani SKM M.Kes
B3 / Adventure Travel / dr. I Wayan Eka Sutyawan Sp.M
B4 / Cruise Ship Travel / dr. Yuliana, M.Biomed
B5 / Medical Tourism / Dr.dr. Sianny Herawati, Sp.PK
B6 / Travel to Cold Climates / dr. Ni Putu Wardani, Sp.An, M.Biomed
B7 / Travel to Mass Gatherings / dr.Luh Nyoman Alit Aryani Sp.KJ
B8 / Fit to dive / Dr dr Elysanti Dwi Martadiani Sp.Rad
B9 / Travel Health Insurance / Dr.IA Sri Wijayanti M.Biomed Sp.S
B10 / Travel to altitude after diving / Dr.dr.IGA Putu Eka Pratiwi Sp.A M.Kes
B11 / Hajj travel / dr. I Made Sudipta, Sp. THT-KL
B12 / Wilderness medicine / Dr.dr. I Nyoman Wande, Sp.PK

LEARNING PROGRAM

LECTURE 1

Introduction and general perspective of Travel Medicine

Travel Medicine is the branch of medicine that deals with the prevention and management of health problems of internationaltravelers. It is concerned with both prevention and management of illness related to travel

Why TM ?

•Increased trend of travelers : many more people are travel abroad

•Scope has largely evolved in response to changing of travel trend, such as :

•The reason for travel and types of travel has become much more diverse.

•Organized package tour remain popular, but many traveler are becoming more adventurous and choose to backpack out with ‘tourist‘ areas, go on expedition into remote areas sometime in several countries and work as volunteers for prolonged period.

•Travel for business take a common place.

•In addition, potentially vulnerable groups of people such as the very young, the elderly, pregnant women and those with underlying medical problems or disabilities and immune compromized are traveling more than ever before.

As a result of these changes, more people need information, more advise and more prophylactic prior and during travel

Important component of TM includes not only vaccination and prophylaxis for malaria, but also advise on accident prevention, sexual health and guidance on contraception, safety food and water, hygiene and other precautions

History of TM ?

The disciplines of TM evolved initially from infectious disease, tropical and preventive medicine and historically from quarantine and international health regulations,the subject encompasses the whole range of clinical and preventive medicine; this includes care of the travelers with special needs such as, children, the elderly, pregnant women, and person with underlying medical problems: cardiovascular, respiratory, kidney, GIT, metabolic , neurological, malignant, HIV and behavioral dis.

TM concerned with both prevention and management of illness related to travel

Illness may result from exposure to infection, accidents, psychological upset, environmental hazards and political unrest

The specialty of TM therefore is truly interdisciplinary and international specialty involving numerous disciplines including , tropical medicine, infectious diseases, microbiology, public health and nursing.

Continued surveillance of illness and disease both in the host countries and returning travelers is necessary to allow sound risk assessment to be made for intending travelers. This is a crucial area for development within the specialty

Dissemination of information regarding real or potential risks can both prevent illness and increase detection of illness in travelers who have returned to their country of origin. This may have important public health implications when considering secondary cases or outbreaks as a results of travelers returning with infections

Risks in Travel

Risk in travel can be non communicable and communicable disease

Non-Communicable disease :

•Aircraft travel, reduced O2, pressure and humidity

•Motion sickness

•Jet Lag

•DVT’s and immobility

•Altitude

•Heat/cold/humidity

•Sunburn

•Water safety

•Accidents and Injuries

•Animals and Insects

•Accidents, vehicles, marine

•Snakes, (vipers, cobras and kraits )

•Marine stings

There are many potential diseases spread via :

•Food and water

•Insect vectors

•Soil and water

•Sexual contact, Body-fluid exposures

•Animals

LECTURE 2

Traveler’s diarrhea

Traveler’s diarrhea (TD) is the most common travel-related health problem that affects up to half of travelers during their first 2 weeks abroad. A case of TD is described as the sudden onset of loose, watery stools associated with abdominal pain, fever or tenesmus. Fever occurs commonly and blood is noted in stools rarely. Nausea and vomiting are also common in the first few hours, adding to the discomfort and water loss. TD usually presents as an acute illness, resolving completely in less than a week. Bacteria are the most common cause of TD and ETEC (enterotoxigenic E. coli) is the most common bacterial cause. Salmonella, Shigella and campylobacter make up the majority of remaining bacterial pathogens. Host factors such as age, pre-existing immunity, underlying medical conditions and genetic factors play a role in susceptibility to TD. Effective pre-travel counseling may motivate some travelers to avoid risky food and drink, which may in turn reduce diarrheal incidence. Since most TD is bacterial in origin, traveling with appropriate antibiotics for treatment and prevention is also important.

LECTURE 3

Emerging Diseases Related Worldwide Travelling

It is believed that increased global travel is the reason for the recent resurgence of many infectious diseases in the world. International movement of individuals, populations, and products is one of the major factors associated with the emergence and reemergence of infectious diseases as the pace of global travel and commerce increases rapidly.

The number of people traveling internationally is increasing every year, and more people are taking trips to remote parts of the world, which often have unfamiliarhealth problems as well asunderdeveloped health care services. Many travelers are also unaware of potential hazards in different parts of the world and do not take the necessary precautions, such as getting necessary vaccines or taking preventive medicine.

Travel can be associated with disease emergence because (1) the disease arises in an area of heavy tourism, (2) tourists may be at heightened risk because of their activities, or (3) because they can act as vectors to transport the agent to new areas.

Many of the newly discovered infections have actually been in existence for a long time, butdoctors have not seen them in areas where new outbreaks occur. With people's ability today to travel anywhere in the world within 36 hours or less, formerly little-known infections are picked up and rapidly spread to areas where they previously did not exist.

LECTURE 4

Air travel and thromoembolism

DVT and thromboembolism have long been proposed as possible complication of air travel. Pulmonary embolism (PE) has been suggested as a culprit in deaths related to air travel, although evidence linking air travel to DVT has been somewhat elusive. Many studies found that 18% of sudden deaths among long distance travelers were attributable to PE.