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A COVID-19 járvány lecsengésével egyidejűleg a nemzetközi utazások is elkezdődnek majd. Azonban sem az utazás megszokott formái, sem az utazók utazással kapcsolatos attitűdjei nem lesznek ugyanazok, mint járvány előtt. Mivel mindenkinek a biztonságos utazás az érdeke, a járványos megbetegedések prevenciója elsődleges fontosságúvá válik. Ennek egyetlen módja az utazás előtti egészségügyi felkészítés. Az orvosi tanácsadással az utazással összefüggő betegségek nagy része megelőzhető. A tanácsadás a COVID járvány után ki kell, hogy terjedjen a vírusfertőzés megelőzésének módjaira, illetve a biztonsági rendszabályok ismertetésére is. Azonban a biztonságos utazás és utaztatás biztosítása nem csak orvosi feladat. A megelőző intézkedések az utazási iparág minden szereplőjének ismeretanyagát kell, hogy képezzék. Ezeket az új ismereteket foglalja össze a tanulmány.

A fogorvosi beavatkozásokkal járó stressz, a hosszabb kezelési idő és a fogorvosi anesztézia széleskörű alkalmazásavalószínűleg megnöveli a rendelői rosszullétek számát is. A rosszullétek prevalenciája a fogorvosi rendelőkben 19–67%között mozog. A szakirodalom rendelőnként átlag évi 2–20 rosszullétet említ. A leggyakoribb, ellátásra szoruló eseményaz összeesés, ájulás volt, és a leggyakoribb rosszulléteket a cukorbetegségből eredő hypoglikémiás roham, az allergiásreakció és a vérnyomáskiugrás okozta. A fogorvos feladata az életet veszélyeztető állapotok elhárítása, ami a szakirodalmiadatok szerint az összes rosszullétek 8-10%-a. A megfelelő beavatkozáshoz szükséges, hogy minden rendelőbenkészüljön „riadóterv” a rosszullétek ellátásra, világosan megjelölve az orvos és az asszisztencia feladatát. A rendelőfelszerelésére a jogszabály tárgyi feltételeket is megjelölt, ezeket azonban érdemes a fogorvosi rendelő lehetőségeinekfényében újragondolni. Ezért a szerzők javaslatot tesznek a szükséges gyógyszerek összeállítására, valamint a szükségeseszközök beszerzésére. A tárgyi feltételek mellett elengedhetetlen az orvosi elsősegélynyújtás naprakész tudása.Erre a meglevő tankönyv és a gyakori posztgraduális képzés lehetőséget ad, ami nemzetközi összehasonlításbanis kiemelkedően jónak mondható.

Taking into consideration two main factors: the general poor condition of dental health of the population and that elderly people are becoming more and more active in traveling one can draw the conclusion that pretravel advice must contain dental issues too. Authors suggests some travel related medical problems such as infection control, a reliable dental service abroad, the proper way of cleaning teeth and prosthesis where safe water isn’t available, failures with the dentures and braces.However the more important issue is the timing of air travel after dental interventions in order to avoid barodontalgia. Unfortunately, the international literature hardly mentions this kind of problem, although it would be useful both for dentists and for the general practitioners and travel medicine professionals. There is no evidence based rules for the optimal duration between the dental intervention and air-travel so authors collect the relevant professionals’ opinion. According to their approach the minimum waiting time should be 24 hours after filling and dental extraction, in the case of implantation without complication it is 24–48 hours, while in case of more difficult interventions connecting to implantation this time can take up to 2 weeks and root canal manipulation requires at least 72 hours but a week proved to be more safe etc.The determining of optimal time of air travel after dental interventions requires more detailed surveys but hopefully the time-suggestions of this paper is good for a rough estimation. The exact timing should be decided by the treating doctor and it is depended on the patient’s condition and the type of the intervention.

Abstract: Introduction: The term “spam” is applied to unwanted commercial e-mails sent to all whose e-mail addresses have been acquired by the spammers. The number of undesirable e-mails is growing in the health-care related areas as well. The targets of health-care related spams are laymen, physicians and academic researchers alike. Method: On the basis of 12,986 unwanted letters received in one year, the authors concluded that percentage of health-related spam is the second most common spam (27%) in relation to all spam. Most of the spam (63%) aggressively promoted purchasing of various consumer goods, but health-related spam are far ahead of the rest. The collected data were grouped by year and topic and they are analyzed by simple descriptive statistics. Spam form of cyber attacks on health care issues were divided into two: spam what is jeopardized individuals’ health (e.g. medical compounds without any curing effect, misleading statement on medical device, fraudulent panacea offers, and cheating cure methods, etc.) and onslaught on medical scientific activity (pseudo-scientific congress invitation, predator journal invitation etc.). Results: The topics of spams addressed to laymen are offered for perfect healing by strange treatments, cures (31%), panaceas (19%), lifestyle advice (19%), massage (16%), brand new health-care devices (4%) and drugs for sexual dysfunction (11%). The topics of spams addressed to physicians and researchers are deluged by pseudoscientific materials: invitation for articles to be sent to no-name/fake open-access journals (68%), invitation to participate at an obscure congress (27%) or newsletters on miscellanous medical topics (5%). Conclusion: The spams offer very often relief or solution to medical problems that the present-day medical practice cannot solve perfectly (oncological, musculo-sceletal, endocrin or metabolic problems). Understandably, the patients would hold on to fake hopes – and the authentic patient education and health promotion will be neglected. These unwanted messages practically cannot be unsubscribed, and – while the spam filters are far from perfection – the victim must go through the filtered spam-dustbin in order not to miss some real messages. Unfortunately no legal regulation (neither local, nor GDPR) can block or stop the spams. The spams are misleading the laymen and jeopardise the effects of professional and responsible health promotion and health education. Orv Hetil. 2019; 160(43): 1706–1710.

It appears that the El Camino pilgrimage route has become a long-distance trek and endurance test of the individual. The continuously increasing number of hikers demands more attention by travel medicine professionals. Analysis of the age groups of the pilgrims over recent years shows that the number of young pilgrims ( 30 years) is decreasing, but the number of middle-aged people (30-60 years) is slightly increasing, while the number of elderly people ( 60 years) is considerably increased. The leading cause of fatalities during the pilgrimage is ACS. The majority of the cardiac problems occur among the elderly people. The second most common cause of death is a traffic accident, and the third and fourth causes are a fatal exacerbation of the pilgrim's pre-existing disease and illnesses caused by the extreme temperature (hot and cold environment alike). The aforementioned data suggest that pre-travel advice should be an indispensable part of the preparation for the El Camino peregrination, especially for the patient with chronic disease and elderly people.

The most significant risk of dental tourism is the timing of air travel after dental interventions in order to avoid the pain or injury caused by barotrauma. Usually the minimum waiting time should be 24 h, but in some cases, it can be up to 2 weeks.

Abstract: The Way of St. James (El Camino) is getting more and more popular. Analysis of the age groups of the pilgrims shows that the number of young pilgrims (30< years) is decreasing, but the number of middle-aged people (30–60 years) is slightly increasing, while the number of elderly people (>60 years) has considerably increased. The statistical data of the Pilgrims’ office in Santiago de Compostela also display the continuous elevation in the number of the “pilgrims” who had completed the El Camino without any religious or spiritual reason. Therefore this pilgrim route became a long-distance trekking – in the point of view of travel medicine. The old age is a high risk for travellers moreover in this long distance trekking. Therefore pre-travel counselling would be vital for aged pilgrims. Unfortunately, a few articles have been published only on the medical problems of El Camino. Taking into consideration the possible health damages during the 800 km long “Camino”, the author describes its health hazards. This study could be a useful guideline for pre-travel advice for El Camino pilgrims as only limited information can be gained from the Pilgrims’ Reception Office (PRO) in Santiago de Compostela. Some information was collected from the relevant pages of the internet. Therefore the author could draw limited consequences from the statistical data. Yet, the analysis of the medical causes of the deceased pilgrims told more about the hazards of ‘The Way’. Although the number of female and male pilgrims was equal in the statistical data, yet the mortality rate of the male pilgrims is much more higher than that of the female pilgrims (93–7%). The most frequent cause of death was acute coronary syndrome or its suspicion (40–34%). The second most frequent cause of death was road traffic accident (17,5–25%). The most vulnerable pilgrims are the cyclists in this respect. The exacerbation of any chronic disease was also different among the genders (3–25%) but homicide is a more frequent cause of death in the female group (2%–8%). The cause of death was exhaustion, stroke, hypothermia and drowning (because of the ritual bathing in the sea, after the route completed) as well. Orv Hetil. 2018; 159(38): 1535–1542.

Abstract: Introduction: According to international surveys, over half of the travellers face some kind of health issue when travelling. The overwhelming majority of travel-related illnesses can be prevented with pre-travel medical consultations, but the syllabus and content of the consultation have to match the travel habits and culture of the given society. Aim: This publication explores the specificities and travel habits of Hungarian travellers. Method: One hundred participants of a travel exhibition completed a survey about their international travel. As the survey was not representative, the data could only be processed through simple statistical methods. However, since the exhibition was presumably attended by those wishing to travel, the conclusions drawn from the results are worth publishing, since no similar survey in Hungary has been published before. Results: Based on the suitable classification of age groups in travel medicine, 11% of the participants were adolescents / young adults (aged 15–24), 81% adults (25–59) and 8% elderly (60–74). Twenty-eight percent of the participants travel multiple times a year, 40% yearly and 32% of them less frequently; 16% of the adults, 8% of the adolescents and 4% of the elderly age group travel multiple times a year. Conclusions: The travel destinations of Hungarian travellers have remained practically unchanged since a study was conducted 13 years ago: the vast majority (95%) travelled within Europe, 2% to the United States, and 11% of them elsewhere. Since Hungarians do not travel to endemic areas, only 5% consulted their general practitioners (GPs) prior to travelling, and 29% did when they had to be vaccinated. Forty-two percent of those wishing to travel never consult their GPs, even though 29% of them are aware of some chronic illness. Instead, 51% gather their health information from the internet and only 6% from their doctors. By the contradiction between the poor health status of the majority of Hungarian travellers and the negligence of seeking pre-travel advice, our survey clearly points out the importance of the propagation of doctor’s advice before trips, even if the travellers visit exclusively non-endemic countries like the European Union. Orv Hetil. 2018; 159(9): 357–362.

Abstract: Introduction and aim: There are no high mountains or any advantageous circumstances for winter sports in Hungary, yet within the 10 million population there are about half a million people (the exact number is 550,000) who tend to go for skiing or snowboarding abroad. Authors compared the injury statistical data with results described in the international literature in order to develop conclusions about the differences in the injury patterns and frequency between the Hungarian ones’ and those found in countries with plenty of winter sport possibilities. Method: Authors analysed the winter sport injury cases of an insurance company. All the injury happened abroad and the assistance provider of the insurance company has managed the patient treatment and repatriation. Three winter seasons (12 months) data was analysed from the point of view of injuries frequency at different body parts and areas. Due to the fact that only limited information was available a simple statistical method was applied. Results: Of 222 cases 90.5% were ski-related injury and 8.6% were snowboard injury. As for the skiers, the upper limb injuries accounted for 21.9%, the truncal region for 24.4% and the lower limb for 55.8%. Among snowboarders the upper limb injuries accounted for 36.9%, the truncal region for 37% and the lower limb for 26.1%. The most frequent was the knee (36.8%), the wrist (12.4) and the shoulder (11.4) injury. Skier’s thumb injury was only 1.5%. The most common snowboard injury was the wrist trauma (31.6%), the head/neck/face was accounted 15.8% of all the injuries. And the ankle was injured in 10.5% of all the cases. The head/neck and the knee injury often combined with injuries of some other body part. 29 patients (13%) had to be repatriated, the most frequent reason for the repatriation was the injury of the lower limb. Conclusions: The Hungarian sportsmen’s injury patterns do not always follow data described in the international literature, but they correspond to data of countries with similar geographical situation. The injury rate of knee and of the shoulder displays same data, the injury rate of the wrist was more frequent than in the international data, and this is true both for skiers and the snowboarders. The Hungarians’ injury of the truncal region (mainly the head) was more frequent, but on the other hand the general injury rate of other body parts proved to be a lower number. It seems that the frequent use of the protective equipment and the preventive measures applied by the Hungarians are mirrored in the lower injury figures. Orv. Hetil., 2017, 158(16), 618–624.

Absztrakt

The Way of St. James (El Camino) is getting more and more popular. Analysis of the age groups of the pilgrims shows that the number of young pilgrims (30years) is decreasing, but the number of middle-aged people (30-60 years) is slightly increasing, while the number of elderly people (60 years) has considerably increased. The statistical data of the Pilgrims' office in Santiago de Compostela also display the continuous elevation in the number of the "pilgrims" who had completed the El Camino without any religious or spiritual reason. Therefore this pilgrim route became a long-distance trekking - in the point of view of travel medicine. The old age is a high risk for travellers moreover in this long distance trekking. Therefore pre-travel counselling would be vital for aged pilgrims. Unfortunately, a few articles have been published only on the medical problems of El Camino. Taking into consideration the possible health damages during the 800 km long "Camino", the author describes its health hazards. This study could be a useful guideline for pre-travel advice for El Camino pilgrims as only limited information can be gained from the Pilgrims' Reception Office (PRO) in Santiago de Compostela. Some information was collected from the relevant pages of the internet. Therefore the author could draw limited consequences from the statistical data. Yet, the analysis of the medical causes of the deceased pilgrims told more about the hazards of 'The Way'. Although the number of female and male pilgrims was equal in the statistical data, yet the mortality rate of the male pilgrims is much more higher than that of the female pilgrims (93-7%). The most frequent cause of death was acute coronary syndrome or its suspicion (40-34%). The second most frequent cause of death was road traffic accident (17,5-25%). The most vulnerable pilgrims are the cyclists in this respect. The exacerbation of any chronic disease was also different among the genders (3-25%) but homicide is a more frequent cause of death in the female group (2%-8%). The cause of death was exhaustion, stroke, hypothermia and drowning (because of the ritual bathing in the sea, after the route completed) as well. Orv Hetil. 2018; 159(38): 1535-1542.Absztrakt: A Szent Jakab-zarándokutat, az El Caminót évről évre egyre többen keresik fel. A fiatal utazók száma csökken, az időseké emelkedik. A zarándokstatisztika azt is mutatja, hogy a nem spirituális indíttatásból útnak indulók száma (a szentéveket kivéve) meghaladja a vallási okokból zarándoklatra indulókét. A fenti tények miatt az utazás előtti orvosi tanácsadás egyre szükségesebbé válik, ezért a szerző összefoglalta a zarándokúttal kapcsolatos lehetséges egészségkárosodásokat, hogy a tanácsadó orvos könnyebben felmérhesse az El Camino zarándoklat kockázatait. Mivel az orvosi szakirodalom alig foglalkozik a Szt. Jakab-zarándokúttal, a feldolgozandó anyagokhoz az El Camino Zarándokiroda évi jelentéseiből és az interneten megjelent egyéni beszámolókból lehetett csak hozzájutni. A kiszűrt anyagokból így csak egyszerű statisztikai következtetéseket lehetett levonni. Az idősebb korosztály részvétele az El Camino 800 km hosszú zarándoklatán szükségessé teszi számukra az utazás előtti egészségügyi felmérést és tanácsadást. A zarándokút utazásorvostani szempontból hosszú távú teljesítménytúrának tekinthető, és az útnak indulók egészségi állapotát ennek megfelelően kell figyelembe venni. A fellelt adatok szerint, noha a zarándokok között a nők és a férfiak egyenlő számban vettek részt, a zarándoklat alatti halálozás a férfiak túlnyomó többségét mutatja (93%, illetve 7%). A leggyakoribb halálozási ok mindkét nemnél akut coronariatörténés vagy annak gyanúja (40%, illetve 34%). A második leggyakoribb halálok a közlekedési baleset volt (17,5%, illetve 25%). Krónikus betegség miatt a nők többsége hunyt el (3%, illetve 25%), míg az emberölés miatt meghaltak száma a nőknél négyszeresen meghaladta a férfiakét (2%, illetve 8%). A halálokok között szerepel még a kimerülés, a stroke, a vízbe fulladás és a hypothermia is. Orv Hetil. 2018; 159(38): 1535–1542.

The number of international travels has been continuously increasing since World War II. Though the travelers’ demand for safer ways of travelling appeared, only a handful of them sought pretravel advices. This is the reason why 50% of the travelers have to face some kind of medical problem during their journey. If they have travel insurance, the company’s assistance team organizes, monitors and covers their abroad treatment. A doctor of the assistance team has to find her/his ways in various fields: not only a multidisciplinary medical knowledge is a must for a professional like this, but she/he needs to have a good grasp of the basic idea behind the insurance policy, too. Also, she/he should be familiar with the public health care systems of different countries and some legal knowledge is also needed. If the patients are unable to continue their trip, they must be repatriated. Making a decision about the repatriation’s timing and modality requires interdisciplinary medical experience and the approach of a critical care/emergency doctor. Among further tasks for the assistance team’s doctor one can find medical escort and on-spot medical visit for foreign patients. Both of these two aforementioned medical activities are highly different from – for example – a general practitioner’s routine. That is the reason why an assistance doctor has to be familiar with the critical and emergency care. Organizing and monitoring medical treatment for a traveler abroad, providing medical escort, making decisions about repatriation and providing medical help for a foreign patient all fall within the competence of a new medical discipline, the assistance medicine. Creating a body of knowledge, collecting appropriate protocols and establishing postgraduate courses for assistance medicine diplomas are the tasks of the critical care and emergency medicine professionals. Orv. Hetil., 2015, 156(20), 808–812.

Background Severe mental illness occurring abroad is a difficult situation for patients, their families, and for the local medical community. Patients with mental problem are doublely stigmatized due to their mental illness and because they are foreigners in an unfamiliar country. The appropriate treatment is often delayed, while patients are often dealt with in a manner that violates their human rights. Moreover, repatriation - which is vital in this case - is often delayed due to the lack of international protocols for the transportation and treatment of mentally ill travelers. Methods Authors analyzed several factors related to acute mental health problems during travel: the etiology of symptoms, the appropriate treatment possibilities abroad, and medical evacuation and repatriation of the psychotic patient. The article presents a brief review of travel-related mental disorders, the epidemiology of mental health issues faced by travelers, and the significance of pre-travel advice for these patients. The first problem is to recognize (and redress) the particular challenges faced by a psychotic patient in a strange country. The second challenge is to prepare the patients, often in a poor psychiatric state, for medical evacuation by commercial aircraft. Another important question is the best way to take the patient through customs and security control. All of these, as yet unresolved, issues can make the mental patient virtually defenseless. Conclusions Although timely repatriation of a mentally ill patient is vital and urgent, most travel insurance policies exclude treatment and repatriation costs incurred due to acute mental illness. The high cost of treatment and repatriation must be paid by the patient or their family, which could lead to severe financial strain or insolvency. Changing the approaches taken by the local mental health care community, police, airport security, and insurance companies remain a challenge for psychiatrists.

Flying is the most important way of travelling in the continually growing international tourism. Number of passengers and those with preexisting diseases, mainly with cardiopulmonary problems, is increasing over years. One of the main tasks of the pre-travel advice is to assess tolerance to hypoxia of the traveler, and specify the necessity, as well as the type and volume of supplementary oxygen therapy. It is indispensable to know the cabin-environment and impact of that on the travelers’ health. Travel medicine specialist has to be aware of the examinations which provide information for the appropriate decision on the fit-to-fly condition of the patient. The physician who prepares the patient with chronic obstructive pulmonary disease for repatriation by regular flight and the escorting doctor have to be fully aware of the possibilities, modalities, advantages and contraindications of the on-board oxygen supply and therapy. In this review, the authors give a summary of literature data, outline the tools of in-flight oxygen therapy as well as discuss possibilities for the preflight assessment of patients’ condition including blood gas parameters required for safe air travel, as recommended in international medical literature. The preparation process for repatriation of patients with chronic obstructive pulmonary disease is also discussed. Orv. Hetil., 2013, 154, 323–337.

Introduction: During airport security check of passenger luggage, hazardous items and substances are prohibited to be taken into the restricted safety zone of the airport and the aircraft. Among equipment of the medical staff escorting the patient, there are several devices and materials which are considered hazardous for security reasons. However, medical equipment and substances are indispensable for treating patients during the flight. Aim: The aim of the author was to present his experience obtained with the use of an instrument developed for testing liquids, aerosols and gels for security reasons. Method: An instrument based on Raman spectroscopy was used for the identification of medical substances. Results: The results confirmed that the instrument was able to recognize the tested medical substances. The non-destructive testing maintained sample integrity and asepsis. Conclusions: The data indicate that the instrument has a promising utility for the identification of medical substances. It seems important that during repatriation medical substances should be selected not only on the ground of their medical necessity, but their packaging should be also taken into consideration. It is necessary to perform more tests on different medical substances used in emergency care in order to make the database of medical substances stored in the library of instrument more complete. Orv. Hetil., 2012, 153, 1469–1474.

Authors analyse questions of medical evacuation of the psychotic patient from abroad to homeland. This task can be considered the most difficult problem for the attending physician and the escorting medical team as well. The main challenge is to recognise the psychotic patient in a foreign country with a different health-care system and to overcome the language barrier and the different cultural background. The second issue is to prepare the patients – who are usually in a poor condition – for the medical evacuation by commercial aircraft. Another important issue is to take the patient through the strict security control. All of these (partially unsolved) problems make the mentally ill patient defenceless. Although the repatriation of a mentally ill patient is vital and urgent, travel insurance policy mostly excludes to cover the cost of treatment and repatriation. The high cost of treatment and repatriation of the patient should be paid by the patient or the family, who are often in the position of insolvency. In this paper authors present the history of a patient and give a brief review on travel-related mental disorders, the epidemiology of mental alterations during travel as well as the problems of appropriate evacuation. Authors conclude that there is a need for a better approach of the airport authorities and insurance decision makers to the mentally ill patient travelling abroad. Orv. Hetil., 2011, 152, 131–138.

A beteg jólléte mindenekelőtt! – ezt az elvet sem a társadalmi, sem a politikai nyomás, sem az adminisztrációs kötelezettségek, sem a kereskedelmi érdekek nem sérthetik az orvosi rendtartás előírása szerint. A mindennapi, repatriációval összefüggő orvosi és nem orvosi tevékenységek azonban ezt az elvet gyakran megszegik. A hazai gyakorlatban az utazási biztosítások alapján történő beteg-hazaszállításoknak komoly anomáliái vannak. Ha ezeknek az eredete a financiális szempontok felülkerekedése a beteg érdekének rovására, akkor ezt a motivációs tényezőt azonnal ki kell iktatni! A torz gyakorlatot (többek között) a hosszú távú, betegszállítással kapcsolatos szakmai szabályok hiánya teszi lehetővé. Elsősorban a repatriáció szakmai indikációinak hiánya, a szállíthatósággal kapcsolatos hiányos állásfoglalások, következésképpen a szakmai felelősség elmosása nyújt erre lehetőséget. A szakmai szabályok hiánya lehetetlenné teszi a hazaszállítással megbízott egészségügyi szolgáltató számára a szakmai szempontok betartását – és ezzel a beteg érdekeinek érvényesítését. A helyzetet rontja, hogy a klinikai szakmák képviselői és maguk az alapellátásban dolgozó orvosok is alig ismerik a beteg hazaszállításának szakmai kérdéseit, annak gyakorlati lebonyolítását. Jelen közleményben a szerzők összefoglalják a repatriáció indikációit és kontraindikációit, útmutatást adnak a szállíthatóság kérdésének eldöntéséhez. Részletesen ismertetik a hazaszállításra alkalmazható járműveket, azok használatának korlátait.

When we survey the possibilities of prevention in travel medicine, it soon becomes clear that the “classical” or “infectology-oriented” approach of the prevention (vaccination, chemoprophylaxis, pretravel advice) cannot respond to all peritravel medical problems. These newly arisen challenges require a new approach to the travel medicine, mainly in the field of prevention, treatment and management of the travel-related illnesses. Although the travellers are still exposed to various infectious diseases, which are mostly preventable by the primary prevention methods (biomedical prophylaxis), yet, the majority of the travellers suffer non-infectious diseases and fall ill or suffer accidents by other, travel-related factors. Moreover, the predominant destination is Europe for an average Hungarian traveller. The travellers, whose destination is not any tropical or third-world country, the adventure travellers, pursuers of extreme sports, the chronic patients all require the same-leveled peritravel (prevention-...

Az utazási orvostan prevenciós lehetőségeinek vizsgálatakor megállapítható volt, hogy a „klasszikus” felfogás, amelyet túlnyomórészt még mindig a primer megelőzés, a vakcináció – kemoprofilaxis –, orvosi (legfőképp infektológiai tartalmú) tanácsadás triásza jellemez, nem teszi lehetővé az utazással összefüggő betegségek megelőzésének és kezelésének komplex feladatát. Az utazók ugyan még mindig ki vannak téve az úti cél endémiás fenyegetésének, és bár igaz, hogy a vakcinációval közel tökéletes prevenciót érhetünk el ezen a területen, az utazók többsége nem fertőző betegségben szenved (vagy hal meg), hanem más, az utazás provokálta noxák miatt. Emellett például a magyar utazók túlnyomó többsége európai országokba utazik. A nem egzotikus (trópusi) országokba utazók, az extrém és szabadidősportot űzők, a krónikus betegségben szenvedők ugyancsak tanácsadást – mégpedig profilaktikus szemléletű tanácsadást – igényelnek. A védőoltások mellé be kell hogy vonuljon a prevenció fegyvertárába a védősisak, a sótabletta, az úti patika és a hordozható oxigenizátor is. Beszélnünk kell továbbá azokról az utazókról is, akik külföldön betegednek meg, és szakszerű repatriációjukhoz szükséges a szakorvos, az utazási orvos együttműködése, a beteg háziorvosának anamnesztikus segítsége és a biztosító orvosának szervezőkészsége is. Mindez olyan komplex tudást igényel, amelyet csak akkor tudunk megkövetelni, ha az utazási orvostan tárgyát és módszereit újradefiniáljuk. Meg kellett határozni az utazással összefüggő betegségeket, az utazók kategóriáit, illetve a prevenció elsődleges, másodlagos és harmadlagos szintjeinek tartalmát, valamint a szintekhez tartozó prevenciós módszereket. Megállapítható, hogy az utazási orvostan tudásanyaga fel kell hogy ölelje az infekciók, de az egyéb, utazással összefüggő betegségek megelőzését is, a szabadidősportok orvostanát (vadonorvoslás vagy wilderness medicine), az assistance orvostant (a betegek hazaszállításának tudományát) és az utasbiztosítási orvostan tárgykörét is. Ez a négyes, multidiszciplináris felosztás jól illeszkedik az utazási orvostan komplex szemléletéhez a nemzetközi gyakorlatban, de megfelelőnek bizonyul a magyarországi betegellátó struktúrában is. Lehetővé teszi, hogy az utazókkal kapcsolatba kerülő orvosok (elsősorban az utazási, a házi-, a biztosítási és a foglalkozás-egészségügyi orvosok) hatékonyan tudjanak részt venni az utazók felkészítésében. A prevenció szakmai alapjait ki kell dolgozni, az utazási orvostan interdiszciplináris jellegének megfelelően minden szakterületen. Szintén sürgető feladat az utazási orvostani tanácsadás országos struktúrájának kifejlesztése és az utazási orvostan graduális és posztgraduális oktatásának megszervezése. Az oktatás során – a szakma sajátosságainak megfelelő – új képzési formákat kell igénybe venni. Csak ilyen alapok birtokában várható, hogy a magyar emberek egészségkultúráját utazási vonalon a nemzetközi szintre tudjuk emelni.

501 n It was in the year 2005 that a ski abroad accident with fatal outcome affecting children had been fervently discussed both among professionals and in mass media. Since then medical escort for ski camps organized for groups, especially for school children, has been often required. The accompanying staff, however, has been recruited without exception from the campers’ family members or acquaintances. So, the medical staff often has been selected among physicians not active in general practice or oxyology (ambulance). However, it is reasonable that doctors active in other kinds of disciplines be less informed in first aid and especially in “travel medicine”, whose chapters on extreme sports deal with health problems attached to winter sports and their medical care [1]. Nevertheless, the tasks of the “ski-camp doctor” not only prove to be sophisticated but require a lot of know-how not used in everyday medical activity too. It is true that our – Hungarian – bibliography only makes allusions on certain parts of these topics. As we already mentioned, not only children but even the elderly and people having chronic diseases use to go on ski-running or would like to do that. Therefore, the know-how of the medical escort has to range from traumatology – through internal medicine – up to dermatology. So, the camp doctor not only has to be a first-aid giving person but even a “health manager” too. In the cases of emergency, as may happen on the ski-track, there is no time left for getting the medical manual out of your pocket! On the other hand, it is true that the camp doctor has not to be a traumatologist “on the spot” but rather a medical first-aid giving person as trained for every situation. It is he who has to solve medical and hygienic problems emerging on the camp or in the catering and even to come to an agreement with the health insuring company, if necessary. People having chronic disturbances (cardio-vascular diseases – as hypertonia – or diabetes etc.) have to get the chance to travel, even to make sports despite their basic affections. These

The number of international travels has been continuously increasing since World War II. Though the travelers' demand for safer ways of travelling appeared, only a handful of them sought pretravel advices. This is the reason why 50% of the travelers have to face some kind of medical problem during their journey. If they have travel insurance, the company's assistance team organizes, monitors and covers their abroad treatment. A doctor of the assistance team has to find her/his ways in various fields: not only a multidisciplinary medical knowledge is a must for a professional like this, but she/he needs to have a good grasp of the basic idea behind the insurance policy, too. Also, she/he should be familiar with the public health care systems of different countries and some legal knowledge is also needed. If the patients are unable to continue their trip, they must be repatriated. Making a decision about the repatriation's timing and modality requires interdisciplinary medical experience and the approach of a critical care/emergency doctor. Among further tasks for the assistance team's doctor one can find medical escort and on-spot medical visit for foreign patients. Both of these two aforementioned medical activities are highly different from - for example - a general practitioner's routine. That is the reason why an assistance doctor has to be familiar with the critical and emergency care. Organizing and monitoring medical treatment for a traveler abroad, providing medical escort, making decisions about repatriation and providing medical help for a foreign patient all fall within the competence of a new medical discipline, the assistance medicine. Creating a body of knowledge, collecting appropriate protocols and establishing postgraduate courses for assistance medicine diplomas are the tasks of the critical care and emergency medicine professionals.

Authors analyse questions of medical evacuation of the psychotic patient from abroad to homeland. This task can be considered the most difficult problem for the attending physician and the escorting medical team as well. The main challenge is to recognise the psychotic patient in a foreign country with a different health-care system and to overcome the language barrier and the different cultural background. The second issue is to prepare the patients - who are usually in a poor condition - for the medical evacuation by commercial aircraft. Another important issue is to take the patient through the strict security control. All of these (partially unsolved) problems make the mentally ill patient defenceless. Although the repatriation of a mentally ill patient is vital and urgent, travel insurance policy mostly excludes to cover the cost of treatment and repatriation. The high cost of treatment and repatriation of the patient should be paid by the patient or the family, who are often in the position of insolvency. In this paper authors present the history of a patient and give a brief review on travel-related mental disorders, the epidemiology of mental alterations during travel as well as the problems of appropriate evacuation. Authors conclude that there is a need for a better approach of the airport authorities and insurance decision makers to the mentally ill patient travelling abroad.

Az egyre szigorúbb biztonsági intézkedések a repülőtereken az utasokat is egyre súlyosabban érintik. Az életbe léptetett megszorítások (a folyadék, illetve a mozgás korlátozása) felerősíthetik a repülőgéppel utazók szervezetében fellépő káros élettani folyamatokat, a legújabb vizsgálati eljárások (például a teljestest-szken) pedig – a kétségtelen etikai és morális aggályok mellett – olyan patológiai folyamatokat indíthatnak el, amelyek későbbi hatása még nem teljesen ismert. Fokozottan igaz ez arra az utazóra, aki útja során betegszik meg vagy éri sérülés, és emiatt nem folytathatja útját. Az ilyen utazót – megfelelő előkészítés után – haza kell szállítani. A hazaszállítás leggyakrabban a menetrendszerű repülőgépen történik, fekvő beteg esetében a kabinban elhelyezett hordágyon, egészségügyi kísérettel. Ez a hazaszállítási mód több biztonsági problémát vet fel: a beteg ellenőrzésén kívül a kísérő egészségügyi felszerelésének ellenőrzését is. Az orvosi táska ugyanis több olyan eszközt, gyógyszert tartalmaz, amelyek repülőgépre vitele tilos. Egységes rendelkezés hiányában ezeket a problémákat a biztonsági személyzet változatos módon kezeli: a skála az empatikus hozzáállástól a kategorikus tiltásig terjed. Szükséges tehát egy olyan szakmai állásfoglalás, amely figyelembe veszi a repülésbiztonság (security) mellett a beteg ember út közbeni ellátásának biztonságát (sickurity) is, és ezáltal kiküszöböli a beteg és kísérőjének kiszolgáltatottságát. Ugyanez érvényes a fogyatékkal élők utazására is. A közlemény nemcsak a nehézségeket veti fel, hanem megpróbálja feloldani az utasbiztonság és a betegbiztonság egymásnak sokszor ellentmondó követelményeit, az úgynevezett „sickurity” problémát. Orv. Hetil., 2010,41,1702–1707.

Mass gathering is well known to concentrate and amplify the transmission of infectious respiratory diseases. Here we report a possible case of coinfection with influenza A/H1N1 and varicella in a young French traveler returning from a rock festival in Hungary. We report a cluster of influenza A/H1N1 cases at this festival.

In the previous part of the paper authors described the repatriation process, the complex medical task of the patient returning home from abroad, and in particular its most crucial phase, the patient repatriation. Authors reviewed the indications and the basic terms of the patient-repatriation. Vehicles and their availability for the different type of repatriation modalities were analyzed as well. In the second part of the paper, the authors analyze the professional aspects and the decision making procedure on the repatriation. Unfortunately, sometimes the treating doctor does not realize the minimum terms of the ability for the transport of the patient. Therefore he might provide an incorrect suggestion on the time and modality of the repatriation. The responsibility of the transport belongs to the doctor who makes the decision, and to the medical team, who performs the repatriation, respectively. The decision has to be made by the doctor of the insurance company, upon detailed and correct medical information. When a non-professional person is involved into the decision making, patient can be jeopardized; and the repatriation process can be failed. The medical transport is a medical activity in Hungary, therefore it must be performed according to the medical regulations and to the professional standards, the protocols and the transport should be carefully documented. Employees of the assistance team of the insurance companies must be familiar with that regulations and protocols.

Due to our medical ethics, welfare of the patient is the first to consider. The therapy applied should not be influenced by any financial, administrative or political considerations. Yet, patient repatriation is such a special medical field, where the interest of an insurance company can often owerwrite medical considerations. The missing protocol of long-distance patient transportation and of repatriation in general, the by-passing of medical responsibility enables malpractice. Unfortunately, practitioners know little about the basic terms of repatriation. The authors review the indications and basic terms of patient repatriation, and the basic considerations on the fit-for-transportation of the patient. The patient transportation vehicles and their availability for the different forms of repatriation modalities are analysed as well. It was found that the form and timing of repatriation should be carefully selected, in order to prevent further deterioration of the patient's status; it must ensure maximum protection of the patient during the transport. The patient's interest must be the first, all the other considerations (financial, social etc.) may come afterwards.

When we survey the possibilities of prevention in travel medicine, it is soon detected that the "classical" or "infectology-oriented" approach of prevention (vaccination - chemoprophylaxis - pretravel advice) cannot respond to all peritravel medical problems. These newly arisen challenges require a new, complex outlook for travel medicine, mainly in the field of prevention, treatment and management of travel-related illnesses. Although travellers are still exposed to various infectious diseases, which are mostly preventable by the primary prevention methods (biomedical prophylaxis), the majority of travellers suffer from non-infectious diseases and fall ill or suffer accident by other, travel-relating factors. Moreover, the predominant destination is Europe for an average Hungarian traveller. The travellers, whose destination is not any tropical or developing country, i.e. adventure travellers, people in extreme sports, chronic patients all require same-level peritravel (prevention-oriented) advice, too. Thus besides vaccination, helmets, salt-tablets, medical kit, mobile oxygenator must belong to a travel doctors' arsenal. We also have to mention the travellers' acute illness/accident abroad, travellers who require repatriation, and also the appropriate travel insurance policy which should be worked out following evidence-based medical considerations. The above-mentioned complex task requires not only a broad-spectrum, multidisciplinary knowledge, but an appropriate co-operation between the travel medicine physician, the general practitioner of the patient, and the doctor of the insurance company. But, above all, we have to redefine the topic of travel medicine, its subspecialties and role in the three-level (primary, secondary and tertiary) prevention. We have to redefine the different prevention levels and the used methods relating to the different subdisciplines of travel medicine. Upon the recent scientific researches, we can lay down four topics of travel medicine: biomedical prophylaxis, assistance medicine, wilderness medicine and travel-insurance medicine. This "four-leaf clover" model is fit for the complex approach of the newly generated peritravel medical problems, both in Hungary and abroad. This kind of approach makes the doctor (who contacted the travellers at any respect: travel medicine specialists, GPs, occupational medicine specialists, insurance physicians) able to participate in the peritravel treatment or pretravel advising of travellers. The basic ideas of the prevention levels have to be established in each subdiscipline of travel medicine. Another urgent task is to establish a countrywide network of travel medicine facilities as well as the organisation of gradual and postgraduate education of physicians and professionals. We have to implement new forms and methods during training. Travel advising and peritravel prevention require well and continuously trained doctors.

Summary At the end of the 1980s, a new peoples’ migration began, during which the inhabitants of the former Eastern bloc discovered the Western world and the interest of Western tourists turned towards Eastern Europe. Thus, a “travel industrial revolution” took place in Eastern Europe, albeit 20 years after the corresponding Western revolution. Both the common features of their past political systems and the local peculiarities of several Eastern European countries could affect the later development of the ideas and microstructures of travel medicine. By reassessing those particularities that have influenced the formation and development of travel medicine in Eastern European countries, based upon Hungarian experiences, the author has reviewed the primary, secondary, and tertiary tasks required in travel medicine and the “four-leaved-clover structure” of travel medicine, which supports it and makes possible its flexible adaptation to local peculiarities. Building upon the experiences gathered in Western countries, with an already established travel medicine structure, Eastern European travel medicine has the chance to create an appropriate, open, and polychromic interdisciplinary science. However, when building a travel medicine system, we must preserve our traditional primary prevention activity: the well-proven triad of vaccination, chemoprophylaxis, and travel advice. We must also consider the divergent social backgrounds, cultural traditions, and local particularities of the pre-existing health care system. A very strong stress must also be placed on the secondary prevention (preparing patients suffering from preexisting diseases), psychosocial preparation, and evaluation of risk factors, use of possible protective devices, and the possibilities and limitations of self-therapy. A medical provider network abroad must be established by Hungarian travel medicine specialists for tertiary prevention, and to oversee well-established protocols for repatriation.

Skiing is a risky sport for many, even for children and beginners. When the ski-group is escorted by doctors who are able to provide advanced life support on the scene and are trained either in the field of emergency medicine or in travel medicine, a good possibility is given for the prevention of ski-accidents and for decreasing the number of travel related illnesses. This fact has led to the basic idea of training ski-camp doctors in Hungary. There is no similar initiative in the Hungarian literature. Therefore the article tries to summarise the medical knowledge and requirements of a ski-camp doctor, and analyses the prevention tasks of the doctor as well. The camp doctor must be well informed and highly trained in the field of emergency and travel medicine. The main tasks are: pre-travel advice, treatment of the common (travel-related) diseases, providing basic and advanced life-support on the scene, and to organise the hospitalisation and repatriation of patient, in cooperation with the hospital and insurance doctor. Moreover, the prevention should start before departure: the estimation of the physical and health condition of the skiers, a continuous care of the chronic people, and supervision of the place (hygienic circumstances, rescue forces available, the condition of the ski slopes, etc.) are vital--as for the primary prevention. The secondary level of the prevention is the treatment of the injured/sick persons, and assistance in the medical evacuation. During the training, not only postgraduate medical, mountain and alpine medicine lessons have been provided, but basic legal and insurance information as well. Moreover, the doctors received ski-course from professional ski-trainers in order to improve their ski-technique and skills on different slopes and off-piste places. In the future the local mountain rescue and air-rescue forces have to be involved in postgraduate training. Hopefully different travel-insurance companies and travel offices will use the trained doctors as a medical escort for ski- and school groups. The presence of a ski-camp doctor could minimise the risk of sport activity for chronic (diabetic, cardiac, etc.) patients, for the beginners and for the elderly. Besides the primary prevention, a secondary level of prevention can be ensured by ski-camp doctors as well.

The author describes the basic ideas and skills of travel medicine, as a new discipline of medical science in Hungary. He also emphasizes the importance of the knowledge of assistance medicine (as a substructure of the travel medicine). The author points out that travel medicine should be assigned to the discipline of insurance medicine in Hungary. In respect of Hungary's joining the European Union, Hungarian doctors should be fully aware of the importance of the traveller's medical treatment.