Dental tourism and the risk of barotrauma and barodontalgia.

Background and aim Dental tourism, which reflects the provision of health care services abroad, also includes a travelling component. Air travel after dental intervention may cause barotrauma and barodontalgia. This paper aimed to provide guiding principles regarding the minimal time interval between dental procedures and air travel to prevent these adverse effects.Methods A literature search was performed to reveal information with regards to complications related to flights following dental treatments. There is little research in this area and most of it has been conducted on the military aircrew population, which has different characteristics of flight and personnel than civilian commercial flights.Results The recommended time of flying is one week after most dental intervention and six weeks after a sinus lift procedure. The minimal time required between a procedure and flight is 24 hours after restorative treatment, 24-48 hours after simple extraction, 72 hours after nonsurgical endodontic procedure, surgical extraction, and implant placement, and at least two weeks after sinus lift procedure.Conclusions The provided guidelines may serve as a starting point for the clinician's decision-making. The tailoring of an individual treatment plan to the patient should take into consideration the patient's condition, dental procedure, complications and flight characteristics. Further research based on commercial flights is needed to formulate more accurate guidelines for the civilian population.

Stranded abroad: a travel medicine approach to psychiatric repatriation.

BACKGROUND: The incurred mental alteration of a traveler abroad should be an alarming signal for patient, for family and for the local healthcare professionals alike. It is estimated that 11.3% of travelers experience some kind of psychiatric problem, with 2.5% suffering from severe psychosis and 1.2% requiring more than 2 months of therapy upon return from a trip abroad. Acute psychotic episode represents approximately one-fifth of travel-related psychiatric events. Yet, the travel-related mental problems have been a neglected topic till today. Now a good selection of literature is available to help further researches. METHODS: Besides describing the most relevant literature of travel-related mental disturbances, authors present two key issues of dealing with psychiatric problems of travelers abroad: to identify the origin of the mental alteration and the process of the patient with psychiatric problems. RESULTS: Identifying the origin and the nature of the mental symptoms of travelers is often difficult because of the language barrier, among extraordinary circumstances. A simple two-step three-branch algorithm could make the decision easier for the attending physician. Some of the brief psychotic disorder and organic origin of mental disturbance can be and often are treated in place. CONCLUSIONS: Some mental problems probably originated from or triggered by the travel or a foreign environment itself. In these cases the full recovery will be expected if the triggering factor is eliminated. The solution is early repatriation. The repatriation for psychiatric reasons is highly different from repatriation for other medical emergencies. The authors describe a proposal of a step-by-step action of repatriation of a psychotic patient. By the help of this suggested protocol, the patient may successfully be taken home.

[Spams in doctors' mailbox: their threat to health education, to patient information and to scientific research]. / Kéretlen e-mailek az orvos postafiókjában: ezek veszélyei az egészségnevelésre, a betegtájékoztatásra és a tudományos munkára.

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.

Managing Medical Emergencies in Hungarian Pharmacies.

To amass a body of knowledge for managing emergency situations in pharmacies, we surveyed the occurrence and nature of medical problems in Hungarian pharmacies. The occurrence of real or suspected emergencies in pharmacies was markedly different and varied from 1-52 per year, with five cases per year on average. The most frequent problems were bleeding (69%) and dizziness (55%), but other more serious problems (allergic reaction (32%), collapse (23%), and chest pain (25%)) also occurred. Sometimes more than one symptom was reported by a patient. People appear to consider pharmacies to be an appropriate site for receiving first aid for minor ailments, including common medical problems (e.g., fever (12%)). Unfortunately, the range of interventions was very limited because of local legal regulations and the lack of appropriate guidelines for emergencies in pharmacies. The most frequent interventions were wound treatment, control of bleeding (78%), alleviation of anxiety (68%), and providing patients with a glass of water (55%). Very often, more than one intervention was reported for the same case. Whereas 76.3% of pharmacists provided interventions only for adults, 21% of pharmacists provided interventions for all types of patients (adults, co-workers in pharmacies, and children). Pharmacists appeared to be reluctant to treat children, owing to the special issues related to pediatrics. This poor range of intervention should encourage responsible officials to develop guidelines for pharmacists to ensure pharmacists' familiarity with the appropriate interventions in emergency situations. Such knowledge could also provide a good basis for preparing pharmacists to perform vaccinations in the future. The pharmacists had a positive attitude toward providing first aid, and 88% of respondents requested more postgraduate education on medical first aid issues.

Medical Problems of Way of St. James Pilgrimage.

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.

[Pre-travel advice for the Hungarian pilgrims of El Camino. Travel risks and instructions]. / Az El Camino zarándokút egészségügyi kockázatai. Tanulságok és tanácsok.

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.

[Pre-travel advice and patient education of Hungarian travellers]. / Utazás elotti tanácsadás és betegedukáció a magyar utazóknál.

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.

Patients with mental problems - the most defenseless travellers.

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.

[Epidemiological data of Hungarian skiers' and snowboarders' medical problems]. / A magyar alpesi sízok és hódeszkázók egészségkárosodásainak összehasonlító statisztikai elemzése.

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.

[Assistance medicine, a novel discipline of emergency medicine]. / A sürgosségi ellátás új területe: az assistance orvostan.

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.