International maritime health
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This contribution is intended to fertilise the current discussion of ship's doctors qualifications required for cruise ships. Therefore 10 points are added to the debate containing different considerations focussing on the recommendations of the German Society of Maritime Medicine, the American College of Emergency Physicians (ACEP's) Health Care Guidelines for Cruise Ship Medical Facilities and the different skills a ship's doctor should have from the perspective of the recruiter.
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The aim of the article is to discuss issues associated with the occurrence of febrile illnesses in leisure and business travellers, with a particular emphasis on fevers of unknown origin (FUO). FUO, apart from diarrhoeas, respiratory tract infections and skin lesions, are one of the most common health problems in travellers to tropical and subtropical countries. ⋯ Other illnesses with persistent fever include dengue, enteric fever, viral hepatitis A, bacterial diarrhoeas and rickettsioses. Fever may also occur in travellers suffering from diseases of non-tropical origin, e.g. cosmopolitan respiratory tract or urinary tract infections, also, fever may coexist with other illnesses or injuries (skin rashes, bites, burns).
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The natural electrical phenomena fascinated humans since antiquity. The electrical discharges produced by the torpedo fish were highly appreciated among ancient physicians as Hippocrates, Scribonius Largus and Galen and were prescribed for headache, gout and prolapsed anus. In the medieval period, torpedo's electrical properties were attributed to occult powers, while Renaissance physicians' and scientists' studied the anatomy and mechanical nature of the provoked shock paving the way for the discovery of the electrical nature of torpedo's activity and the evolution of electrotherapy.
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Physicians and nurses from shore based practice who move to work on cruise ships often have concerns about the management of critically ill patients and questions about the resources available to transfer by helicopter to a tertiary care facility. This article seeks to outline some of the clinical, operational and logistical issues associated with using a helicopter to transfer a patient from a ship to a shore-side hospital. While it focuses on resources available in the maritime areas around North America, most of the clinical comments would apply to helicopter evacuations anywhere in the world.
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Global travel and transport play a critical role in the spread of infections. We see this clearly in the first two pandemics of the 21st century: SARS and influenza H1N1-2009. Although air travel contributed to dissemination in these two pandemics, the travel restrictions, quarantines, and heightened vigilance which resulted had an impact on maritime health. ⋯ No effective vaccine exists for SARS at this time, whereas countries were able to deploy millions of doses of pandemic influenza vaccine within 7 months after the outbreak was first recognized in Mexico. The lack of a protective vaccine and the higher case fatality rate in SARS will mean that stringent quarantine measures may still be required for outbreak control if SARS ever occurs again. Compliance with international health regulations, and the ability to adapt these to maritime health needs, will be important in the shipping industry.