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Surfing the web for travel health resources

Liz Rosies
RGN MSc(TravelMed)
Bank Nurse
Travel Clinic - InterHealth
London
Author of www.travelhealth.co.uk
E:liz@travelhealth.co.uk

Health professionals use a variety of information sources when providing travellers with health advice, such as printed leaflets, travel health textbooks and wallcharts. However, changing political situations and disease patterns within a country often mean that printed publications rapidly go out of date.
While these printed sources still remain effective in certain situations, the introduction of web-based resources has meant that up-to-date information can be instantly accessible via the internet. However, even with such a valuable resource, research has shown that few health professionals make use of the internet to access travel health information.(2) The need to find a trustworthy resource among the many options available means that the use of printed materials remains high among health professionals.
In determining a dependable web-based resource, not only must the information be up-to-date, but it must also come from what is considered a reliable source. While many sources used by the traveller are easy to define - such as visa requirements, flight times and arrival dates - in the area of health, risks are not always definable.(3) Health risks vary not only from country to country but also within a country depending on the lifestyle, season and disease risk factors.
 
Online databases
The most effective resource as far as country-related information is concerned is the online database - a collection of global health information sources indexed and accessible from one specific website. While there are several excellent databases on the internet, it is important to ensure that the information retrieved is from a UK source. We currently do not have standard global recommendations for vaccination and malaria prophylaxis, and so databases established in other countries can differ.(4)
Using an online database provides precise country information, with daily updates reflecting health changes within that country. Change could result from natural disaster, or an unusual rainy season causing a differing disease pattern, such as with malaria and dengue fever. Once a user becomes proficient, it is a very quick and easy way to retrieve information.
It is essential that nurses are able to interpret a database and adapt the relevancy of information and advice to the individual traveller. Some online databases are run by enthusiasts who leave nothing out of a health brief, often leaving the poor traveller with more anxiety than they started with - and leaving new travellers totally overwhelmed!
One of the best databases available is the TRAVAX database. This interactive online database is a reliable and medically recognised resource for those practising travel health within the UK. Maintained and updated on a daily basis by the Scottish Centre for Infection and Environmental Health, TRAVAX is a part of the NHS in Scotland. In terms of a reliable and credible source - TRAVAX reflects the views of the Joint Committee of Vaccinations and Immunisations for the UK along with the views of the Malaria Prevention Advisory Panel for the UK, which is coordinated by the Public Health Laboratory Service and the Malaria Reference Laboratory.(5)
TRAVAX is an excellent resource for nurses. It does not just look at individual countries, but goes deeper, assessing regional risks by way of maps and online advice. TRAVAX is also password controlled which means that only registered professionals are able to use it. The service is accessible from any computer linked to the internet, so the health professional is able to become familiar with the system from the privacy of their home as well as in the surgery or travel clinic. Registering online is easy and can be done either through a surgery or as an individual.

Resources for education and learning
With more health professionals looking to distance-learning courses to improve their practice, the internet is an excellent tool for finding references and, in some instances, full text travel health research articles.(6) It is possible to do a literature search today from the confines of your own home using just the internet as a tool. The internet provides unlimited access to hundreds of online resources and journals through nursing libraries not only in the UK but also around the world.
When looking for good resources it is often worthwhile going to travel health associations' and specialist groups' websites, which along with information will usually have numerous useful links. Many travel medicine centres can be found online such as tropical disease hospitals, along with specialist organisations both in the UK and around the world.

Practice pointers
As professionals we need to be aware that our patients are going to use multiple resources in looking for travel health information. Our job is to bring those sources into line with a standard level of advice. Becoming proficient in our use of travel health resources on the web will not only improve our own practice but enable us to recommend good quality sites to our patients, pointing them to a "reliable source".
By having access to online travel health resources we are better able to advise travellers. When we become more accomplished in developing our practice, by use of the internet, we will actually help our clients to help themselves. By pointing patients towards recommended internet resources we will in turn reinforce the information we give them in a travel health consultation, thus achieving our goal of health promotion.(7)

References

  1. Morris T, Guard JR, Marine SA, et al. Approaching equity in consumer health information delivery. J Am Med Inform Assoc 1997;4:6-13.
  2. Leggat P, Hayden J, Menon A. Resources used by general practitioners for advising travellers from New Zealand. J Trav Med 2000;7:55-8.
  3. Walker E. Sources of information for travel health advisors. In: Lockie C, Walker E, Calvert L, et al, editors. Travel medicine and migrant health. London: Churchill Livingstone; 2000.
  4. Silberg W, Lundberg G, Musacchio R. Assessing, controlling and assuring the quality of information on the ­internet. J Am Med Inform Assoc 1997;277(15):1244-5.
  5. TRAVAX - omline database from the Scottish Centre for Infection and Environmental Health. Available at URL: http://www.travax.scot.nhs.uk
  6. Nicoll L. Nurses guide to the internet. 3rd ed. Philadelphia: Lippincott; 2001.
  7. Warner M, et al. Healthcare futures. A report commissioned by the UKCC Education Commission WIHSC. London: UKCC; 1998.

Resources
TRAVAX
W:www.travax.scot.nhs.uk 
Promed
Affiliated to the International Society of Infectious Diseases. Provides an ­internet forum for professionals to rapidly share ­information on health topics ­relating to travel
W:www.promedmail.org
The WHO Weekly Epidemiological Report
W:www.who.int/wer
The International Travel and Health publication from the WHO
W:www.who.int/iht
Public Health Laboratory Service
W:www.phls.org.uk
Centers for Disease Control - travel section
An excellent American-based travel resource
W:www.cdc.gov/travel
Department of Health. Health information for overseas travel. 2nd ed. London: The Stationery Office; 2001.
W:www.official-documents.co.uk/document/doh/hinfo/index.htm