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Travel guide
TRAVEL GUIDE Some information which will help you stay healthy on holiday. WATER Diseases can be caught from drinking contaminated water. In order to avoid illness, unless you know definitely that the water supply where you are staying is safe, use only 1. Bottled water (make sure the seal on the lid has not been tampered with). 2. Boiled water 3. Canned drinks 4. Water treated with a sterilising agent Avoid ice cubes (they will have been made with local water) and do use bottled water for cleaning your teeth. FOOD Travellers’ diarrhoea is the most common cause of illness in travellers. Eating contaminated food and, less commonly, drinking contaminated water are the main ways of acquiring travellers’ diarrhoea. Consider the following guidelines to prevent becoming ill.
1. Avoid salads if possible 2. Only eat well cooked fresh food, avoid re-heated food 3. Avoid buying food from street vendors 4. Do not drink unpasteurised milk 5. Avoid ice cream, shellfish, and raw meat 6. Only eat fruit which you can peel “Boil it, cook it, peel it or forget it” Be aware that gastro-intestinal illnesses that lead to vomiting and / or diarrhoea can result in the reduction of effectiveness of some medication including oral contraception. In this case additional precautions should be considered.
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SWIMMING If you are swimming in the sea check local information regarding tides and weather conditions. Consider swimming only in designated safe areas. When using swimming pools try to ensure that the water is well chlorinated. Swimming in freshwater lakes, streams or rivers in countries such as Africa, China, Cambodia (Mekong River), Laos, and in South America is not advisable as a disease called Schistosomiasis can be caught from these places. PERSONAL HYGIENE Travellers’ diarrhoea (TD) is acquired by ingesting faecally contaminated water or food. To help prevent transmission of disease always wash your hands with soap and water before (and after) going to the toilet, before handling food and before eating. TRAVELLERS’ DIARRHOEA Travellers’ diarrhoea (TD) is the most common cause of illness in travellers abroad. All travellers are at risk. Exposure to poor sanitary conditions, incorrectly cooked and stored food, fruit which cannot be peeled and ground-grown leafy vegetables are all causes of TD. The risk of infection is higher in some countries that in others. High risk Developing countries of South America, Africa, The Middle East, and Asia. Low risk Western Europe, North America and Australia. Prevention Follow advice under food, water and personal hygiene sections. Symptoms Incubation period varies from a few hours to a few days. Watery diarrhoea (usually 3 or more stools in 24 hours). Diarrhoea is sometimes accompanied by stomach pain / cramps, vomiting. Most sufferers will not have a raised temperature. Blood in the stools is less common. Often the disease is self-limiting lasting only 3 - 6 days though a very small number of people will have diarrhoea for longer. The illness often disrupts holiday plans. Treatment Rehydration is very important and is the mainstay of treatment. Parents who travel to high risk areas with children should take rehydration preparations with them (available in most pharmacies). The elderly are also at higher risk from dehydration. Anti-diarrhoeal tablets can also be taken by adults but never by children under the age of 4 years old. These tablets should NOT be used if the person has a temperature or blood in the stool. Only very occasionally are antibiotics administered but then only under medical supervision. Medical help should be sought if «Title» «Forename» «Middle_Names» «Surname» - DOB «Date_of_birth»
1. The person has a temperature 2. There is blood in the stools 3. The diarrhoea persists for more than 48 hours (24 hours in children) 4. The person becomes confused HEPATITIS B AND HIV Hepatitis B has global distribution. HIV is present throughout the world the highest prevalence being in sub-Sahara Africa. Both diseases can be transmitted by
1. Infected blood transfusions 2. During exchange of body fluids during unprotected sex 3. Via contaminated needles shared by injecting drug users 4. Via medical / dental procedures with non-sterile equipment 5. Via contaminated needles used during body piercing, tattooing, acupuncture Preventative Measures Avoid having casual sex, and use condoms at every opportunity (locally made condoms may not be of adequate quality, use those with a Kitemark ). Do not share needles or any other medical equipment. Try to avoid having tattoos or piercings done. Avoid having a blood transfusion. Carry a sterile medical kit. ANIMAL BITES Rabies is present in many countries world-wide and is an acute, invariably fatal illness. Dogs are most commonly associated with transmission. Considerations
1. Avoid the risk. Avoid contact with dogs, cats, bats (wild or domestic) 2. If you are bitten or licked on an area of broken skin in a country that has rabies, wash the area thoroughly in water / soap and water vigorously for 5 minutes. 3. Seek medical help immediately in order to receive post-exposure treatment even if you were vaccinated before travelling. 1. Bite avoidance. Use insect repellent spray containing DEED (diethyltoluamide) at appropriate strength (50% in malarious areas). Caution in young children and pregnant ladies. Re-apply after swimming or sweating. 2. Use mosquito nets, impregnate clothing with insecticide e.g. permethrin. 3. Be aware of the risk and time of risk e.g. dusk until dawn. 4. Wear long sleeves, trousers, socks and shoes. 5. Use air conditioning, mosquito coils, “Bug Bands” There are other diseases caused by mosquito bites, these include:
1. Yellow fever (daytime biting) vaccination is available 2. Dengue fever (daytime biting) no vaccination is available «Title» «Forename» «Middle_Names» «Surname» - DOB «Date_of_birth»
3. Japanese Encephalitis (dusk until dawn) vaccination is available ACCIDENTS Road traffic accidents are the leading cause of death of children overseas, with drowning being the second most common cause of death. When hiring a car try to make sure it is from a reputable source. Child seats should be brought over from the U.K. as they may not be available at the holiday destination. Avoid alcohol when driving and familiarise yourself with local regulations. Avoid hitch-hiking. Avoiding eating a large meal or drinking alcohol before swimming. Take note of any safety restrictions on beaches e.g. the current, safe swimming areas, tide times. INSURANCE Make sure you have adequate insurance cover for your trip.
Inform the insurance company of any pre-existing medical conditions. Check the details of your medical insurance before travelling
Obtain an EHIC before travelling to an EU country (available at Post Offices). This will give you some basic cover so make sure you have secondary insurance too. AIR TRAVEL Especially on long-haul flights
Try to ensure enough leg room. This may entail special pre-booking with the airline or booking a more expensive seat.
Move around as much as possible. Exercise your legs and feet every 30 minutes. Do some deep-breathing exercises.
Drink plenty of fluids (water). Excess alcohol intake can lead to dehydration. NOTE: Those travellers with a previous history of DVT (deep vein thrombosis), PE (pulmonary embolism) must see their G.P. as soon as their flight is booked as they may need specialised medication whilst travelling. HEAT AND SUN Sunburn and heat related illnesses can cause serious skin problems in travellers and can curtail holiday plans. Sunburn can cause skin cancer in the long term. Just taking a few precautions could help prevent a painful holiday !
1. Limit yourself to 20 minutes of sun exposure daily, initially «Title» «Forename» «Middle_Names» «Surname» - DOB «Date_of_birth»
2. Use sunblock, reapply regularly especially after swimming. Children aged under 3 should wear sunblock. Children aged 6 months or younger should be kept out of the sun 3. Try to keep out of the sun between 10a.m. and 3p.m. when the sun is at its hottest. 4. Wear hats and protective clothing when possible. 5. Keep well hydrated with water (alcohol can make you dehydrated). WEBSITES (Department of Health) (National Travel Health Network ad Centre) (Foreign and Commonwealth Office) MOST OF ALL HAVE A VERY ENJOYABLE AND SAFE TRIP With reference to: Health Information for Overseas Travel (The Yellow Book) Nathnac 2010 Travel Medicine Pollard, A J and Murdoch, DR 2001 Grieve, S Independent Nurse 21 February – 06 March 2011
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Several Tulare County farms could become solar, wind energy producers David Castellon, Visalia-Times Delta, 7-6-20 Erika Carette is ready to make a change on her 40-acre farm southeast of Visalia. Nearly half of her farm is covered with lush, green walnut trees while the other half is mostly barren, overgrownwith brush and dead trees. She can afford neither to clear the land nor plant a ne
Color profile: Generic - CMYK US Negative ProofingComposite Default screen The Heck reaction in the production of fine chemicals Johannes G. de Vries Abstract . An overview is given of the use of the Heck reaction for the production of fine chemicals. Five commercial products have been identified that are produced on a scale in excess of 1 ton/year. The herbicide Prosulfuron™ is pro- duce
TRAVEL GUIDE 
1. The person has a temperature