ISTM Committee Reports
Message from the ISTM Secretary Treasurer
David Freedman, M.D.
I am pleased to report on our current financial status and on our budget plans for the coming year. A financial report for calendar 2004 was presented in Lisbon by my predecessor Frank von Sonnenburg and can be found elsewhere in this mailing.
On July 1, 2005 ISTM officially began its new fiscal year structure. A July to July structure allows robust budgeting and allocation in coordination with the annual Executive Board meeting which occurs each year in May or June.
Prior to my assuming the Secretary-Treasurer position this past May and implementing the new budgeting year, a complete audit of the ISTM books were carried out by Fulton, Kozak, LLP of Atlanta. ISTM received a clean bill of health. The figures presented at the membership assembly in Lisbon are the audited figures.
I am pleased to begin my term with ISTM finances in such excellent shape. I was able to take a role in negotiating the financial aspects of the ISTM's new 5-year publishing contract with Blackwell. This contract gives ISTM much more favorable terms than in the past and should end subsidies to the journal that ISTM had been providing. The money saved will provide funding for future ISTM initiatives.
Thanks to Frank von Sonnenburg, CISTM9 in Lisbon was the largest travel medicine meeting ever and the revenues should allow us to help loan advance funds to ISTM regional meetings held in non-CISTM years. ISTM membership is at record levels so membership income is also strong.
While Brenda Bagwell, our administrative director, will continue to process payments and receipts on a daily basis, we have engaged an outside accounting firm, Heritage Accounting, to provide and analyze monthly financial statements against budget and to assist in the annual budgeting process. Heritage serves solely non-profit organizations including membership organizations such as ISTM. All budget variances identified in the monthly reports need to be approved by the ISTM Finance Committee.
Our investments continue very conservative but with guaranteed steady income. Our reserves are mandated to be such that we could survive the complete failure of a CISTM meeting and continue operating through to the next meeting. We are well in excess of this amount.
A formal budget application process for ISTM committees and initiatives wanting funding for the year was begun this past spring, with the Executive Board the final arbiter of which activities will receive priority for funding. For 2005-6 significant funding was provided for the following committees:
- Membership - to continue to grow the membership,
- Development - to identify and solicit new sources of external funding in this time of decreased support from industry,
- Migration - to develop consensus documents and identify ways of incorporating those providers who serve the VFR population into the ISTM community.
Funds were also set aside to support the ISTM travel medicine research grant program, should no external contributions be available during the fiscal year.
I look forward to serving as your Secretary-Treasurer and I look forward to hearing from any member at istm@istm.org with any concerns or questions.
David
ISTM Research Committee
Anne McCarthy, Canada, Chair
2005 Grant Award Recipients
Congratulations to Daniel Uslan and William Stauffer, the principal investigators of the two winning research grants awarded by ISTM's Research Committee at CISTM9 in Lisbon. There were a total of 12 applicants for this competition. The review committee consisted of Irmgard Bauer (Australia), Pat Schlagenhauf (Switzerland), Annelies Wilder-Smith (Singapore) and Susan McLellan (USA). The funding was provided by generous support of GSK. The winning projects were:
- International travel and exposure risks in solid-organ transplant recipients. PI Daniel Uslan, USA ($9976);
- Prevalence of Malaria and evaluation of screening techniques for refugees arriving in the United States from West Africa. William Stauffer, USA ($8500).
In follow-up to the 2003 awards, all four awardees have completed their projects, and multiple abstracts from these projects were presented at CISTM9. We look forward to reading the published manuscripts.
The ISTM executive board supports an annual research competition. This year applications will be accepted from 31 October to 31 December. Winners will be announced in May, 2006. For further information, please look on the ISTM website under committees. A new grant application form will be available by the middle of October.
The ISTM research committee fosters research in travel medicine in keeping with the mission and goals of the society, including the promotion of international collaboration. The main research committee consists of nine members from four continents. Moderate grants (usually $5000- $10,000 maximum) are provided through a peer-reviewed comprehensive process. These grants are designed to stimulate travel medicine research by supporting comprehensive research projects or, for larger projects, providing support for pilot studies to enable researchers to collect data/tests hypotheses so that they can then apply to other agencies for more substantive research grants.
Award recipients are expected to provide updates to the committee chair every six months. The research project should be completed within two years of money receipt, and published within one year of project completion. All awardees are expected to present their data to the scientific community, and are encouraged to publish in Journal of Travel Medicine.
The winner of one of the Free Communications award at the Lisbon meeting, Tom Cumbo, was financially assisted in his research by ISTM. The abstract of his presentation appears on page 7.
Anne
Conflict of Interest Declaration (COID) for the Journal of Travel Medicine
Robert Steffen MD, Editor
The Journal of Travel Medicine (JTM) requires that all authors sign a declaration of conflicting interests. We will not reject papers simply because of conflicting interests, but we will declare the conflicts to the readership. A conflicting interest exists when professional judgment concerning a primary interest (such as patients' welfare or the validity or interpretation of research) may be influenced by a secondary interest (such as financial gain or personal rivalry). If conflicts of interest were revealed after an article was published, they might make a reasonable reader feel misled or deceived.
Authors should review all of the following items before concluding they have no conflicts of interest that are relevant to the manuscript being submitted for publication.
1) Acceptance in the past two years of any of the following from an organization that may in any way gain or lose financially from the results of your study or the conclusions of your paper:
- A fee for speaking
- A fee for writing this article
- A fee for organizing or chairing education
- Reimbursement for attending a symposium
- Funds for research
- Funds for a member of staff
- Fees for consulting and/or serving on an Advisory Board
- Patent royalties
2) Employment in the past five years by an organization that may in any way gain or lose financially from the results of your study or the conclusions of your paper.
3) Ownership of any stocks or shares in an organization that may, in any way, gain or lose financially from the results of your study or the conclusions of your paper.
4) Acting as an expert witness on the subject of your study or paper.
5) Any other financial, commercial, personal, political, or academic conflicts of interest.
We also require authors to disclose any research sponsorship that they received to conduct the study or prepare the manuscript or review. This information will be published together with the author affiliation information.
- Examples of acceptable statements are: "The study was carried out with support of an unrestricted educational grant from X" or "This study was funded in whole/in part by a grant from Y" or "XY has accepted fees for speaking from A and B and has served on an Advisory Board for C."
- The role of the funding organization or sponsor in each of the following should be specified: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
It is important that authors return this form as early as possible in the publication process. We will not publish articles without completion and return of the form.
Please tick one of the following boxes:
__We have no interests to declare. Please print "No interest declared" with the article.
__We have sponsorship and/or interests to declare.
__The corresponding author guarantees the integrity of the data and its analysis. Persons having a major part in manuscript preparation are acknowledged.
Signature (s) _____________________
Date ___________________________
Robert
Report of the ISTM Migration Health Sub-Committee
Brian Gushulak, MD, Co-Chairman
Louis C. Loutan MD, Co-Chairman
The opportunities and potential benefits to the International Society of Travel Medicine related to the health and medical issues of non-traditional international travelers, such as immigrants, refugees and asylum seekers ("migrants") have been the subject of discussion at the level of the Executive Committee for some time.
Interest in this area has been supported by a number of factors:
- In many locations migrants represent the cohort of international travelers with the greatest incidence and prevalence of what is generally considered travel related diseases - malaria, parasitic disease, and tropical infectious disease, for example.
- Migrants often represent the major or significant case loads of practitioners who deal with tropical medicine or imported infections in the developed world.
- Migrants living in industrialized countries who travel to visit friends and relatives in their country of origin represent an increasingly important travel medicine risk group.
- Increasing migration from developing countries to industrialized countries, particularly those in Europe, Asia and the Middle East, is expanding the number of physicians and health care providers involved with the care of these populations.
- At the present time there is no generally recognized group or organization that deals in an integrated manner with the travel health issues of migrants in the international context.
These factors have provided and continue to provide the perception of opportunity for the ISTM in terms of organizing standard approaches to the issues, creating useful links and networks for those involved, and sharing knowledge gained by those who deal with migrant travelers. As the appreciation and study of the health of migrants has grown over the past decade, positioning the Society to capitalize on these opportunities has been a desired goal of some members of the Executive Committee.
Work to Date
Effectively capitalizing on these opportunities to the benefit of the ISTM has been a goal since the mid-1990s. The results of these efforts have not been dramatically rewarding. The issue remains of direct interest to some members of the Society but the Committee has been ineffective in generating wide interest in the issue within the ISTM as a whole.
The general strategy that has been used by the Society over the past few years has been one of trying to build the appreciation of the potential opportunities provided by the issues of migration health within the general society membership. This 'build it and they will want it' approach has not been particularly effective and, in retrospect, that is probably not surprising. Given the current demographic makeup and practice patterns of the Society's membership, there are probably few members not already involved with migrants who are likely to become so. Attracting new interest from within the ISTM will be limited to some specific issues, not the area of migration and refugee health in general.
The difficulties in promoting a cause or an idea in an organizational context where the general appreciation of the cause is low are significant and, for some of the promoters, can be demoralizing. While some members of the Committee on Migration have extensive experience in the area, others are newly facing the challenges posed by migrants in their particular locations, hospitals and clinics, and are there to learn. This creates a situation where much Committee action is directed at repetitively redefining the issue, explaining relevance and linkages, and identifying areas of potential study for Committee members.
The outcome is that the Committee often becomes a focus group for those few with common interest who end up at the Society's events. While useful for a few, the 'focus group' nature of the Committee functions impedes the production of documents and tools of broader interest. At the same time, 'committee work' is, in reality, a strategic task for the organization that is not actually 'committee' activity.
The current committee model as used for other ISTM committees is, in retrospect, probably inappropriate for the desired task. Strategic direction in organizations is only rarely provided by committee. Committees are important in the delivery of product in the strategic context but are singularly ineffective in the development of strategic guidance. That must come from the organization executive who must champion the issues and defend and support the efforts. As the migration and refugee health issue is not a current mainstream activity for the society, the focus of those involved in its further development will have to change. The executive may have to consider a 'working group' or 'task force' model where those involved are more responsible to the organization's management as opposed to the committee membership.
Examples of Potential Utility for the ISTM
Specific issues, however, such as VFR (visiting friends and relatives) do have the potential to directly impact on the broader membership of the Society and it is here that internal focus may be productive.
The experience with VFR travel as an issue provides a positive example of this effort. Migration Health Committee members produced a short publication, The Migrant as Traveler? - Visiting Friends and Relatives, for NewsShare in March/April of 2002. At that time, a MedLine search of the term "VFR Travel" found no peer-reviewed citations. A similar MedLine search conducted on January 25, 2005 discloses three citations dealing with the issue, all by Society members.
- Angell SY, Cetron MS. Health disparities among travelers visiting friends and relatives abroad. Ann Intern Med. 2005;142:67-72.
- Bacaner N, Stauffer B, Boulware DR, Walker PF, Keystone JS. Travel medicine considerations for North American immigrants visiting friends and relatives. JAMA. 2004;291:2856-2864.
- Loutan L. Malaria: still a threat to travelers. Int J Antimicrobe Agents. 2003;21:158-163.
While none of the authors cite the NewsShare article directly, and in spite of the fact that two of the three publications are authored by members of the Migration Sub-Committee, the topic does provide an example of how some specific, migration-associated issues can be relevant in the broader travel medicine context.
Where Do We Go from Here?
At the strategic planning meeting for the Society in December 2004, the potential benefits to the ISTM related to the issues of migration and refugee health were again the subject of debate and discussion. The Executive of the Society remains, with some exceptions, committed to the issue. A Charter for the Committee was drafted and presented:
- The Migrant and Refugee Health Committee is responsible for developing the area of Migrant and Refugee Health as an area of strategic investment for the ISTM.
- The Migrant and Refugee Health Committee is charged with developing and proposing initiatives to increase the membership of Migrant and Refugee Health practitioners within the ISTM.
- The Migrant and Refugee Health Committee is charged with proposing specific programs or initiatives to serve the interest of migrant and refugee health.
Brian and Louis
Publications Committee Report
Charles D. Ericsson, MD, Chair
In September the Executive Board approved the Publications Committee's final iteration of the plan to develop evidence bases for clinical practice. A Task Force will be composed of two members from the Publications, JTM, Professional Education, Exam, Practice, and Nursing Issues Committees. This task force will be assigned to come up with 1-2 topics per year for the development of evidence bases to be published in JTM. "Evidence Bases for Clinical Practice" by any other name is clinical guidelines, but the consensus was not to use the title "clinical guidelines" since there are too many differences in actual practice around the world and the Board wanted to avoid any political or legal implications of having "guidelines".
If anyone in the membership has an idea about a topic that they wish to be developed into an evidence base please forward the idea to Dr. Ericsson at charles.d.ericsson@uth.tmc.edu. When topics have been decided, the membership will be notified and will be given the opportunity to volunteer to be on the writing panel for that topic with the understanding that the final constitution of the writing panel will be decided by the task force and the Executive Board based on expertise and geographic representation.
The Board has approved a new face for JTM for when Blackwell takes over at the beginning of 2006. The new cover is much more modern and fresh in appearance.
The Board has agreed to consider in more detail a proposal to publish our meeting abstracts in JTM as a standalone supplement. This is a complex issue that might imply additional fixed cost to ISTM. The scientific committee and editor will need to decide which abstracts, if not all, are publication-worthy, since some abstracts are accepted to encourage participation and development of our discipline rather than because of solid scientific value. The finance committee will explore whether additional costs can be defrayed by new funding sources. The Board will need eventually to decide whether any additional costs of publishing abstracts might be outweighed by an anticipated increase in our journal impact factor. A final decision on publishing our abstracts in JTM awaits resolution of these thorny issues. Charlie
Membership Committee
Bradley A. Connor, Chair
The ISTM leadership has identified growth in membership as a strategic priority of the Society. We have therefore launched a Membership Committee responsible for developing and deploying strategies to increase our membership in all geographic areas, and I have agreed to lead this effort.
Growth in membership has leveled off at about 5% per year. While this growth is a positive reflection on the Society, we can do much better. To become an even more influential global entity, we need to expand our membership. More members help provide additional resources for important Society initiatives.
If we intend to have influence in the developing world, we need to develop membership in developing countries. If we intend to address the issues of Migrant and Refugee Health, we need to expand our membership in the Migrant and Refugee Health community. If we intend to maintain our positions and influence in Europe and North America, we need to maintain and grow our membership in these areas.
Over the past several years the ISTM has placed little effort into membership growth. However, we have reached a size and scope as a Society where membership growth needs to be proactive rather than a byproduct of our other activities. Developing, organizing and implementing a membership outreach program is a challenge which requires effort, thoughtfulness and resources. Therefore, I have agreed to chair this Committee over the next two years: to reestablish the committee, set its direction and implement strategies and processes which will grow the society into the future.
In order to meet these challenges the Committee needs representation from every part of the world. One of my near term priorities is to identify and name regional associate chairs of the Committee.
To anyone with ideas for reaching out to new members in your communities, I am open to your ideas. I encourage you to join me. Please get out the word about the ISTM to your professional contacts and colleagues.
Brad
Award Winning Presentations at CISTM9, Lisbon
Innumerable individuals spend much time and energy in making ISTM meetings so successful and do not get the recognition that they deserve. Therefore, we print the abstracts of some of the award winners for outstanding presentations. Here are two abstracts of the Free Communications award winners.
Higher Venous Levels of Bicarbonate Anion Concentration are Associated with Excessive Hypoxemia in Lowland Dwellers Ascending to Moderate Altitude (4250m) Cumbo T.1, Braude D.2, Basnyat B.3, Shah M.2, Radder D.4, Bashyal G.4, Gambert S.1, Rabinowitz L.2, Lescano A.5
1Johns Hopkins University / Sinai Hospital Internal Medicine Program, Medicine, Baltimore, Maryland, 2University of New Mexico School of Medicine, Emergency Medicine, Albuquerque, New Mexico, 3Nepal International Clinic, Kathmandu, Nepal, 4Himalayan Rescue Association, Kathmandu, Nepal, 5Johns Hopkins University School of Public Health, Baltimore, Maryland
Objectives: To determine the relationship between hypoxemia and venous bicarbonate anion concentration in lowland dwellers ascending to moderate altitude.
Background: Little is known concerning the relationship between excessive hypoxemia and acid-base balance at altitude. Our group had previously noted a strong association between decreased urinary base excretion, decreased intravascular volume, acute mountain sickness (AMS) and hypoxemia in a large cohort of lowland dwelling pilgrims making an ascent to approximately 4250 meters in the Langtang region of the Nepal Himalayas. To further investigate the hypothesis that base retention is associated with lower oxygen saturation at altitude, we returned one year later to obtain more precise serologic measures of alkalosis. Our expeditions occurred during an annual Hindu festival in Honor of the Vedic Deity Shiva (Janai Purnima). Each year thousands of individuals ascend from approximately 2000 meters to 4250 meters in 1-3 days. This rapid ascent has as its final destination Lake Gosainkunda, located north of Kathmandu and approximately 20 kilometers south of the Tibetan border. Ill pilgrims frequently develop marked hypoxemia and commonly exhibit arterial oxygen saturation (SaO2) levels lower than 75%.
Is there a Long-Term Persistence of Malaria Immune Memory in African Migrants Living in France for Years? Bouchaud O.1, Genty S.1, Ralaimazava P.1, Cha O.1, Matheron S.2, Leclerc D.1, Heller M.1, Pole Nord Tropical G.3
1Avicenne Hospital, Travel Clinic, Bobigny, 2Bichat Hospital, Paris, 3Ministry of Health, France
Objectives and Background: (fixed font) In population living in areas endemic for malaria, repeated parasite exposure allows protective immunity to the disease to progressively rise. However, it is usually considered that, several years after termination of exposure, this acquired immunity vanishes. The aim of this study was to investigate this point by comparing the features of malaria attacks in Europeans and in African immigrants, resident in Europe for several years.
Material and Methods: (fixed font and spacing) We performed a prospective study with uni- and multivariate analyses of 252 African immigrants resident in Europe for at least 4 years, and 99 European patients presenting at our institution with a Plasmodium falciparum (Pf) malaria attack after a short-term trip in sub-Saharan Africa (<3 months). Clinical and biological features of their disease and Pf antibody level (measured by immunofluorescence 10 to 12 days after onset of symptoms were collected for patients of each group.
Results: (fixed font and spacing) Both Africans and Europeans were comparable in age and sex-ratio and were generally infected in west or central Africa (most frequently Cameroon or Côte d'Ivoire). Patients originating from Africa (median length of residence in France of 14 years [4-45]) exhibited reduced mean "SD parasite densities (0.8"1.5 /100 red blood cells versus 1.4"2.8 /100 red blood cells, p=0.007), less frequent severe disease (4.4% versus 15.2%, p=0.0005), and an accelerated parasite and fever clearance mean "SD times following treatment (respectively, 55"24 hours versus 62"30 h, p=0.03, and 40"25 h versus 56"31 h, p<0.0001), when compared to the European patients. In addition, their Pf antibody levels were higher (77.3% of Africans had reciprocal titers of 256 or more, compared to only 52.4% of Europeans ; p=0.0003).
Conclusions: Our results suggest a persistence of acquired immunity among patients originating from Africa, even after several years in non-endemic area. However, given the persistence of the risk of malaria and, in some cases, of a severe disease, prevention counseling should remain vigilant and be improved.
