Prebiotics and probiotics: potential strategies for reducing travellers' diarrhoea in athletes competing abroad

Travellers’ diarrhoea (TD) is the most common gastrointestinal illness to affect athletes competing abroad. Consequences of this debilitating condition include difficulties with training and/or participating in competitions which the athlete may have spent several years preparing for. Currently, there are no targeted strategies to reduce TD incidence in athletes. General methods used to reduce TD risk, such as avoidance of contaminated foods, chemoprophylactics and immunoprophylactics, have disadvantages. Since most causative agents of TD are microbial, strategies to minimise TD risks may be better focused on the gut microbiota. Prebiotics and probiotics can fortify the gut microbial balance, thus potentially aiding the fight against TD-associated microorganisms. Specific probiotics have shown promising actions against TD-associated microorganisms through antimicrobial activities. Use of prebiotics has led to an improved intestinal microbial balance which may be better equipped to combat TD-associated microorganisms. Both approaches have shown promising results in general travelling populations; therefore, a targeted approach for athletes has the potential to provide a competitive advantage.

A double-blind, placebo-controlled, randomized human study assessing the capacity of a novel galacto-oligosaccharide mixture in reducing travellers' diarrhoea.

Background/Objectives: Prebiotics have attracted interest for their ability to positively affect the colonic microbiota composition, thus increasing resistance to infection and diarrhoeal disease. This study assessed the effectiveness of a prebiotic galacto-oligosaccharide mixture (B-GOS) on the severity and/or incidence of travellers' diarrhoea (TD) in healthy subjects. Subjects/Methods: The study was a placebo-controlled, randomized, double blind of parallel design in 159 healthy volunteers, who travelled for minimum of 2 weeks to a country of low or high risk for TD. The investigational product was the B-GOS and the placebo was maltodextrin. Volunteers were randomized into groups with an equal probability of receiving either the prebiotic or placebo. The protocol comprised of a 1 week pre-holiday period recording bowel habit, while receiving intervention and the holiday period. Bowel habit included the number of bowel movements and average consistency of the stools as well as occurrence of abdominal discomfort, flatulence, bloating or vomiting. A clinical report was completed in the case of diarrhoeal incidence. A post-study questionnaire was also completed by all subjects on their return. Results: Results showed significant differences between the B-GOS and the placebo group in the incidence (P<0.05) and duration (P<0.05) of TD. Similar findings occurred on abdominal pain (P<0.05) and the overall quality of life assessment (P<0.05). Conclusions: Consumption of the tested galacto-oligosaccharide mixture showed significant potential in preventing the incidence and symptoms of TD.

Antecedents of travellers' electronic word-of-mouth communication

Electronic word-of-mouth (eWOM) is recognised as a means of interpersonal communication and a powerful marketing tool. However, previous studies have focussed on related motivations, and limited attention has been given to understanding the antecedents of eWOM communication behaviour in the travel industry. This study proposes a full and partial mediation model, which brings together for the first time three key antecedents: adoption of electronic communication technology, consumer dis/satisfaction with travel consumption experience, and subjective norm. The model aims to understand the impact of these antecedents on travellers' attitude towards eWOM communication and intention to use eWOM communication media. The data were collected from international travellers (n = 524), and structural equation modelling is used to test the conceptual framework. The findings of the study suggest that overall attitude towards eWOM communication partially mediates the impact of the traveller's adoption of electronic communication technology and subjective norm, and fully mediates the impact of consumer dis/satisfaction with travel consumption experience on travellers' intention to use eWOM communication media.

Pharmacotherapy, vaccines and malaria advice for HIV-infected travellers

Since the introduction of effective antiretroviral therapy (ART), HIV-infected individuals are travelling more frequently and international travel has become much safer. Specific concerns include the safety of ART during travel, drug adherence and interaction considerations, and effects of immunosuppression. This review describes potentially important infections, vaccine effectiveness, safety and special approaches for their use, and HIV-related issues regarding predeparture counselling. With advanced immunosuppression (CD4+ T-cell count < 200/microl or < 14%), the immunogenicity of several vaccines is reduced, complications could occur after live attenuated vaccines and certain infections acquired during travel may be more frequent or severe. Challenges include the best options for malaria chemoprophylaxis, standby treatment and medical follow-up of the increasing number of HIV-infected long-term travellers.

High colonization rates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in Swiss Travellers to South Asia- a prospective observational multicentre cohort study looking at epidemiology, microbiology and risk factors.

BACKGROUND International travel contributes to the worldwide spread of multidrug resistant Gram-negative bacteria. Rates of travel-related faecal colonization with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae vary for different destinations. Especially travellers returning from the Indian subcontinent show high colonization rates. So far, nothing is known about region-specific risk factors for becoming colonized. METHODS An observational prospective multicentre cohort study investigated travellers to South Asia. Before and after travelling, rectal swabs were screened for third-generation cephalosporin- and carbapenem-resistant Enterobacteriaceae. Participants completed questionnaires to identify risk factors for becoming colonized. Covariates were assessed univariately, followed by a multivariate regression. RESULTS Hundred and seventy persons were enrolled, the largest data set on travellers to the Indian subcontinent so far. The acquired colonization rate with ESBL-producing Escherichia coli overall was 69.4% (95% CI 62.1-75.9%), being highest in travellers returning from India (86.8%; 95% CI 78.5-95.0%) and lowest in travellers returning from Sri Lanka (34.7%; 95% CI 22.9-48.7%). Associated risk factors were travel destination, length of stay, visiting friends and relatives, and eating ice cream and pastry. CONCLUSIONS High colonization rates with ESBL-producing Enterobacteriaceae were found in travellers returning from South Asia. Though risk factors were identified, a more common source, i.e. environmental, appears to better explain the high colonization rates.

Repatriations and 28-day mortality of ill and injured travellers: 12 years of experience in a Swiss emergency department

QUESTIONS UNDER STUDY Many persons are travelling all over the world; the elderly with pre-existing diseases also travel to places with less developed health systems. Reportedly, fewer than 0.5% of all travellers need repatriation. We aimed to analyse and examine people who are injured or ill while abroad, where they travelled to and by what means they were repatriated. METHODS Retrospective cross-sectional study with adult patients repatriated to a single level 1 trauma centre in Switzerland (2000-2011). RESULTS A total of 372 patients were repatriated, with an increasing trend per year. Of these, 67% were male; the median age was 56 years. Forty-nine percent sustained an injury, and 13% had surgical and 38% medical pathologies. Patients with medical conditions were older than those with injuries or surgical emergencies (p <0.001). Seventy-three percent were repatriated from Europe. For repatriation from Africa trauma was slightly more frequent (53%, n = 17) than illnesses, whereas for most other countries illnesses and trauma were equally distributed. Injured patients had a median Injury Severity Score of 8. The majority of illnesses involved the nervous system (38%), mainly stroke. Forty-five percent were repatriated by Swiss Air Ambulance, 26% by ground ambulance, 18% by scheduled flights with or without medical assistance and two patients injured near the Swiss boarder by helicopter. The 28-day mortality was 4%. CONCLUSIONS The numbers of travellers repatriated increased from 2000 to 2011. About half were due to illnesses and half due to injuries. The largest group were elderly Swiss nationals repatriated from European countries. As mortality is relatively high, special consideration to this group of patients is warranted.

Health in Africa : a medical handbook for European travellers and residents, embracing a study of malarial fever as it is found in British Central Africa

by David Kerr Cross

Key quality factors and travellers profiles at interurban interchanges

La planificación y las políticas de transporte no pueden descuidar la calidad del servicio, considerando que influye notablemente en el cambio modal del coche hacia otros medios de transporte más sostenibles. El concepto se aplica también a los intercambiadores de transporte público, los nodos del sistema donde se cruzan las distintas redes del transporte público y privado. Aunque se han logrado numerosos avances para medir y evaluar la calidad en el sector del transporte público, se han dedicado relativamente pocos esfuerzos a investigar estos aspectos relacionados con la calidad de los intercambiadores del transporte público. Este trabajo de investigación se concentra en la calidad del servicio de la transferencia modal en los intercambiadores interurbanos, según la perspectiva de los viajeros. Su objetivo es identificar los factores clave de la calidad del servicio y los perfiles de los viajeros en los intercambiadores. La investigación es exploratoria y ofrece información acerca de la percepción de los viajeros intermodales relacionada con los aspectos de la calidad, aportando nuevos elementos y datos para adentrarse en estudios más detallados. La metodología del trabajo combina técnicas de análisis estadístico multivariante para analizar los datos de las encuestas sobre la satisfacción de los clientes y se subdivide en tres etapas. En primer lugar, se ha implementado el análisis de correspondencias múltiples para explorar los constructos latentes relacionados con la satisfacción de las características cualitativas de los intercambiadores interurbanos, identificando así los factores clave de la calidad. En segundo lugar, se ha aplicado un análisis de conglomerados de k-medias sobre los factores clave de calidad para clasificar a los viajeros en grupos de usuarios de transportes homogéneos, de acuerdo con su percepción de satisfacción, identificando de este modo los perfiles de los viajeros. Por último, se han formulado sugerencias y recomendaciones sobre la calidad para respaldar la formulación de políticas, estableciendo las prioridades para los intercambiadores interurbanos. La metodología se aplicó en cuatro intercambiadores interurbanos (estaciones de ferrocarriles o de autobuses ) en Madrid, Zaragoza, Gothenburg y Lion, analizando los datos recogidos mediante una encuesta de satisfacción del cliente llevada a cabo en 2011 en los cuatro casos de estudio, donde se interconectan distintos medios de transporte público y privado, de corta y larga distancia. Se recogieron datos sobre la satisfacción de los viajeros con 26 criterios de calidad, así como información sobre aspectos socio-económicos y pautas de comportamiento de viajes. Mediante el análisis de correspondencias múltiples se identificaron 4-5 factores clave de calidad en cada intercambiador, que se asocian principalmente con el sistema de emisión de billetes, el confort y la interconexión, mientras que los viajeros no perciben los temas clásicos como la información. Mediante el análisis de conglomerados se identificaron 2-5 perfiles de viajeros en cada intercambiador. Se reconocieron dos grupos de viajeros en casi todos los casos de estudio: viajeros de cercanía/trabajadores y turistas. Por lo que concierne a las prioridades para apoyar a las partes interesadas en la formulación de políticas, la expedición de billetes es el factor clave para los intercambiadores interurbanos españoles, mientras que la interconexión y los aspectos temporales se destacan en los intercambiadores de Francia y Suecia. Quality of Service can not be neglected in public transport planning and policy making, since it strongly influences modal shifts from car to more sustainable modes. This concept is also related to Public Transport interchanges, the nodes of the transport system where the different sub-systems of public passenger transport and personal vehicles meet. Although a lot of progress has been generally done to measure and assess quality in public transport sector, relatively little investigation has been conducted on quality at PT interchanges. This research work focusses on Quality of Service in the use of transfer facilities at interurban interchanges, according to current travellers’ perspective. It aims at identifying key quality factors and travellers profiles at interurban interchanges. The research is exploratory and offers insight into intermodal travellers’ perception on quality aspects, providing new elements and inputs for more definitive investigation. The methodology of the work combines multivariate statistical techniques to analyse data from customer satisfaction surveys and is subdivided in three steps. Firstly, multiple correspondence analysis was performed to explore latent constructs as concern satisfaction of quality attributes at interurban interchanges, thus identifying the so-called Key Quality Factor. Secondly, k-means cluster analysis was implemented on the key quality factors to classify travellers in homogeneous groups of transport users, according to their perception of satisfaction, thus identifying the so-called Travellers Profiles. Finally, hints and recommendations on quality were identified to support policy making, setting priorities for interurban interchanges. The methodology was applied at four interurban interchanges in Madrid, Zaragoza, Gothenburg and Lyon, analysing the data collected through a customer satisfaction survey carried out in 2011 at the four railway or bus stations where different modes of public and private transport are interconnected covering both short and long trips. Data on travellers’ satisfaction with 26 quality attributes were collected, as well as information on socio-economical and travel patterns. Through multiple correspondence analysis were identified 4-5 key quality factors per interchange. They are mainly related to ticketing, comfort and connectivity, while classical issues, as information, are not perceived as important by travellers’. Through cluster analysis were identified 2-5 travellers profiles per interchange. Two groups of travellers can be found in almost all case studies: commuter / business travellers and holiday travellers. As regards the priorities to support stakeholders in policy making, ticketing is the key-issue for the Spanish interurban interchanges, while connectivity and temporal issues emerge in the French and Swedish case studies.