From IBS to DBS: The Dysbiotic Bowel Syndrome.

Irritable bowel syndrome is a chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of organic disease. We present 2 cases where diarrhea-predominant irritable bowel syndrome occurred in association with earlier intestinal infection or antibiotic treatment. Both were successfully treated with instillation of an anaerobic cultivated human intestinal microbiota. Thereafter, they were symptom free for at least 12 months. We now introduce the term dysbiotic bowel syndrome covering cases where a disturbed intestinal microbiota is assumed to be present. We recommend that restoration of the dysbiotic gut microbiota should be first-line treatment in these conditions.

[Underlying dysbiosis may be the cause of some forms of IBS. Patients were free of symptoms after the administration of microbiota]. / Bakomliggande dysbios kan vara orsak till vissa former av IBS - Patienter blev symtomfria efter tillförsel av mikrobiota.

Two cases of post-infectious IBS were successfully treated with transplantation of an anaerobic cultivated human intestinal microbiota. This suggests that a dysbiosis of the intestinal microbiota could be the culprit at least in some cases of IBS. Resetting the gut microbiota might be a possible solution for these patients that otherwise may face a life-long reduction in quality of life. Studies have suggested that conditions as varied as chronic constipation, metabolic syndrome, autoimmunity, asthma, cardiovascular disease and Crohn's disease may be caused by intestinal dysbiosis. If this is the case we would like to suggest a new term: Dysbiotic Bowel Syndrome (DBS).

Health risks and risk-taking behaviors among International Committee of the Red Cross (ICRC) expatriates returning from humanitarian missions.

OBJECTIVE: To assess self-reported health risk and risk-taking behavior of humanitarian expatriates. METHODS: A self-administered anonymous questionnaire was completed by International Committee of the Red Cross (ICRC) expatriates returning during May 2003 to September 2004, covering perceived health status before and after mission, malaria prevention, prevalence of exposure to stress, accidents and violence, and risk-taking behaviors. FINDINGS: More than one-third (36.4%) reported worse health on return from the mission. A third (35%) of expatriates returning from Sub-Saharan Africa excl. South Africa reported not having followed ICRC's recommendation on taking malaria prophylaxis in spite of stating a high degree of awareness of the risks and availability of effective drugs. Over 40% reported the mission having been more stressful than expected, mostly due to the working environment; 10% reported injury or accidents and 16.2% exposure to at least one act of violence. Almost one-third of the respondents reported having engaged in casual sexual relationships. Of these, 64% reported using condoms at every sexual contact, and women reported lower usage of condoms than men. Many (27%) reported involvement in risk-taking behavior. CONCLUSION: This study shows that humanitarian aid workers experience significant worsening of their health during overseas missions. Many are at risk of experiencing violence, accidents, or injuries. Despite awareness of the risks, many expatriates engage in behaviors that could endanger their health. Improved selection of expatriate staff, training programs emphasizing areas of concern, strengthening social support locally, and follow-up in field may help to alleviate these problems.

Prevention of travel-related infectious diseases: knowledge, practices and attitudes of Swedish travellers.

More Swedish residents travel to countries where they are at risk for contracting malaria, hepatitis, and other serious travel-related diseases. To safeguard the public's health, it is important to determine if travellers accurately perceive health risks and take appropriate preventative measures before and during their trips. This study examined travel health knowledge, attitudes and practices among Swedish residents traveling to destinations with risk of malaria and hepatitis. Self-administered anonymous questionnaires were distributed to Swedish residents (n=957) waiting to board intercontinental flights at the Stockholm-Arlanda International Airport. A majority of travellers sought general information (74%) and travel health advice (59%) prior to departure. Most perceived vaccination as safe and effective, but only 40% and 3% of travellers reported adequate vaccine coverage against hepatitis A or hepatitis B, respectively. Although most did not know the actual malaria risk at the destination, 97% of persons flying to high-risk areas were carrying malaria medication. The study results were in line with those found in surveys conducted in other countries, and demonstrate need for further health education among travellers to risk destinations. Efforts should focus on reaching more travellers, providing clear information and improving compliance with recommended travel health advice.

Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey.

BACKGROUND: The European Travel Health Advisory Board conducted a cross-sectional pilot survey to evaluate current travel health knowledge, attitudes and practices (KAP) and to determine where travelers going to developing countries obtain travel health information, what information they receive, and what preventive travel health measures they employ. Subsequently, the questionnaire used was improved and a cross-sectional, multicenter study was undertaken in airports in Europe, Asia, South Africa and the United States. This paper describes the methods used everywhere, and results from the European airports. METHOD: Between September 2002 and September 2003, 5,465 passengers residing in Europe and boarding an intercontinental flight to a developing country were surveyed at the departure gates of nine major airports in Europe. Questionnaires were self-administered, and checked for completeness and validated by trained interviewers. RESULTS: Although the majority of travelers (73.3%) had sought general information about their destination prior to departure, only just over half of the responders (52.1%) had sought travel health advice. Tourists and people traveling for religious reasons had sought travel health advice more often, whereas travelers visiting friends and relatives were less likely to do so. Hepatitis A was perceived as the most probable among the infectious diseases investigated, followed by HIV and hepatitis B. In spite of a generally positive attitude towards vaccines, 58.4% and 68.7% of travelers could not report any protection against hepatitis A or hepatitis B, respectively. Only one in three travelers to a destination country with at least some malaria endemicity were carrying antimalarial drugs. Almost one in four travelers visiting a high-risk area had an inaccurate risk perception and even one in two going to a no-risk destination were unnecessarily concerned about malaria. CONCLUSIONS: The large variation in destinations, age of the travelers and reasons for traveling illustrates that traveling to a developing country has become common practice. The results of this large-scale airport survey clearly demonstrate an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives, and the elderly. Additionally, travel health advice providers should continue their efforts to make travelers comply with the recommended travel health advice. Our common objective is to help travelers stay healthy while abroad, and consequently to also reduce the potential importation of infectious diseases and the consequent public health and other implications.