Highlights from the Executive Board Meeting at CISTM, Lisbon 2005

Blackwell Publishing

Ms. Sherri Frank and Mr. Nigel Fletcher-Jones, representatives of Blackwell, addressed the Executive Board to discuss issues of mutual interest. (See Blackwell article). They outlined Blackwell's strategic development plan for JTM:

• Establish links between the goals of the ISTM and JTM
• Define the role of Blackwell in helping deliver these results
• Survey the membership/readership to devise plans to attract the best papers, recruit and retain the best authors, and to review these plans on an ongoing basis
• Review opportunities for growth of the JTM including marketing activities such as advertising, direct mail, electronic promotions, conferences, public relations, research surveys to evaluate readership and membership
• Long term benefits of expanded marketing for ISTM and JTM - ISTM membership, readership, impact factor, international exposure and visibility
• Review of JTM opportunities for growth online:
• Blackwell Synergy - online delivery to readers
• JTM/ISTM branded website on Blackwell's corporate site
• Back files mounted on Synergy to enrich site and increase usage
• Targeted email campaigns to attract readers and top authors
• Electronic Table of Contents (eTOC) and alerts

A question was raised concerning the impact of offering the full journal free online and what this does to the current full rate subscriptions. It was noted that the journal would be freely available in the consortia sites and that Blackwell wants to protect and increase the current print subscriptions. Also noted was that in selected developing countries, HINARI with free online access to the journal will be available but only to institutions and not to individuals.

Both Ms. Frank and Mr. Fletcher-Jones noted that non-subscription sales (advertising, reprint sales, sponsored subscription arrangements, supplement business, sponsored subscription program CME activities, translation opportunities, etc.) are very important. Concerning industry sponsored materials, the ISTM would have the ultimate accept/reject on any industry sponsored supplement, for example.

Journal of Travel Medicine (JTM)

Dr. Robert Steffen, Editor

Robert reported that new instructions for authors have been published as well as a conflict of interest statement for authors to complete prior to publication. He also noted that the JTM is striving to improve the impact factor.

Robert brought up the need to change the cover of the journal and whether or not the title should be changed to include `migrant health'. There was discussion on the issue with a reminder that a complete change of the journal's title would require a review by ISI. (ISI is the Institute of Scientific Information, the major international database of scientific journals.) It was felt best to avoid this possibility. Some expressed the idea of creating a migrant health "department" in each issue. The Blackwell representatives thought this to be a positive approach. They added that since the journal will be, in effect, "re-launched" in January, 2006, it would be a good time to re-educate the membership on this issue, but not change the title of the journal, as we currently have an established brand.

A motion was made, seconded, and passed to keep the title of ISTM's journal as "The Journal of Travel Medicine."

Robert offered that one possibility would be to include pictographs related to various activities on the front cover, illustrating the various pillars that the society is built upon. This will be discussed and design suggestions presented in the near future.

Robert reported that articles will be available online earlier than the print edition. These will be posted as soon as they are ready and the page proofs have been reviewed by the editor. The board thought this was a good idea.

Proposal to hold the 3rd Regional Conference of ISTM in Australia in 2008.

Dr. Peter Leggat reviewed the background for the proposal. He noted that the Executive Board had agreed to explore Australia as a possible site for the 2008 regional conference. Peter contacted convention bureaus and directors of relevant travel medicine organizations for support and feedback on possible sites. Many key stakeholders in both Australia and New Zealand were very enthusiastic about the conference.

Peter conferred with Frank (von Sonnenburg) on some of the logistics of holding a meeting in Australia, noting that the conference should aim for an attendance of 550 paying registrants and be held in a venue that could accommodate 800-1000 participants.

Peter also noted that the meeting would be held between February and May of 2008 and will be in a similar format to previous ISTM regional conferences. CME would be sought for the meeting.

Peter presented the next steps for this meeting: a teleconference with the full local committee, examination of venues and consideration of potential meeting organizers. He will report his progress to the Board as soon as possible.

Report of the Exam Committee

Of the 254 individuals who applied to take the Travel Medicine Certificate of Knowledge Examination in Lisbon, 239 completed it. About two-thirds of the candidates were physicians, one-third nurses, with several "others," pharmacists and physicians assistants, for example. The male/female ratio was about 50%. The average number of years in practice was 7. Of the 239, 175 passed, scoring 70% or more. The percent of physicians passing was somewhat higher than that of nurses. Candidates came from 34 countries. According to Knapp and Associates International, an independent company that advises the Committee, the statistics of the exam were excellent, with the bulk of questions being extremely reliable in terms of predictability of knowledge about our subject matter. Congratulations are due the Committee who worked so hard to write and review questions and to Bert Dupont, the chair of our ad hoc grievance subcommittee.

We have had an excellent response to the survey made available at the Lisbon meeting and in NewsShare regarding the exam process. Hopefully, our analysis of the survey will help determine a baseline of knowledge and attitudes about the Certificate process and obtain information and ideas about future administration of the exam. Suggestions include giving the exam annually (using regional meetings as venues), giving it at additional sites (e.g. testing sites), giving it more frequently than once a year, and providing it through a secure internet site. You will receive the results of the survey in early fall. We are most grateful for the generous grant from Sanofi-Pasteur for supporting our efforts related to the Lisbon examination and our exam administration research efforts.

We are already working toward the next examination. It will be held in Vancouver in 2006. The Committee, along with Brenda Bagell, the ISTM administrative director and Janet Christenbury, the exam administrator, and me, will brainstorm over the next several months as to how to encourage our professional friends and colleagues to sit for the exam.

We are again reconfiguring the Committee. Unlike other ISTM standing committees, membership on the Exam Committee is contingent upon having passed the exam. We need new members to participate as members are rotated off the Committee and new ones asked to join. We will continue to be sensitive to the geographic make up of the Committee and practice patterns of the ISTM.  

Thank you for your ongoing support and continue to send us suggestions. 

Phyllis Kozarsky, Chairperson

Conflict of Interest Statement

The International Society of Travel Medicine (ISTM) requires balance, independence, objectivity and scientific rigor in all of its activities. All board members, and those working for or contributing to the work of ISTM, are required to declare any real or supposed conflict(s) of interest that may have a potential influence on their contributions to ISTM.

Conflicts of interest arise in circumstances in which an independent observer might reasonably question whether the individual's professional objectivity in that situation is affected by considerations of financial gain, personal or professional interests or familial relationship. This pertains to relationships with pharmaceutical companies or other organizations whose products or services are related to the goals and objectives of the ISTM. The intent of this policy is not to prevent an individual with a potential conflict from participation with ISTM, but to ensure that any potential conflict be transparent to ISTM members.

Members of the Executive Board, any ISTM administrative staff person, or any member of the ISTM who may serve in a decision-making position or in a representative capacity for CME must complete this statement every two years and update it during the year as necessary. Any member who has been invited to present at an ISTM-sponsored CME activity must also complete this form.

1. A conflict of interest exists with either a for-profit commercial organization (FPO) or a non-for-profit organization (NFPO) under the following circumstances:

A. The individual or family member has a financial interest in the organization. Financial interest is defined as a significant (more than $500 USD) position in stock, bond, stock options or self-directed pension plan holder. (Investments entirely managed by a third party such as mutual funds and certain pension plans are excluded.)

B. The individual has received gifts, travel reimbursements or accommodations in the past calendar year of more than $500 USD in value.

C. The individual has had or will have an official relationship with an organization in the past or upcoming calendar year. Official position is defined as: paid consultant, scientific advisory committee member, or member of its Speakers' Bureau; is an officer, board member, trustee, owner, and employee; is a recipient of grant monies or contracts from the organization, or is likely to have such a position in the near future.

2. Financial Disclosure Statement

Circle EITHER a) or b):

   a) I do not have a financial interest in or official relationship with any organizations.

   b) I have a financial interest or official position with one or more organizations that could be a conflict of interest in my work or participation with ISTM. I have disclosed any conflict(s) of interest that may have a potential influence on my contributions to ISTM.

The relationship(s) is/are as follows:

Company Name: __________________

Relationship: ____________________

3. Verification

I verify that the information given above is accurate. I acknowledge that my work or participation with ISTM must be balanced and not influenced by my interests as indicated above.

I agree neither to participate in the discussion of nor to vote in any ISTM business or activity in which I have a conflict of interest. If I am uncertain about a conflict of interest or any activity that may be of ethical concern, I will explore the issue with the Ethics Committee.

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Date: ___________________

Award Winners at Lisbon

CISTM9 in Lisbon was a huge success from every standpoint: the caliber of the presentations, large attendance, enthusiasm of the attendees, quality of the social programs, the meeting halls, and the City of Lisbon itself, to mention just a few.

Unfortunately, it is impossible to mention all contributors to meetings and, too often, the "minor" presentations at meetings do not receive the recognition that is due them. These presenters spend considerable time, energy, and enthusiasm. Therefore, whenever possible, we will print the abstract of such presentations.

Below are the abstracts of the two winners of the Free Communications awards in Lisbon.

A Questionnaire Study of the Dishwashing Methods Used by Expeditions and Adventure Travel Companies, and a Laboratory Evaluation of the Three-Bowl System

J Hargreaves, Southmead Hospital, Bristol, UK

Introduction: There is some evidence that dishwashing plays a role in the reduction of wilderness-associated gastrointestinal infections. The three-bowl system is a way of washing-up on expeditions and tours, when running water is not freely available. It consists of three washing-up bowls. The plates and utensils are washed until visibly clean in the first bowl, rinsed in the second bowl, and disinfected in the third.

Objectives: This study had two objectives: 1. To determine what washing-up methods are used by expedition/adventure travel companies when staying in camps with very basic facilities, and 2. To determine, using laboratory experiments, whether the three-bowl system is better at reducing bacterial load on mess tins than alternatives.

Material and Methods: A questionnaire survey of expedition/adventure travel companies was undertaken to determine aspects of camp hygiene; more detailed questions were asked about dishwashing. In the laboratory the different washing-up systems were tested with a simulated dish wash of five contaminated mess tins (1 to 5) followed by five uncontaminated mess tins (6-10). Porridge was used to simulate food residue. The porridge was mixed with E. coli to produce contamination.

Results: Questionnaire results show that 27% of companies use the three-bowl system and 24% a two-bowl variation. 70% use some sort of disinfectant. Dettol (chloroxylenol) or bleach were most popular for washing-up. In the laboratory, disinfectant use, especially bleach in an alternative three-bowl system, produced a marked reduction in bacterial load on contaminated and uncontaminated tins. The use of bleach in a two-bowl system also reduced the final bacterial load; this was statistically significant for tins 5 and 10, compared to systems where no disinfectant was used. In addition, detergent is needed somewhere in the system to remove grease, and a final rinse removes the smell of disinfectant.

Conclusion: A variety of washing-up systems are in use, the majority including disinfection. Overall the most effective washing-up system at reducing bacterial load in the laboratory was to remove most food residue in bowl 1, with detergent; finish washing until visibly clean in bowl 2, with bleach; then if a source of drinkable water is available rinse in bowl 3. This system has the advantage of getting mess tins clean relatively easily, killing potentially harmful bacteria, and removing the taste of disinfectant at the end.

Frequency of Travelers' Diarrhea (TD) during travel identifies a subset of travelers that are likely to develop Persistent Abdominal Symptoms (PAS).

Lee S.A.¹, Carlin L.¹, Forbes C.E.¹, Jiang Z.-D.²,
DuPont H.L.³, Belkind-Gerson J.⁴, Okhuysen P.C.²

¹University of Texas-Houston Medical School, Houston. ²University of Texas-Houston Medical School and School of Public Health, Houston, ³University of Texas-Houston Medical School, Houston, St. Luke's Episcopal Hospital, and Baylor College of Medicine, Houston, 4Instituto Nacional de Salud Publica, Cuernavaca, Morelos.

Background: Persistent abdominal symptoms (PAS) include the irritable bowel syndrome (IBS) and functional abdominal disorders (FAD). It has been proposed that IBS and FAD may develop after an exposure to an infectious trigger. Since most cases of TD are due to an infectious agent, we hypothesized that the clinical features of TD might offer clues as to which travelers would be likely to develop PAS following their travels.

Objective: To determine the frequency of post-infectious PAS after TD, and what clinical criteria could be used to predict which individuals would go on to develop PAS.

Material and Methods: 385 healthy U.S. students were followed prospectively for up to six weeks for the occurrence, duration and etiology of diarrhea while studying in Mexico. Subjects were asked to complete a follow-up questionnaire at 6 months to determine the presence of FAD or IBS. Pre-existing FAD and IBS had been excluded prior to enrollment.

Definitions: TD was defined as three or more watery stools within a 24-hour period accompanied by two gastrointestinal symptoms. FAD was defined as two or more weeks of abdominal symptoms during the six months after travel. IRS was determined using the Rome II criteria. We defined PAS as individuals who met the criteria for either FAD or IBS. A subsequent episode of diarrhea was defined if a new episode developed after an asymptomatic period of at least 48 hours.

Result: 266 of 385 (69%) students returned the questionnaire six months after travel. A similar response rate was noted for students that developed TD (152 of the 221 or 69%). Six months after travel, 24 students (16%) reported symptoms that met the criteria for FAD and 8 students (5%) met the criteria for IBS. There was no significance difference between those that develop PAS and those that did not in the day of onset of their diarrhea, nor in their duration of stay in Mexico. Those that developed IBS had more unformed stools (mean 24) than those that did not (mean 17). However this did not reach statistical significance. The mean number of diarrhea episodes was higher for those developed PAS (2.00 episodes) versus those that did not (1.21 episodes) p=0.0011

Conclusions: Chronic gastrointestinal complaints occur frequently after TD and IBS may occur as a consequence. The number of episodes of diarrhea experienced during travel is associated with the development of PAS. Ongoing studies focus on host genetic predisposition and the infectious agent that may predispose to PAS.