The characteristics of drowning among different types of international visitors to Australia and how this contributes to their drowning risk

OBJECTIVE

Australia is a popular destination for international visitors. This study reviews international visitor drowning deaths in Australia and analyses drowning by visitor type.

METHODS

A total population retrospective study exploring drowning deaths of international visitors was conducted between 2008 and 2018. Data were extracted from the Royal Life Saving National Fatal Drowning Database and categorised into four subgroups: overseas tourists, international students, working holiday makers and work-related visitors. Descriptive statistics, non-parametric tests and relative risk (RR) were calculated.

RESULTS

In total, 201 international visitors drowned in Australia, 7% of all drowning deaths; a crude drowning rate of 0.27/100,000 visitors versus 0.95/100,000 for residents (RR=0.19 [95% CI: 0.16-0.22]). Most deaths were males (79%) and people aged 18-34 years (50%). Visitors frequently drowned at beaches (33%), and when swimming (41%). Thirty-five percent recorded a pre-existing medical condition. Overseas tourists on holiday were the most likely to drown compared to other subgroups.

CONCLUSION

International visitors represent a small but increasing proportion of people drowning in Australia. The circumstances of which visitors drown vary by travel purpose, age, country of origin, location of drowning and activity.

IMPLICATIONS FOR PUBLIC HEALTH

International visitors have unique safety needs, requiring tailored prevention based on the purpose of travel and country of origin.

Improving disaster management in international tourism

Despite strong interest in tourism during the pandemic, frameworks of disaster management have not been rigorously provided for the international tourism field. The present research aimed to study how to improve disaster management in international tourism toward mitigating human suffering and economic damages. Qualitative content analysis was used as the key methodology in investigating passive and active disaster management. These two approaches were compared considering tourists, tourism industry, regional governments, and international organizations as variables. The main finding has been that stakeholders must shift from passive to active disaster management, while strategically addressing networking, the disaster management cycle, and local education, among other factors. This study provided a systematic framework of disaster management by studying not only the supply but also the demand side in international tourism.

COVID-19 Pandemic and Local Cultural Tourism in the Buzău Carpathians and Subcarpathians (Romania)

The COVID-19 pandemic was and continues to be a major challenge for tourist activities worldwide. Cultural tourism was mostly hit because of the social distancing measures, travel restrictions and ban on people gatherings for cultural events. The current study is trying to provide an overall image of the challenges local cultural tourism has faced during the COVID-19 pandemic in a predominantly rural area of Romania-the Buzău Carpathians and Subcarpathians. The area has a high tourist potential stemming from the complexity and diversity of the natural landscapes and the local historical setting. The survey relies on two field campaigns carried out in 2020 when 161 questionnaires were applied to tourists, businesses and residents. The results highlight the significant impact of the COVID-19 pandemic on small businesses during and after the travel restrictions (e.g., revenue losses, temporary business shut-downs and layoffs/technical unemployment), but also on tourists' travelling preferences and sentiment and on residents' attitudes and behaviour.

The Mechanism and Mediating Effect of the "Perception-Emotion-Behaviour" Chain of Tourists at World Natural Heritage Sites-A Case Study from Bayanbulak, China

The pro-environmental behaviour intentions (PEBIs) of tourists is a popular topic in tourism geography research. Visitors are important stakeholders in the development and conservation of World Natural Heritage sites (WNHs). Based on the perspective of the Mehrabian–Russell (M-R) theory, to advance our understanding of the transmission mechanism and mediation effect of the “perception–emotion–behaviour” chain of visitors at World Natural Heritage sites, we introduced two variables, namely heritage genes perception (HGP) and environmental knowledge perception (EKP), combined with place attachment (PA) and pro-environmental behaviour intentions (PEBIs), and scientifically constructed the conceptual model of the “EHPP model”, consisting of EKP, HGP, PA and PEBIs. Taking the Bayanbulak Heritage Site as an example, the EHPP model was fitted and tested using the structural equation model (SEM). The results show that: (1) the EHPP model is applied to fit the “cognitive–emotional–behaviour intentions” chain of visitors in WNHs and passed the empirical test; (2) there were positive and significant effects of EKP on HGP, and EKP indirectly affects PEBIs via HGP and PA; (3) place dependence (PD) had a significant and positive influence on place identity (PI); and (4) compliance with pro-environmental behaviour intentions (CPEBIs) had a direct positive influence on pro-environmental behaviour intentions (PPEBIs). The findings of this study provide empirical references for stimulating the pro-environmental behaviour intentions of tourists at World Natural Heritage sites.

a Health-Based Sun-Protective Intervention on French Summer Tourists' Behaviors in a Cluster Randomized Crossover Trial: The PRISME Protocol

Background: Sun exposure has short- and long-term adverse effects on eyes, skin, and the immune system. The most serious effect, melanoma, is largely attributable to natural ultraviolet radiation. Its prevalence is steadily increasing in fair-skinned populations in most European countries. Despite annual prevention campaigns, the French population continues to be overexposed to the sun and under-protected. Social and psychosocial characteristics may play an important role in sun protection determinants. Overexposure is partially motivated by a desire to tan oneself for aesthetic reasons. During summer, intense exposure constitutes a major risk factor for melanoma, making tourists a particularly high-risk population. Literature reviews concluded that appearance-based interventions highlighting the aesthetic effects of sun exposure on skin photoaging showed promise in terms of improving sun-exposure and sun-protection behaviors, especially among younger people, but that more rigorous studies were needed. In this context, we implemented the PRISME study to: - identify the determinants, in particular social and psychosocial, of sun-protection of French summer tourists visiting the Mediterranean coastline; - design two prevention interventions grounded in psychosocial theories; - compare the impact of both interventions on tourists' sun-protection behaviors, and identify the determinants influencing this impact. This paper presents the methodology of the PRISME study. Methods: During summer 2019, we conducted a cluster randomized crossover trial to compare two prevention interventions, one based on health-related messages (health effects information, phototype calculation), the other on appearance-related messages (photoaging information, ultraviolet photography), among French tourists aged 12-55 years old in coastline campsites in the French region of Occitanie. Both interventions were anchored in the theory of planned behavior and in the transtheoretical model. The interventions' impact was measured using face-to-face questionnaires and skin color measurements both immediately before and 4 days after the interventions. A second follow-up, using an online questionnaire, will be conducted in September 2020 to measure the longer-term effects of both interventions. Discussion: Despite certain study limitations, PRISME take into consideration several known methodological gaps. The study's results will enable to evaluate the efficacy of the promising appearance-based approach in France, and to identify vulnerable sub-populations and mechanisms to improve sun-protection behaviors of French tourists.

Species Composition of Anopheles (Diptera: Culicidae) in Selected Forested Tourist Areas of Nigeria Endemic for Malaria

The study was carried out to determine relative abundance, species diversity, of Anopheles species (Diptera: Culicidae) in selected forested areas in Cross River State, Nigeria and the prevalence of malaria infection in the specimens. Mosquitoes were collected using pyrethrum spray catch and Centre for Disease Control light traps modified with yeast and sugar to generate carbon dioxide (CO2) and identified using morphological identification keys. We used a multiplex polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) to simultaneously distinguish sibling species of the An. gambiae s.l, including separation of An. gambiae s.s. and An. coluzzii (Diptera: Culicidae). The samples were also screened for Plasmodium infection using the enzyme-linked immunosorbent assay. One hundred and four Anopheles specimens were collected during the study of which 97% was An. gambiae complex and 3% was An. rufipes (Diptera: Culicidae). Only 77% of the An. gambiae s.l. was identify to species level. The result shows that 41.6% was An. gambiae s.s. and 34.6% was An. coluzzii. No sporozoite of Plasmodium was detected in the Anopheles species. The study also found a hybrid form of An. gambiae s.s. and An. coluzzii. These findings suggest the first documented evidence of hybrid forms of An. gambiae s.s./An. coluzzii in South Eastern Nigeria although its epidemiological implication is still not clear.

Evaluation of Self-Assessed State of Health and Vitamin D Knowledge in Emirati and International Female Students in United Arab Emirates (UAE)

INTRODUCTION

Globally, vitamin D deficiency is one of the most common deficiencies, affecting nearly half the world's population. The objective of this survey was to assess and compare the knowledge about vitamin D and the perceived state of health in Emirati and international tourist female students in Dubai, United Arab Emirates (UAE).

METHODS

This is a cross-sectional study that took place in universities in Dubai, United Arab Emirates. This survey consisted of 17 multiple choice questions and was adapted from a study recently conducted in Poland. The first part of the survey assessed levels of supplementation, diet and UV exposure. Another section evaluated the participants' self-assessed state of health in terms of vitamin D testing, symptoms related to vitamin D deficiency and general welbeing. The collected data were statistically analyzed using SPSS statistics for windows version 26.0 (SPSS Inc., Chicago, IL, United States). Statistical significance was set at P < 0.05.

RESULTS

105 respondents were Emiratis and 65 were international students. The average age was 21, with an average BMI 23.3 kg/m2. Almost one-third of each group reported using Vitamin D supplements once weekly. The vast majority of both groups reported rarely getting tanned. Almost all participants in both groups reported regular consumption of Vitamin D rich foods. In both groups, more than half reported consuming milk and cheese regularly and up to one-third reported consuming fish in a regular manner. Although more than half of the students rated their health as good; more than two-thirds reported experiencing muscle pain; only half reported having their blood Vitamin D levels measured once; half reported experiencing problems with concentration and more than three-quarters reported experiencing bad mood in the past month. The prevalence of these symptoms was almost similar across different categories of vitamin D supplementation, tanning habits, dietary intake, or nationality. No statistically significant differences were noted between the Emirati and International tourist students regarding any of the studied variables.

CONCLUSION

Notably, more Emirati students were aware of the association between vitamin D and osteoporosis than International tourist students (40% vs. 21.9%, respectively; p < 0.05). On the other hand, both groups had lower knowledge about the relationship between vitamin D deficiency and depression, Rheumatoid Arthritis and Hypertension, and the optimal vitamin D level; however, no statistically significant differences were noted regarding this knowledge of Emiratis and international students.

Emirati Adults Have a Higher Overall Knowledge on Vitamin D Compared to Tourists

Objectives

In the last decade, vitamin D deficiency has become a major global issue. One of the main functions of vitamin D is the proper absorption of calcium in the gastrointestinal track. Optimal vitamin D levels are mandatory for adequate calcium absorption and bone health. The purpose of this study was to assess the level of knowledge of vitamin D, calcium, and physical activity among Emirati and tourist adults in Abu Dhabi.

Methods

This is a cross-sectional study that took place in three different malls in Abu Dhabi and included Emirati and tourist adults. Participants were asked to fill in a questionnaire consisting of 32 questions. These included questions on vitamin D, calcium, supplement, and physical activity knowledge. Another section of the questionnaire included general information on age, sex, education, weight, and height. The collected data were statistically analyzed using descriptive statistics using IBM SPSS statistics for Windows version 26.0 (SPSS Inc., Chicago, IL, United States). Statistical significance was set at P < 0.05.

Results

Out of 147 adults, 113 were females and 34 males. The mean age, height, and weight were 27.9 ± 8.6 years, 162.7 ± 10.4 cm, and 66.5 ± 19.5 kg, respectively. Emiratis had statistically significant higher basic knowledge on vitamin D compared to tourists (44.9 vs 27.1%), respectively. More than 66% of the whole sample was aware that vitamin D deficiency can affect muscle strength, as well as that calcium may affect osteoporosis. In a multiple regression model to analyze the possible effects of other factors to knowledge, it was found that only age (Beta: 0.045, P < 0.014) and nationality (Beta: 0.750, P < 0.018) were independently and significantly associated to vitamin D.

Conclusion

Emirati participants showed a higher overall vitamin D knowledge than their tourist counterparts. Both groups had low/medium level of knowledge when it comes to physical activity and calcium and vitamin D supplements.

Consular Crisis Management Operations: Special Considerations and Challenges

Assisting the increasing number of tourists and foreign nationals exposed to crises situations in third countries-many of them far from home and extremely vulnerable-presents significant challenges. Despite the need to explore consular crisis management from an operational perspective, there are few studies that address the issue. This paper aims to describe the characteristics and context of consular crisis management operations based on personal experiences, scientific papers, grey literature, and key informant interviews.Consular crisis management operations are conducted in a context where the stakeholders and the legal environment may differ from humanitarian or civil protection operations. The physical distance causes logistical challenges and demands specific considerations for both civilian and medical evacuation. Consular crisis management operations often include medical care, psychosocial support activities, and disaster victim identification (DVI) activities. Political and media interest may also add significant challenges to such operations. Therefore, specific knowledge, skills, and preparations are needed for both diplomatic crisis management professionals and health professionals. Further research on consular crisis management activities-as well as the concept of consular crisis management itself-is strongly needed.

Food Markets: A Motivation-Based Segmentation of Tourists

Food markets are becoming popular as new spaces for recreation, and this research aims to discover the motivations driving the tourists that visit these markets. Factorial analysis, cluster analysis and Student's t-test were applied on 456 surveys from two food markets in Córdoba (Spain). Three motivational factors were obtained: Gastronomic experience and novelty; hedonism and leisure; and the relationship of the experience with work. Segmenting and analyzing the profile of the tourist may help economic agents develop new strategies for the tourism management of a destination and more accurate marketing and branding strategies that target specific customers with a niche message. The study could help develop products that align with tourists' motives to increase satisfaction and loyalty.

Gnathostomiasis Acquired by Visitors to the Okavango Delta, Botswana

Gnathostomiasis is a zoonotic nematode parasite disease, most commonly acquired by eating raw or undercooked fish. Although the disease is well known in parts of Asia and Central and South America, relatively few cases have been reported from Africa. Raw fish consumed in the Okavango River delta area of Botswana, and in nearby western Zambia, has previously produced laboratory-proven gnathostomiasis in tourists. The purpose of this communication is to record additional cases of the infection acquired in the Okavango delta, and to alert visitors to the inadvisability of eating raw freshwater fish in the southern African region.

Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas

We report Mycobacterium lepromatosis infection in a US-born person with an extensive international travel history. Clinical symptoms, histopathology, and management are similar to those of infections caused by M. leprae. Clinicians should consider this pathogen in the diagnosis of patients with symptoms of leprosy who have traveled to endemic areas.

Concurrent Infection of a Young Tourist by Hookworm and Strongyloides Stercoralis During Low Budget Travel in Southeast Asia

Strongyloidiasis and hookworm infections are neglected helminth diseases widespread in tropical and subtropical areas. In humans, particularly in immunocompromised patients infections potentially may lead to the life-threatening clinical conditions involving the respiratory as well as gastrointestinal systems. The increased number of tourists travelling to tropical regions is associated with more frequent infection with parasites such as Strongyloides and hookworm. The infection takes place when filariform larvae penetrate the skin exposed to soil, than migrate through the lungs and finally reach the intestine. Travelers are often not aware of how they could get infected. Physicians may suspect strongyloidiasis and hookworm infections in tourists with diarrhea returning from endemic areas, especially when an elevated eosinophilia is observed. In the literature there are many reports about the presence of parasites in indigenous communities, but very few are available regarding travelers. This paper describes a dual infection with hookworm and Strongyloides stercoralis in a young female tourist returning from Southeast Asia. To our knowledge, this is the first report of hookworm and Strongyloides stercoralis infection in a tourist from Europe, acquired in an endemic area.

Sexual risk taking in a community sample of international backpackers visiting Brisbane, Australia

We sought to examine correlations between international backpackers' alcohol consumption and sexual behaviors and determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoea in this population. A cross-sectional study design consisting of a convenience sample (N = 168) of non-treatment-seeking international backpackers visiting Brisbane, Australia was recruited. Participants were asked to self-complete a questionnaire on sexual behavior and to undertake a urine-based polymerase chain reaction test for C trachomatis and N gonorrhoea. Since arriving in Australia, 73.2% reported having had sex, with a median number of 2 different sex partners (range = 0-21). Most participants had consumed alcohol (53.7%) and used condoms (46.3%) the last time they had sex. In our sample, there was a 4.3% prevalence of C trachomatis and a 0% prevalence of N gonorrhoea. This study identified a variable pattern of risk among backpackers, with those spending longer periods in the country more likely to have sex with Australians.

Tourist satisfaction with primary health care services in aseer region

OBJECTIVE

The objective of this study was to assess the satisfaction of tourists who utilized health care services of five selected primary health care centers in Abha, Aseer region of Saudi Arabia in the summer of the year 2000.

METHODS

This study was conducted during July of 2000 in five primary health care centers (PHCCs) in Aseer region, Saudi Arabia. Self-administered questionnaire designed by the investigators was distributed to all tourists who fulfilled the following criteria: aged above 15 years, can read and write and has intent on participating voluntarily. The questionnaire concerned satisfaction with different health care services delivered by the PHCCs and suggestions for the improvement of the services. Data was entered and analyzed using SPSS.

RESULTS

A total of 413 tourists fulfilled the selected criteria. The mean age of the participants was 29.2 years; 81.4% were males, 37.3% were highly educated and 32.7% came from western province. PHCCs services were accessible to 87% and the working hours at PHCCs were suitable for 88.6% of the tourists. More than three-quarters of the visitors came for cure. Satisfaction with the different health services on a 5-point scale ranged from 4.63 points for availability of medications to 4.85 points for cooperation of treating doctors. Seventeen suggestions and comments were reported by 26% of the participants. Most of these suggestions and comments were about providing an adequate number of female doctors and medications.

CONCLUSION

This study revealed that most of the tourists who utilized the selected PHCCs in Aseer region were satisfied with most of the different PHCCs services. However, many tourists gave valid suggestions and comments which should be considered for the improvement of the quality of care in these PHCCs in the future.