***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Travellers are at risk of acquiring infectious diseases during travel , with risks differing by destination , travel and traveller characteristics . A pre-travel health consultation may minimize this risk . However , uptake of pre-travel health advice remains low . We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia . Methods Prospect i ve enhanced surveillance of notified cases of typhoid , paratyphoid , measles , hepatitis A , hepatitis E , malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014 . Details of pre-travel health preparation and disease-specific risk behaviours were collected . Results Among 180 cases associated with international travel , 28 % were < 18 years , 65 % were VFR travellers and 22 % were frequent travellers , having travelled ≥5 times in the past 5 years . 25 % had sought pre-travel advice from a healthcare provider , and 16 % reported a pre-travel vaccine . Seeking pre-travel health advice did not differ by immigrant status ( P = 0.22 ) or by reason for travel ( P = 0.13 ) but was more commonly sought by first time travellers ( P = 0.03 ) . Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water ( P < 0.001 ) and eating uncooked food ( P = 0.03 ) during travel compared to other travellers . Conclusions Pre-travel health advice seeking practice s and vaccine uptake was suboptimal among cases of notified disease . The results of this study highlight the need for a better underst and ing of barriers to pre-travel health seeking , particularly among high risk travellers , to reduce the importation of infectious diseases into Australia Prebiotics are nondigestible food ingredients that encourage proliferation of selected groups of the colonic microflora , thereby altering the composition toward a more beneficial community . In the present study , the prebiotic potential of a novel galactooligosaccharide ( GOS ) mixture , produced by the activity of galactosyltransferases from Bifidobacterium bifidum 41171 on lactose , was assessed in vitro and in a parallel continuous r and omized pig trial .  In situ fluorescent hybridization with 16S rRNA-targeted probes was used to investigate changes in total bacteria , bifidobacteria , lactobacilli , bacteroides , and Clostridium histolyticum group in response to supplementing the novel GOS mixture . In a 3-stage continuous culture system , the bifidobacterial numbers for the first 2 vessels , which represented the proximal and traverse colon , increased ( P < 0.05 ) after the addition of the oligosaccharide mixture . In addition , the oligosaccharide mixture strongly inhibited the attachment of enterohepatic Escherichia coli ( P < 0.01 ) and Salmonella enterica serotype Typhimurium ( P < 0.01 ) to HT29 cells . Addition of the novel mixture at 4 % ( wt : wt ) to a commercial diet increased the density of bifidobacteria ( P < 0.001 ) and the acetate concentration ( P < 0.001 ) , and decreased the pH ( P < 0.001 ) compared with the control diet and the control diet supplemented with inulin , suggesting a great prebiotic potential for the novel oligosaccharide mixture Daniel Maeusezahl and colleagues conducted a cluster-r and omized controlled trial in rural Bolivia of solar drinking water disinfection  , and find only moderate compliance with the intervention and no evidence of reduction in diarrhea among children 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 , r and omized , 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 r and omized 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 question naire 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 BACKGROUND Travelers ' diarrhea ( TD )  is a significant problem for travelers . TD is treatable once it occurs , but few options for prevention exist . Probiotics have been studied for prevention or treatment of TD ; however , very few combination probiotics have been studied . Therefore , the purpose of this study was to determine if prophylactic use of an oral synbiotic could reduce the risk of acquiring TD and reduce antibiotic use if TD occurred . METHODS Healthy subjects traveling to an area of the world with an increased risk of TD were eligible . All subjects received pre-travel counseling and were provided antibiotics and antidiarrheals ( loperamide ) for use only if TD developed . The subjects were blinded and r and omized to take two capsules of placebo or oral synbiotic ( a combination of two probiotics and a prebiotic ) called Agri-King Synbiotic ( AKSB ) beginning 3 days prior to departure , daily while traveling , and for 7 days after return . All subjects kept symptom and medication diaries and su bmi tted a stool sample for pathogen carriage within 7 days of return . The study was powered to detect a 50 % reduction in the incidence of TD . RESULTS Of the 196 adults ( over 18 years of age ) enrolled in the study , 54.3 % were female and 80.9 % were younger than 60 years . The study r and omized 94 people to the AKSB arm and 102 to placebo . The incidence of TD was 54.5 % in the overall group with 55.3 % in the AKSB arm and 53.9 % in the placebo ( p = 0.8864 ) . Among the subjects who experienced diarrhea ( n = 107 ) there was no significant difference in the proportion of subjects that took antibiotics versus those that did not take antibiotics ( 35 % vs 29 % , p = 0.68 ) . AKSB was safe with no difference in toxicity between the two arms . CONCLUSIONS The prophylactic oral synbiotic was safe but did not reduce the risk of developing TD among travelers , nor did it decrease the duration of TD or the use of antibiotics when TD occurred 
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Results and conclusions Travellers ' diarrhoea and use of pre/probiotics : There is no significant evidence to suggest the benefit of using pre or probiotics to prevent or treat TD .
A new second generation of B-GOS prebiotics shows some potential in preventing the incidence and symptoms of TD but lack high levels of grade d evidence .
The evidence behind water purification and diarrhoeal disease : Evidence suggests there is no direct correlation that water purification has an impact on diarrhoeal disease , although some studies underline the value of water purification .
With new water purification products and methods being introduced a benefit could be found for publishing effectiveness against pathogen groups to improve comparison .
Are travellers given good sanitary advice and do they follow it ?
Within the clinical sector the advice provided and the outcomes of advice provision do not correlate with a reduction in TD as a variance can occur by travellers ' changes and behaviours towards the advice given .
Following recommended advice and consuming higher risks foods do not correspond directly with levels of reported TD , suggesting attitudes and practice s deviate away from this advice when travelling