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Each year the global tourism market records increasing numbers of international tourist arrivals, drawing attention to the negative impacts on environmental sustainability. As such, the concept of sustainability has become of paramount concern in the tourism sector over the last few decades with an emphasis on "going green" and reducing the environmental footprint associated with this growth of tourism. At the same time, tourists have become increasingly concerned about environmental issues while traveling, forcing tourism providers to carefully plan in a sustainable way. The tourism industry has accepted this trend and has applied new approaches and strategies towards environmental sustainability in their management practices. The greening of tourism began when the fi rst ecolabel, Blue Flag, launched in France in 1985. After two years, the company expanded its activities to other European countries; it became an international ecolabel in 2001. The idea behind ecolabelling is to help tourists make informed decision about their prospective destinations. The purpose of this paper is to explore and compare the widespread ecolabelling process in the tourism industry today. Since the fi rst ecolabel in tourism was launched, the number of ecolabels in the tourism sector has rapidly increased in number; today there are more than two hundred distinct ecolabels within the tourism industry. Unfortunately, there is no standardized set of criteria for certification relative to environmental sustainability practices. Given this practical issue within the global tourism industry, this research seeks to review whether the existing scholarship on sustainability and ecolabelling in tourism has informed the actual practice of ecolabel certification. [ABSTRACT FROM AUTHOR]

Background and Aims: Conventional follow-up of teenagers with inflammatory bowel diseases [IBD] is done during scheduled outpatient visits regardless of how well the patient feels. We designed a telemonitoring strategy for early recognition of flares and compared its efficacy with conventional follow-up. Methods: We used a multicentre randomized trial in patients aged 10-19 years with IBD in clinical remission at baseline. Participants assigned to telemonitoring received automated alerts to complete a symptom score and send a stool sample for measurement of calprotectin. This resulted in an individual prediction for flare with associated treatment advice and test interval. In conventional follow-up the health check interval was left to the physician's discretion. The primary endpoint was cumulative incidence of disease flares. Secondary endpoints were percentage of participants with a positive change in quality-of-life and cost-effectiveness of the intervention. Results: We included 170 participants [84 telemonitoring; 86 conventional follow-up]. At 52 weeks the mean number of face-to-face visits was significantly lower in the telemonitoring group compared to conventional follow-up [3.6 vs 4.3, p < 0.001]. The incidence of flares [33 vs 34%, p = 0.93] and the proportion of participants reporting positive change in quality-of-life [54 vs 44%, p = 0.27] were similar. Mean annual cost-saving was €89 and increased to €360 in those compliant to the protocol. Conclusions: Telemonitoring is as safe as conventional follow-up, and reduces outpatient visits and societal costs. The positive impact on quality-of-life was similar in the two groups. This strategy is attractive for teenagers and families, and health professionals may be interested in using it to keep teenagers who are well out of hospital and ease pressure on overstretched outpatient services. [ABSTRACT FROM AUTHOR]

Background: This European Crohn's and Colitis Organisation [ECCO] topical review focuses on the transition of adolescents with inflammatory bowel disease [IBD] from child-centred to adult-oriented care. The aim was to provide evidence-supported, expert consensus for health professionals taking part in the transition. Methods: An online survey determined the areas of importance for health professionals involved in the transition of adolescents with IBD. Thereafter an expert panel of nine paediatric and five adult gastroenterologists was formed to identify the critical elements of the transition programme, and to prepare core messages defined as 'current practice points'. There is limited literature about transition, therefore this review is mainly based on expert opinion and consensus, rather than on specific evidence. Results: A total of 21 practice points were generated before the first [online] voting round. Practice points that reached >80% agreement were accepted, while those that did not reach 80% agreementwere refined during a consensus meeting and subjected to voting. Ultimately, 14 practice points were retained by this review. Conclusion: We present a consensus-based framework for transitional care in IBD that provides a guidance for clinical practice. [ABSTRACT FROM AUTHOR]

Physical activity confers protection against age-related cognitive dysfunction, but less is known about whether cognition is impacted by sedentary behaviour, specifically its mentally-active and passive forms. Both physical inactivity and sedentary behaviour are highly prevalent in bipolar disorder (BD), yet if and how they relate to the disorder's cognitive symptoms remains unclear. In this study, we explored whether individual variation in physical activity and sedentary behaviour was directly associated with cognition and/or moderated the extent of decrements in cognitive performance occurring as a function of age in people with BD versus psychiatrically-healthy controls. Relevant UK Biobank data were available for 1074 BD patients and 59,653 psychiatrically-healthy controls, aged 40–70. Age, mentally-active (computer use) and passive sedentary behaviour (TV viewing), physical activity, diagnosis, and their interactions were regressed on a global cognitive score. Cognition was inversely associated with physical activity (β = −0.003, CI: −0.003, −0.003) and mentally-passive sedentary behaviour (β = −0.03, CI: −0.04, −0.02) and positively associated with mentally-active sedentary behaviour (β = 0.13, CI: 0.12, 0.15). The latter association was stronger in the BD group. Mentally-active sedentary behaviour moderated the age-cognition association in both BD patients and controls (β = 0.01, CI: 0.008, 0.01), such that age-related decrements in cognition were more apparent in those who engaged in less mentally-active sedentary behaviours compared to those who engaged in more. Mentally-active sedentary behaviour may not only attenuate age-related cognitive dysfunction, but may be important for cognition irrespective of age, particularly in those with BD. These findings support the notion that intellectual stimulation is a protective factor conferring cognitive benefits, even in the context of a sedentary lifestyle. • Mentally active sedentary behaviour positively associated with cognition, with this strengthened in bipolar disorder group. • Mentally active sedentary behaviour may attenuate age-related cognitive dysfunction. • Mentally passive sedentary behaviour and higher levels of physical activity detrimentally associated with cognition. • Increasing intellectual stimulation may be a potentially viable intervention for cognitive dysfunction in bipolar disorder. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to evaluate the incidence of neurologic complications after elbow surgery and to provide perioperative tips and potential pitfalls for neurologic complications and how to cope with them. Methods A single orthopedic surgeon performed 2759 elbow-related surgical procedures between January 2006 and October 2014. The surgical records and the postoperative follow-up of all 2759 patients were retrospectively reviewed to determine the preoperative diagnosis, the type of procedure, and postoperative neurologic complications. Results Neurologic complications were very uncommon. Neurologic deficit occurred in 10 of 2759 elbow operations. A neurologic complication occurred 4 distal biceps tendon surgeries (5.3%), 4 elbow arthroscopies (0.4%), 2 ligament reconstructions (0.7%), and 2 total elbow prosthesis (1.4%). Conclusions A thorough understanding of the 3-dimensional anatomy of the elbow and surrounding nerves is needed to avoid neurologic complications. The neurologic complications we encountered in our series are well within the limits of earlier reports and show that elbow surgery is a relatively safe procedure to perform for a wide variety of indications. [ABSTRACT FROM AUTHOR]

While physical inactivity is associated with adverse psychological outcomes, less is known about the psychological outcomes associated with sedentary behaviour, and specifically, its mentally active and passive forms. The COVID-19 pandemic represents a unique opportunity to study associations between these variables in light of widespread stay-at-home mandates and restrictions on outdoor exercise/social activities. Using a cross-sectional dataset acquired during the COVID-19 pandemic in Australia, we examined whether physical activity and sedentary behaviour were associated with subjective quality of life (sQoL) and subjective cognitive dysfunction, and whether these associations were mediated by depressive symptoms. 658 participants (males = 169, females = 489) self-reported data on physical activity and sedentary behaviour in an online survey during May 2020–May 2021. Data on physical activity and sedentary behaviour (both mentally active and passive types) was compared according to whether it was collected during or out of a lockdown period. Regression models were used to test associations of physical activity and sedentary behaviour with sQoL and subjective cognitive dysfunction, and whether these associations were mediated by depression severity. Physical activity was beneficially associated with sQoL, whereas sedentary behaviour (both total hours and the reduction of mentally active/increase in mentally passive behaviour) was detrimentally associated with sQoL. These associations were mediated by depression severity. Physical activity and sedentary behaviour were also indirectly associated with subjective cognitive dysfunction by virtue of their associations with depression severity. There are important differences in the psychological correlates of mentally passive and active sedentary behaviours. Our findings suggest that health promotion strategies should focus on not only increasing physical activity but also reducing passive sedentary behaviours as a means of maintaining good psychological health. • Physical activity (PA) or sedentary behaviour (SB) did not differ according to lockdown status. • Psychological outcomes correlated differently with mentally active and mentally passive SB. • Less mentally passive SB and more PA associated with better quality of life. • Depression severity mediated the association of PA/SB and subjective cognitive dysfunction. • Health promotion should focus on increasing PA and reducing mentally passive SB. [ABSTRACT FROM AUTHOR]