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Gatterer H, Villafuerte FC, Ulrich S, Bhandari SS, Keyes LE, Burtscher M. Altitude illnesses. Nat Rev Dis Primers 2024; 10:43. [PMID: 38902312 DOI: 10.1038/s41572-024-00526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/22/2024]
Abstract
Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect high-altitude resident populations worldwide. The prevalence of acute HAIs varies according to acclimatization status, rate of ascent and individual susceptibility. AMS, characterized by headache, nausea, dizziness and fatigue, is usually benign and self-limiting, and has been linked to hypoxia-induced cerebral blood volume increases, inflammation and related trigeminovascular system activation. Disruption of the blood-brain barrier leads to HACE, characterized by altered mental status and ataxia, and increased pulmonary capillary pressure, and related stress failure induces HAPE, characterized by dyspnoea, cough and exercise intolerance. Both conditions are progressive and life-threatening, requiring immediate medical intervention. Treatment includes supplemental oxygen and descent with appropriate pharmacological therapy. Preventive measures include slow ascent, pre-acclimatization and, in some instances, medications. CMS is characterized by excessive erythrocytosis and related clinical symptoms. In severe CMS, temporary or permanent relocation to low altitude is recommended. Future research should focus on more objective diagnostic tools to enable prompt treatment, improved identification of individual susceptibilities and effective acclimatization and prevention options.
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Affiliation(s)
- Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT TIROL-Private University for Health Sciences and Health Technology, Hall in Tirol, Austria.
| | - Francisco C Villafuerte
- Laboratorio de Fisiología del Transporte de Oxígeno y Adaptación a la Altura - LID, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sanjeeb S Bhandari
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
- Emergency Department, UPMC Western Maryland Health, Cumberland, MD, USA
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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2
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Raberin A, Burtscher J, Burtscher M, Millet GP. Hypoxia and the Aging Cardiovascular System. Aging Dis 2023; 14:2051-2070. [PMID: 37199587 PMCID: PMC10676797 DOI: 10.14336/ad.2023.0424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
Older individuals represent a growing population, in industrialized countries, particularly those with cardiovascular diseases, which remain the leading cause of death in western societies. Aging constitutes one of the largest risks for cardiovascular diseases. On the other hand, oxygen consumption is the foundation of cardiorespiratory fitness, which in turn is linearly related to mortality, quality of life and numerous morbidities. Therefore, hypoxia is a stressor that induces beneficial or harmful adaptations, depending on the dose. While severe hypoxia can exert detrimental effects, such as high-altitude illnesses, moderate and controlled oxygen exposure can potentially be used therapeutically. It can improve numerous pathological conditions, including vascular abnormalities, and potentially slows down the progression of various age-related disorders. Hypoxia can exert beneficial effects on inflammation, oxidative stress, mitochondrial functions, and cell survival, which are all increased with age and have been discussed as main promotors of aging. This narrative review discusses specificities of the aging cardiovascular system in hypoxia. It draws upon an extensive literature search on the effects of hypoxia/altitude interventions (acute, prolonged, or intermittent exposure) on the cardiovascular system in older individuals (over 50 years old). Special attention is directed toward the use of hypoxia exposure to improve cardiovascular health in older individuals.
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Affiliation(s)
- Antoine Raberin
- Institute of Sport Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland.
| | - Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland.
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, A-6020, Austria.
| | - Grégoire P. Millet
- Institute of Sport Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland.
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3
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Knowledge, Attitudes, Behavior, Acceptance, and Hesitancy in Relation to the COVID-19 Vaccine among Pregnant and Breastfeeding Women: A Systematic Review Protocol. WOMEN 2023. [DOI: 10.3390/women3010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A new coronavirus, SARS-CoV-2, was identified at the end of 2019. It swiftly spread all over the world, affecting more than 600 million people and causing over 6 million deaths worldwide. Different COVID-19 vaccines became available by the end of 2020. Healthcare workers and more vulnerable people (such as the elderly and those with comorbidities) were initially prioritized, followed by the entire population, including pregnant and breastfeeding women. Despite the safety and efficacy of COVID-19 vaccines, a certain level of skepticism was expressed, including among pregnant and breastfeeding women. There were several reasons for this reluctancy, among them, fear of side-effects for both women and fetuses. Nevertheless, acceptance, as well as hesitancy, were time, country and vaccine specific. This review will collect available evidence assessing knowledge, attitudes, behaviour, practice and acceptance/hesitancy of pregnant/breastfeeding women in relation to the COVID-19 vaccination. The PubMed/MEDLINE, Scopus and EMBASE databases will be consulted. A predefined search strategy that combines both free text and MESH terms will be used. The systematic review will adhere to the PRISMA guidelines and the results will be reported in both narrative and summary tables. A meta-analysis will be conducted if data are available.
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Ascent rate and the Lake Louise scoring system: An analysis of one year of emergency ward entries for high-altitude sickness at the Mustang district hospital, Nepal. PLoS One 2022; 17:e0276901. [PMID: 36301827 PMCID: PMC9612449 DOI: 10.1371/journal.pone.0276901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022] Open
Abstract
More travellers are making swift ascents to higher altitudes without sufficient acclimatization or pharmaceutical prophylaxis as road connectivity develops in the Himalayan region of Nepal. Our study connects ascent rate with prevalence and severity of acute mountain sickness (AMS) among patients admitted to the emergency ward of the Mustang district hospital in Nepal. A register-based, cross-sectional study was conducted between June 2018 and June 2019 to explore associations of Lake Louise scores with ascent profile, sociodemographic characteristics, and comorbidities using chi-square test, t-test, and Bayesian logistic regression. Of 105 patients, incidence of AMS was 74%, of which 61%, 36%, and 3% were mild, moderate, and severe cases, respectively. In the Bayesian-ordered logistic model of AMS severity, ascent rate (odds ratio 3.13) and smoking (odds ratio 0.16) were significant at a 99% credible interval. Based on the model-derived counterfactual, the risk of developing moderate or severe AMS for a middle-aged, non-smoking male traveling from Pokhara to Muktinath (2978m altitude gain) in a single day is twice that of making the ascent in three days. Ascent rate was strongly associated with the likelihood of developing severe AMS among travellers with AMS symptoms visiting Mustang Hospital's Emergency Ward.
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Croughs M, Nyakunga GB, Sakita FM, Kilonzo K, Mmbaga BT, Soentjens P. Incidence and predictors of severe altitude illness symptoms in Mt. Kilimanjaro hikers: a prospective cohort study. J Travel Med 2022; 29:6554584. [PMID: 35348739 DOI: 10.1093/jtm/taac044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Each year several Mt. Kilimanjaro hikers die due to altitude illness (AI) although urgent descent is technically easily possible. The objectives of this study were to determine the incidence and predictors of severe altitude illness (SAI) symptoms and of summit success in Mt. Kilimanjaro hikers, and the measures taken when AI symptoms develop. METHODS A prospective observational cohort study in Mt. Kilimanjaro hikers was conducted from December 2019 until March 2020. Participants were asked to complete a questionnaire at the entrance gate and one at the descend gate. A multivariate logistic regression was performed to study the relations between the variables. RESULTS A total of 1237 recreational hikers and 266 porters or guides were included. The incidence of severe symptoms was 8.6% in recreational hikers and 1.5% in porters and guides. One percent (1.1%) of hikers was hospitalized due to SAI. A history of SAI, young age, summit failure and lack of clear advice predicted the development of severe symptoms. Uhuru peak was reached by 87.9% of the hikers. Absence of severe symptoms, acetazolamide prophylaxis, climbing higher in daytime, young age and climbing in more days predicted summit success. The majority climbed further despite the presence of mild or severe symptoms. The only measure taken in case of mild symptoms that was associated with a lower incidence of severe symptoms was not climbing further. CONCLUSION The incidence of SAI symptoms in Mt. Kilimanjaro hikers was observed to be high. However, how hikers reacted during symptoms was not appropriate. Therefore, travel health counsellors should emphasize even more that hikers do not ascend higher until mild symptoms have resolved and that it is vital to descend immediately when severe symptoms develop. In addition, they can be informed on the measures, which improved summit success.
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Affiliation(s)
- Mieke Croughs
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp 2000, Belgium
| | - Gissela B Nyakunga
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi 3010, Tanzania.,Clinical Trial Unit, Kilimanjaro Clinical Research Institute (KCRI), Moshi 2236, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College (KCMCUCO), Moshi 2240, Tanzania
| | - Francis M Sakita
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi 3010, Tanzania.,Clinical Trial Unit, Kilimanjaro Clinical Research Institute (KCRI), Moshi 2236, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College (KCMCUCO), Moshi 2240, Tanzania
| | - Kajiru Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi 3010, Tanzania.,Clinical Trial Unit, Kilimanjaro Clinical Research Institute (KCRI), Moshi 2236, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College (KCMCUCO), Moshi 2240, Tanzania
| | - Blandina T Mmbaga
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi 3010, Tanzania.,Clinical Trial Unit, Kilimanjaro Clinical Research Institute (KCRI), Moshi 2236, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College (KCMCUCO), Moshi 2240, Tanzania
| | - Patrick Soentjens
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp 2000, Belgium.,Department of Infectious Diseases, Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels 1120, Belgium
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Ferrara P, Gianfredi V. The Italian PrEPventHIV challenge: a scoping systematic review on HIV pre-exposure prophylaxis monitoring in Italy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022164. [PMID: 35775760 PMCID: PMC9335444 DOI: 10.23750/abm.v93i3.12766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM In Italy, pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) was authorized for HIV prevention in 2017. This scoping systematic review summarizes current evidence on PrEP implementation in Italy since 2017. METHODS A systematic search was conducted in relevant databases, using a search strategy built upon controlled vocabulary, cross-referencing of the citation lists from included reports, and hand-searching of surveillance documents. Findings were summarized narratively according to key issues and themes. RESULTS A total of 106 reports were retrieved and six met criteria for inclusion in the review, being three journal articles and three surveillance report by the European Centre for Disease Prevention and Control (ECDC). In Italy, users can obtain in PrEP in specific hospital- or community-based PrEP services, under prescription by specialists. Due to drug costs, the access is limited to those who can afford it. Data and indicators on PrEP use and monitoring are limited. The vast majority of users were men who have sex with men. In this population, PrEP knowledge and attitudes were investigated across two reports, finding a medium to high level to knowledge and a scare use (mostly due to high costs). A health technology assessment on the adoption of PrEP in Italy advised that the most cost-containing strategy would be the use of PrEP as an "add-on" strategy. CONCLUSIONS In conclusion, this scoping review found a relevant evidence gap on PrEP monitoring. Italy needs to implement specific policies and programs for effective and timely delivery of care.
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Affiliation(s)
- Pietro Ferrara
- Center for Public Health Research, University of Milan - Bicocca, Monza, Italy.
| | - Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy .
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Small E, Phillips C, Marvel J, Lipman G. Older Age as a Predictive Risk Factor for Acute Mountain Sickness. Am J Med 2022; 135:386-392.e1. [PMID: 34715059 DOI: 10.1016/j.amjmed.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older populations are increasing and comprise a substantial portion of high-altitude travelers. Aging physiology may influence susceptibility to acute mountain sickness, though prior research remains inconclusive. The goal of this study was to investigate the relationship between increasing age and acute mountain sickness. METHODS This study was a pooled analysis of 5 prospective randomized controlled trials conducted at White Mountain, California from 2010, 2016-2019 with identical 4-hour rapid ascent from 1242 m to overnight sojourn at 3810 m. Acute mountain sickness was defined by the 2018 Lake Louise Questionnaire criteria. RESULTS There were 491 participants analyzed, 234 (48%) diagnosed with acute mountain sickness and 71 (14%) with moderate acute mountain sickness. Mean age was 37 years (±13). There was no significant correlation between Lake Louise Questionnaire severity and age (r = -0.02; 95% confidence interval [CI], -0.11-0.07, P = .7), 40-year-old dichotomy (t = -0.6; 95% CI, -0.53-0.28, P = .6), or decade of life (P = .4). Logistic regression found no increased odds of acute mountain sickness for increasing age by decade of life (odds ratio [OR] 1.0; 95% CI, 0.97-1.0) or 40-year-old dichotomy (OR 1.4; 95% CI, 0.97-2.1). A history of acute mountain sickness increased odds of acute mountain sickness (OR 3.2; 95% CI, 1.5-7.7). CONCLUSIONS Older age was not associated with incidence nor severity of acute mountain sickness. A history of altitude illness increased odds of acute mountain sickness and should be used for pre-ascent risk stratification.
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Affiliation(s)
- Elan Small
- Emergency Medicine Residency, Stanford University School of Medicine, Palo Alto, Calif.
| | - Caleb Phillips
- Department of Computational Science, University of Colorado, Boulder
| | - James Marvel
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Grant Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, Calif
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8
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Nucci D, Santangelo OE, Provenzano S, Fatigoni C, Nardi M, Ferrara P, Gianfredi V. Dietary Fiber Intake and Risk of Pancreatic Cancer: Systematic Review and Meta-Analysis of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111556. [PMID: 34770068 PMCID: PMC8583332 DOI: 10.3390/ijerph182111556] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/21/2021] [Accepted: 10/30/2021] [Indexed: 12/24/2022]
Abstract
The burden of pancreatic cancer varies greatly across countries, with the number of deaths, incident cases, and disability-adjusted life years more than doubling in recent years, and with high-income countries having the highest incidence and mortality rates. We conducted this systematic review with meta-analysis with the goal of summarizing the current evidence on dietary fiber intake and its role in reducing the risk of pancreatic cancer, given the importance of identifying risk factors. This systematic review followed the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The structured literature search was conducted on PubMed/Medline and Scopus, combining free text words and medical subject headings. Our review contained 18 records at the end of the process. Our results show that dietary fiber intake reduces the risk of pancreatic cancer. When the analysis was differentiated according to the type of fiber considered, sub-grouped by gender (reduction of around 60% among women), and when case-control studies were conducted, the strength of the association increased. Clinicians and policymakers should improve interventions to raise the population's awareness regarding the consumption of high-fiber diets, both in practice and in terms of public health policy.
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Affiliation(s)
- Daniele Nucci
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (D.N.); (M.N.)
| | | | | | - Cristina Fatigoni
- Department of Pharmaceutical Sciences, University of Perugia, 06122 Perugia, Italy;
| | - Mariateresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (D.N.); (M.N.)
| | - Pietro Ferrara
- Center for Public Health Research, University of Milan—Bicocca, 20900 Monza, Italy
- Value-Based Healthcare Unit, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
- Correspondence:
| | - Vincenza Gianfredi
- School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy;
- CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 Maastricht, The Netherlands
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Ferrara P, Masuet-Aumatell C, Ramon-Torrell JM. Acceptance of yellow fever vaccine in the older traveller: a cohort study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021098. [PMID: 34487067 PMCID: PMC8477116 DOI: 10.23750/abm.v92i4.11619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Current demographic changes and improvement of quality of life of elderly population have direct consequences on international travelling. The older traveller demands for specific care and precautions to be observed, as for the yellow fever (YF) vaccination, due to the increased incidence rate of adverse events following immunization (AEFI) in people aged 60 years or over. The aim of our study was to determine the adherence to YF vaccine and travel behaviours in a sample of elderly travellers moving to YF endemic areas. METHODS Participants in this cohort study were offered YF vaccine, and informed about the increased risk of AEFIs and the unavoidable risk of acquiring YF at the destination. The research was planned on survey-based design, using pre- and post-travel questionnaires. RESULTS In 2018, 239 travellers aged 60 years or older attended our travel clinic, of whom 36.8% (n = 88) planned to travel to YF endemic areas and 23.0% (n = 55) for the first time. Of these, 63.6% accepted and 36.4% rejected the vaccination, with 15 travellers moving to endemic areas without immunization, including one patient who presented contraindications to YF vaccine. CONCLUSIONS The presence of more than a third of elderly travellers who travelled without vaccination is a substantial public health problem and, since the number of older travellers continues to increase, it becomes necessary to implement robust actions to improve YF vaccine advocacy and adherence.
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Hadley R, Veremu M, McMaster D. Do UK trekking companies recommend prophylactic acetazolamide for expeditions to Mount Kilimanjaro? J Travel Med 2021; 28:5897802. [PMID: 32856060 DOI: 10.1093/jtm/taaa146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Robert Hadley
- School of Medicine, The University of Sheffield, Sheffield, UK
| | - Munashe Veremu
- Barts and the London School of Medicine, Queen Mary University of London, Victoria, Malta
| | - David McMaster
- School of Medicine, University of Nottingham, Nottingham, UK
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11
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Vlot JA, Vive MGD, Brockhoff HJ, van Genderen PJJ, Trompenaars MCE, van Steenbergen JE, Visser LG. Predicting morbidity in older travellers during a short-term stay in the tropics: the ELDEST study. J Travel Med 2021; 28:taaa216. [PMID: 33225347 PMCID: PMC7788562 DOI: 10.1093/jtm/taaa216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/19/2020] [Accepted: 11/06/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Older persons may suffer more from travel-related health problems because of ageing and underlying chronic disorders. Knowledge on who is more likely to have these health problems helps to tailor travel health advice more specifically. This study aimed to determine predictors of travel-related morbidity in older travellers by assessing their pre-travel characteristics and performance using physical and cognitive functioning tests. METHODS Multicentre prospective cohort study among older travellers (≥60 years) who consulted one of the participating Dutch travel clinics. Handgrip strength and cognitive performance were measured pre-travel. Participants completed questionnaires before departure and 1 and 4 weeks after return. A diary recorded health complaints during travel until 2-week post-travel. RESULTS In total, 477 travellers completed the study (follow-up rate of 97%). Participants' median age was 66 years. The most visited regions were South-East Asia (34%) and South Asia (14%). Median travel duration was 19 days. Polypharmacy (≥5 medications per day) was not uncommon (16%). The median Charlson Comorbidity Index (CCI) score was 0. Self-reported travel-related infectious diseases concerned primarily respiratory tract infections (21%) and gastroenteritis (10%) whereas non-infectious complaints were injuries (13%), peripheral edema (12%) and dehydration (3%). Medical assistance was sought by 18%, mostly post-travel from their general practitioner (87%). Self-reported physical and mental health-related quality of life significantly improved during and after travel. Predictors for an increased risk of travel-related morbidity were higher CCI score, more travel experience, longer travel duration, higher number of daily medications, visiting northern Africa or South-East and East Asia, and phone and social media use. CONCLUSION Older Dutch travellers are generally fit, well-prepared and suffer not only from common infectious health problems, but also from injuries. Travel improved their self-perceived health. The predictors could be used to identify the more at-risk older traveller and to decrease travel-related morbidity by optimizing pre-travel advice.
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Affiliation(s)
- Jessica A Vlot
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marissa G D Vive
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Henricus J Brockhoff
- Department of Infectious Diseases, Municipal Health Service, Westeinde 128, 2512 HE The Hague, The Netherlands
| | - Pieter J J van Genderen
- Harbour Hospital and Institute for Tropical Diseases, currently working on Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - James E van Steenbergen
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Centre for Infectious Disease Control, Netherlands Institute for Public Health and Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Leonardus G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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12
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Zafren K, Shlim DR, Basnyat B, Visser J. Advancing the evidence in altitude and wilderness medicine. J Travel Med 2020; 27:5881392. [PMID: 32761151 DOI: 10.1093/jtm/taaa129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/14/2022]
Abstract
The themes of this special issue of the Journal of Travel Medicine are wilderness and adventure travel. We hope that the wilderness medicine and travel medicine communities can work together on these areas of mutual interest.
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Affiliation(s)
- Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, USA.,Department of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, USA.,Himalayan Rescue Association, Kathmandu, Nepal
| | - David R Shlim
- Jackson Hole Travel and Tropical Medicine, Jackson Hole, WY, USA
| | - Buddha Basnyat
- Himalayan Rescue Association, Kathmandu, Nepal.,Oxford University Clinical Research Unit-Nepal, Kathmandu Nepal.,Travel and Mountain Medicine Center, Kathmandu Nepal
| | - Jenny Visser
- Wellington School of Medicine, Wellington New Zealand.,The Travel Doctor, Wellington, New Zealand
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13
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Yang SL, Ibrahim NA, Jenarun G, Liew HB. Incidence and Determinants of Acute Mountain Sickness in Mount Kinabalu, Malaysia. High Alt Med Biol 2020; 21:265-272. [PMID: 32614265 PMCID: PMC7482124 DOI: 10.1089/ham.2020.0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/22/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Acute mountain sickness (AMS) is the most common type of high-altitude sickness. The incidence of AMS varies by mountain location, trail characteristics, and study design. The lack of local epidemiology data has driven us to investigate the incidence and severity of AMS and its associated factors at Mount Kinabalu, Malaysia. Methods: A cohort study was conducted to collect data from climbers after days 1 (3272 m) and 2 (4095 m) of ascent. A self-administered questionnaire was used to explore climbers' demographic and climb characteristics, history of AMS, alcohol exposure, and AMS prevention measures. The Lake Louis score 2018 was used to assess the presence and severity of AMS (cutoff ≥3). Univariate and multivariable logistic regressions were performed to determine the factors associated with the development of AMS on day 2. Results: Data from 345 climbers were analyzed. The incidence of AMS was 23.9% (95% confidence interval [CI] 19.5%-28.7%) and 21.7% (95% CI 17.5%-26.3%) on days 1 and 2, respectively. The majority were mild cases. Experiencing AMS on day 1 (odds ratio [OR] = 12.88; 95% CI 6.71-24.75), alcohol consumption (OR = 3.73; 95% CI 1.66-8.39), receiving guide advice on day 1 (OR = 0.49; 95% CI 0.26-0.93), and age (OR = 0.96; 95% CI 0.93-0.99) were significant determinants of AMS at Mount Kinabalu. Gender, history of AMS, past exposure to high altitude, ascending time, water intake, acetazolamide use, physical fitness, pulse rate, and peripheral capillary oxygen saturation (SpO2) were not associated with AMS at Mount Kinabalu. Conclusion: Future analysis with age strata is required to ascertain the association of age with AMS. Our research has signposted a strong call for collaborative efforts to improve the provision of hiking advice and discourage alcohol sales to mitigate the risk of AMS among Mount Kinabalu climbers.
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Affiliation(s)
- Su Lan Yang
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | | | - Grazele Jenarun
- Clinical Research Centre, Hospital Queen Elizabeth II, Kota Kinabalu, Malaysia
| | - Houng Bang Liew
- Clinical Research Centre, Hospital Queen Elizabeth II, Kota Kinabalu, Malaysia
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Otani S, Miyaoka Y, Ikeda A, Ohno G, Imura S, Watanabe K, Kurozawa Y. Evaluating Health Impact at High Altitude in Antarctica and Effectiveness of Monitoring Oxygen Saturation. Yonago Acta Med 2020; 63:163-172. [PMID: 32884435 DOI: 10.33160/yam.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022]
Abstract
Background The Japanese Antarctic Research Expedition (JARE) has been conducting research activities in inland Antarctica, which is extremely cold dryland covered with a thick ice sheet. This environment may cause a health disorder called acute mountain sickness (AMS). To improve the safety of expedition members, we evaluated the impact of extreme environmental conditions on human health and the effectiveness of monitoring of hypoxia for the early detection of AMS. Methods In total, 9 members from JARE 59 were studied. Dome Fuji Station (Dome F), located 3,810 m above sea level (ASL), was the destination of the research party. We analyzed daily AMS scores (higher values correspond to more severe AMS-related symptoms), physiological findings, and percutaneous arterial blood oxygen saturation (SpO2) during the inland activity. We also determined the factors related to AMS scores. Results The average AMS score on arrival at Dome F was significantly higher than that at the departure point (560 m ASL). The average SpO2 level was significantly lower than that at other points. The SpO2 level correlated negatively with the AMS score in Spearman's rank correlation. Generalized estimating equations analysis showed that the AMS score was negatively associated with SpO2 level and positively associated with age. Conclusion Hypoxia is a contributory factor to AMS which we can easily assess by measuring the SpO2 level with a pulse oximeter. SpO2 monitoring is a potentially useful health management tool for members in inland Antarctic expeditions. In addition, our results are helpful for understanding physiological responses and health issues in extreme environments.
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Affiliation(s)
- Shinji Otani
- International Platform for Dryland Research and Education, Tottori University, Tottori 680-0001, Japan
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Hokkaido University, Sapporo 060-8648, Japan
| | - Atsushi Ikeda
- Department of Urology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Giichiro Ohno
- Department of Surgery, Tokatsu Hospital, Nagareyama 270-0153, Japan.,National Institute of Polar Research, Tachikawa 190-8518, Japan
| | - Satoshi Imura
- National Institute of Polar Research, Tachikawa 190-8518, Japan
| | | | - Youichi Kurozawa
- Division of Health Administration and Promotion, Department of Social Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Abstract
Health-oriented tourism has emerged as one of the fastest-growing niche tourism fields worldwide. Although there have been studies on the relationship between health and travel behavior, most have been from the perspective of travel motivation and have rarely examined the impact of travel on health. This study explores those travel elements that have a positive influence on health in the domestic health tourism industry, with health being viewed across three domains: psychological, physical, and social. A total of 28 health-contributing travel items reported by 862 package tour participants were analyzed. On the psychological health dimension, experiencing good feelings and escaping bad ones is important. On the physical wellness dimension, natural patterns of food intake during the day is strongly recognized, including the results of increased appetite and improved digestion. On the social health dimension, relationship improvements were experienced, along with a greater understanding of partner(s). These findings add to our understanding of traveler wellness, a significant step towards having the right information to enhance the quality of travel services, especially in the domestic health tourism industry.
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Melatonin Relations with Energy Metabolism as Possibly Involved in Fatal Mountain Road Traffic Accidents. Int J Mol Sci 2020; 21:ijms21062184. [PMID: 32235717 PMCID: PMC7139848 DOI: 10.3390/ijms21062184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/18/2022] Open
Abstract
Previous results evidenced acute exposure to high altitude (HA) weakening the relation between daily melatonin cycle and the respiratory quotient. This review deals with the threat extreme environments pose on body time order, particularly concerning energy metabolism. Working at HA, at poles, or in space challenge our ancestral inborn body timing system. This conflict may also mark many aspects of our current lifestyle, involving shift work, rapid time zone crossing, and even prolonged office work in closed buildings. Misalignments between external and internal rhythms, in the short term, traduce into risk of mental and physical performance shortfalls, mood changes, quarrels, drug and alcohol abuse, failure to accomplish with the mission and, finally, high rates of fatal accidents. Relations of melatonin with energy metabolism being altered under a condition of hypoxia focused our attention on interactions of the indoleamine with redox state, as well as, with autonomic regulations. Individual tolerance/susceptibility to such interactions may hint at adequately dealing with body timing disorders under extreme conditions.
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