1
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Horakova L, Kriemler S, Študent V, Pichler Hefti J, Hillebrandt D, Jean D, Mateikaitė-Pipirienė K, Paal P, Rosier A, Andjelkovic M, Beidlemann B, Derstine M, Keyes LE. Hormonal Contraception and Menstrual Cycle Control at High Altitude: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2024. [PMID: 38607652 DOI: 10.1089/ham.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Horakova, Lenka , Susi Kriemler, Vladimír Študent, Jacqueline Pichler Hefti, David Hillebrandt, Dominique Jean, Kastė Mateikaitė-Pipirienė, Peter Paal, Alison Rosier, Marija Andjelkovic, Beth Beidlemann, Mia Derstine, and Linda E. Keyes. Hormonal contraception and menstrual cycle control at high altitude: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 00:00-00, 2024. Background: Women who use hormonal contraception (HC) may have questions about their use during travel to high altitude. This scoping review summarizes current evidence on the efficacy and safety of HC and cycle control during high-altitude travel. Methods: We performed a scoping review for the International Climbing and Mountaineering Federation (UIAA) Medical Commission series on Women's Health in the Mountains. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including contraception) with additional publications found by hand search. Results: We identified 17 studies from 7,165 potentially eligible articles. No articles assessed the efficacy of contraception during a short-term high-altitude sojourn. Current data show no advantage or disadvantage in HC users for acclimatization or acute mountain sickness (AMS). Use of HC during high-altitude travel is common and safe for menses suppression. A potential concern of estrogen-containing HC is the increased thrombotic risk, which theoretically could be compounded in hypobaric hypoxia. Conclusions: Evidence is limited for the interaction of HC and high altitude on performance, thrombosis, and contraceptive efficacy. HC does not affect the risk of AMS. The most efficacious and safest method at high altitude is generally the one women are most familiar with and already using.
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Affiliation(s)
- Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University Prague, Kladno, Czech Republic
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vladimír Študent
- Department of Gynecology and Obstetrics, Prachatice Hospital, Prachatice, Czech Republic
| | | | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsorthy, United Kingdom
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth Beidlemann
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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Andjelkovic M, Paal P, Kriemler S, Mateikaite-Pipiriene K, Rosier A, Beidleman BA, Derstine M, Pichler Hefti J, Hillebrandt D, Horakova L, Jean D, Keyes LE. Nutrition in Women at High Altitude: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2024; 25:9-15. [PMID: 37971430 DOI: 10.1089/ham.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Andjelkovic, Marija, Peter Paal, Susi Kriemler, Kaste Mateikaite-Pipiriene, Alison Rosier, Beth Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, Lenka Horakova, Dominique Jean, and Linda E. Keyes. Nutrition in women at high altitude: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 25:9-15, 2024. Background: Nutritional concerns such as food composition, energy intake, and nutrient absorption are essential for performance at high altitude and may differ between men and women. We performed a scoping review to summarize what is currently known on nutrition for women during short-term, high-altitude, physically active sojourns. Methods: The UIAA Medical Commission convened an international team to review women's health issues at high altitude and to publish updated recommendations. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including nutrition, metabolism, energy composition, micronutrients) with additional publications found by hand search. Results: We found 7,165 articles, of which 13 original articles assessed nutritional aspects in physically active women on short-term high-altitude sojourns, with other articles found by hand search. We summarize the main findings. Conclusions: Data on women's nutrition at altitude are very limited. Reduction in energy intake plus increased energy expenditure at high altitude can lead to unbalanced nutrition, negatively influencing high-altitude adaptation and physical performance. Therefore, adequate dietary and fluid intake is essential to maintaining energy balance and hydration at high altitude in women as in men. Iron supplementation should be considered for women with iron depletion before travel.
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Affiliation(s)
- Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Institute of Pharmacy, Singidunum University, Belgrade, Serbia
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Kaste Mateikaite-Pipiriene
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Beth A Beidleman
- U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jacqueline Pichler Hefti
- Swiss Sportclinic, Bern, Switzerland
- Department of Internal Medicine, Hospital Biel/Bienne, Biel, Switzerland
| | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, Devon
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology, Perioperative and Intensive Care, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Paediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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Mateikaitė-Pipirienė K, Jean D, Paal P, Horakova L, Kriemler S, Rosier AJ, Andjelkovic M, Beidleman BA, Derstine M, Hefti JP, Hillebrandt D, Keyes LE. Menopause and High Altitude: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2024; 25:1-8. [PMID: 37922458 DOI: 10.1089/ham.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023] Open
Abstract
Mateikaitė-Pipirienė, Kastė, Dominique Jean, Peter Paal, Lenka Horakova, Susi Kriemler, Alison J. Rosier, Marija Andjelkovic, Beth A. Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, and Linda E. Keyes for the UIAA MedCom writing group on Women's Health in the Mountains. Menopause and high altitude: A scoping review-UIAA Medical Commission Recommendations. High Alt Med Biol. 25:1-8, 2024. Background: Older people are an important fraction of mountain travelers and climbers, many of them postmenopausal women. The aim of this work was to review health issues that older and postmenopausal women may experience at high altitude, including susceptibility to high-altitude illness. Methods: We performed a scoping review for the UIAA Medical Commission series on Women's Health in the mountains. We searched PubMed and Cochrane libraries and performed an additional manual search. The primary search focused on articles assessing lowland women sojourning at high altitude. Results: We screened 7,165 potential articles. The search revealed three relevant articles, and the manual search another seven articles and one abstract. Seven assessed menopausal low-altitude residents during a high-altitude sojourn or performing hypoxic tests. Four assessed high-altitude residents. We summarize the results of these 11 studies. Conclusions: Data are limited on the effects of high altitude on postmenopausal women. The effects of short-term, high-altitude exposure on menopause symptoms are unknown. Menopause has minimal effect on the physiological responses to hypoxia in physically fit women and does not increase the risk of acute mountain sickness. Postmenopausal women have an increased risk of urinary tract infections, which may be exacerbated during mountain travel. More research is needed on the physiology and performance of older women at high altitude.
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Affiliation(s)
- Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Clinics, Elektrėnai Division, Lithuania
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Paediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelesus Medical University, Salzburg, Austria
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Alison J Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth A Beidleman
- US Army Research Institute of Environmental Medicine, Military Performance Division, Natick MA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, Devon, United Kingdom
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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Kriemler S, Mateikaitė-Pipirienė K, Rosier A, Keyes LE, Paal P, Andjelkovic M, Beidleman BA, Derstine M, Pichler Hefti J, Hillebrandt D, Horakova L, Jean D. Frostbite and Mortality in Mountaineering Women: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2023; 24:247-258. [PMID: 37824760 DOI: 10.1089/ham.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Kriemler, Susi, Kastė Mateikaitė-Pipirienė, Alison Rosier, Linda E. Keyes, Peter Paal, Marija Andjelkovic, Beth A. Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, Lenka Horakova, and Dominique Jean; for the UIAA MedCom Writing Group on Women's Health in the Mountains. Frostbite and mortality in mountaineering women: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 24:247-258, 2023. Background: The harsh environment of high altitudes (HA) poses many serious health risks for mountaineers, including cold injuries and death. The aim of this work was to review whether female mountaineers are at special risk for frostbite or death at HA compared with their male counterparts. Methods: The UIAA Medical Commission convened an international author team to review women's health issues at HA and to publish updated recommendations. Pertinent literature from PubMed and Cochrane was identified with additional publications found by hand search. The primary search focus was for articles assessing cold injuries and death in women mountaineers at HA. Results: We reviewed the literature and identified 20 relevant studies: 2 studies on frostbite at HA, plus 7 studies and 1 report for death at HA. An additional 10 studies about frostbite at low altitude were included. We found that female mountaineers at HA were at lower risk of death than their male counterparts, but sex differences in frostbite were inconclusive. Conclusions: The frequency of cold injuries and mortality in female mountaineers is not yet well studied, and the studies that have been published tend to lack precise exposure data. More studies and registries with sex-differentiated data are needed.
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Affiliation(s)
- Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth A Beidleman
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, Devon, United Kingdom
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anesthesiology, Perioperative and Intensive Care, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pediatrics, Infectious Diseases, and Altitude Medicine, Grenoble, France
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Pichler Hefti J, Jean D, Rosier AJ, Derstine M, Hillebrandt D, Horakova L, Keyes LE, Mateikaitė-Pipirienė K, Paal P, Andjelkovic M, Beidlemann BA, Kriemler S. High-Altitude Pulmonary Edema in Women: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2023; 24:268-273. [PMID: 37906126 DOI: 10.1089/ham.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Pichler Hefti, Jacqueline, Dominique Jean, Alison Rosier, Mia Derstine, David Hillebrandt, Lenka Horakova, Linda E. Keyes, Kastė Mateikaitė-Pipirienė, Peter Paal, Marija Andjelkovic, Beth Beidlemann, and Susi Kriemler. High-altitude pulmonary edema in women: a scoping review-UIAA Medical Commission Recommendations. High Alt Med Biol. 24:268-273, 2023. Background: High-altitude pulmonary edema (HAPE) can occur >2,500-3,000 m asl and is a life-threatening medical condition. This scoping review aims to summarize the current data on sex differences in HAPE. Methods: The International Climbing and Mountaineering Federation (UIAA) Medical Commission convened an international author team to review women's health issues at high altitude. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including HAPE), with additional publications found by hand search. The primary search focus was for original articles that included minimum one woman and at least a rudimentary subgroup analysis. Results: The literature search yielded 7,165 articles, 416 of which were relevant for HAPE, and 7 of which were ultimately included here. Six were case series, consistently reporting a lower HAPE prevalence in women. The one retrospective case-control study reported male HAPE prevalence at 10/100,000 and female at 0.74/100,000. No studies were identified that directly compared sex differences in the prevalence of HAPE. No published data was found for topics other than epidemiology. Conclusions: Few studies and associated methodological limitations allow few conclusions to be drawn. Incidence of HAPE may be lower in women than in men. We speculate that besides physiological aspects, behavioral differences may contribute to this potential sex difference.
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Affiliation(s)
| | - Dominique Jean
- Paediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Alison J Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsorthy, Devon, United Kingdom
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University Prague, Kladno, Czech Republic
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Clinics, Elektrėnai Division, Lithuania
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth A Beidlemann
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Derstine M, Jean D, Beidleman BA, Pichler Hefti J, Hillebrandt D, Horakova L, Kriemler S, Mateikaitė-Pipirienė K, Paal P, Rosier AJ, Andjelkovic M, Keyes LE. Acute Mountain Sickness and High Altitude Cerebral Edema in Women: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2023; 24:259-267. [PMID: 37870579 DOI: 10.1089/ham.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Derstine, Mia, Dominique Jean, Beth A. Beidleman, Jacqueline Pichler Hefti, David Hillebrandt, Lenka Horakova, Susi Kriemler, Kasté Mateikaité-Pipiriené, Peter Paal, Alison Rosier, Marija Andjelkovic, and Linda E. Keyes. Acute mountain sickness and high altitude cerebral edema in women: A scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 24:259-267, 2023. Background: Acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) are illnesses associated with rapid ascent to altitudes over 2,500 m in unacclimatized lowlanders. The aim of this scoping review is to summarize the current knowledge on sex differences in the epidemiology, pathophysiology, symptomatology, and treatment of AMS and HACE, especially in women. Methods and Results: The UIAA Medical Commission convened an international author team to review women's health issues at high altitude and to publish updated recommendations. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including AMS, HACE, and high altitude), with additional publications found by hand search. The primary search focus was for articles assessing lowland women sojourning at high altitude. Results: The literature search yielded 7,165 articles, 37 of which were ultimately included. The majority of publications included did not find women at increased risk for AMS or HACE. There was extremely limited sex-specific data on risk factors or treatment. Conclusions: There is a limited amount of data on female-specific findings regarding AMS and HACE, with most publications addressing only prevalence or incidence with regard to sex. As such, general prevention and treatment strategies for AMS and HACE should be used regardless of sex.
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Affiliation(s)
- Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Paediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Beth A Beidleman
- US Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massachusetts, USA
| | | | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, United Kingdom
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Clinics, Elektrėnai Division, Lithuania
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelesus Medical University, Salzburg, Austria
| | - Alison J Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pharmacy, Singidunum University, Belgrade, Serbia
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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Horakova L, Paal P, Pichler Hefti J, Andjelkovic M, Beidleman BA, Derstine M, Hillebrandt D, Jean D, Mateikaitė-Pipirienė K, Rosier AJ, Kriemler S, Keyes LE. Women's Health at High Altitude: An Introduction to a 7-Part Series by the International Climbing and Mountaineering Federation Medical Commission. High Alt Med Biol 2023; 24:243-246. [PMID: 37862559 DOI: 10.1089/ham.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Horakova, Lenka, Peter Paal, Jacqueline Pichler Hefti, Marija Andjelkovic, Beth A. Beidleman, Mia Derstine, David Hillebrandt, Dominique Jean, Kastė Mateikaitė-Pipirienė, Alison J. Rosier, Susi Kriemler, and Linda E. Keyes. Women's health at high altitude: An introduction to a 7-part series by the International Climbing and Mountaineering Federation Medical Commission. High Alt Med Biol. 24:243-246, 2023. Background: Women have been traveling to high altitude since the inception of modern mountaineering. Although there are distinct female-specific features such as menstruation and menopause relevant to adaptation to and performance at high altitude, very little data exist on women's high-altitude health. To summarize what is known to date, the Medical Commission of the International Climbing and Mountaineering Federation (UIAA) has created a series of articles on women's health, high altitude illness, and performance at high altitude. Methods: Assembling an international author team, two types of manuscripts were developed: (1) reviews on female-specific topics such as pregnancy; (2) reviews on sex differences in high-altitude related illnesses, nutrition, cold injuries, and mortality. Results: The literature search yielded 7,165 articles, with 482 studies meeting the inclusion criteria for full-text review. The authors of individual chapters reviewed these articles and performed additional hand searches. Conclusions: Some important questions on women sojourning and exercising at high altitude have been studied, but many are still awaiting a qualified and evidence-based response. Our seven reviews, to be published in future issues of this journal, summarize what is known about lowland women sojourning at high altitude, provide recommendations, and highlight knowledge gaps in high altitude women's medicine.
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Affiliation(s)
- Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | | | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth A Beidleman
- US Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, Devon
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Paediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Alison J Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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8
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Hillebrandt D, Gurtoo A, Kupper T, Richards P, Schöffl V, Shah P, van der Spek R, Wallis N, Milledge J. UIAA Medical Commission Recommendations for Mountaineers, Hillwalkers, Trekkers, and Rock and Ice Climbers with Diabetes. High Alt Med Biol 2023; 24:110-126. [PMID: 30335516 PMCID: PMC10282971 DOI: 10.1089/ham.2018.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023] Open
Abstract
Hillebrandt, David, Anil Gurtoo, Thomas Kupper, Paul Richards, Volker Schöffl, Pankaj Shah, Rianne van der Spek, Nikki Wallis, and Jim Milledge. UIAA Medical Commission recommendations for mountaineers, hillwalkers, trekkers, and rock and ice climbers with diabetes. High Alt Med Biol. 24: 110-126.-The object of this advice article is not only to give the diabetic mountaineer general guidance but also to inform his or her medical team of practical aspects of care that may not be standard for nonmountaineers. The guidelines are produced in seven sections. The first is an introduction to the guidelines, and the second is an introduction to this medical problem and is designed to be read and understood by diabetic patients and their companions. The third section is for use in an emergency in mountains. The fourth is for rock, ice, and competition climbers operating in a less remote environment. These initial sections are deliberately written in simple language. The fifth and sixth sections are written for clinicians and those with skills to read more technical information, and the seventh looks at modern technology and its pros and cons in diabetes management in a remote area. Sections One and Two could be laminated and carried when in the mountains, giving practical advice.
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Affiliation(s)
- David Hillebrandt
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Derriton House, Holsworthy, England
| | - Anil Gurtoo
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Department of Medicine, Lady Hardinge Medical College and Associated SSK Hospital, New Delhi, India
| | - Thomas Kupper
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany
| | - Paul Richards
- Faculty of PreHospital Care, Basildon and Brentwood CCG, Essex, England
| | - Volker Schöffl
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Section Sportsmedicine, Department of Trauma and Orthopedic Surgery, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, University of Erlangen-Nuermebrg, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Pankaj Shah
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Rianne van der Spek
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Nikki Wallis
- Emergency Department, Ysbyty Gwynedd, Bangor, Wales
| | - Jim Milledge
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Northwick Park Hospital, Harrow, United Kingdom
- Department of Medicine, Medical Research Council, United Kingdom
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Harkensee C, Hillebrandt D. An Occupational Health Survey of British Mountain Guides Operating Internationally. Wilderness Environ Med 2019; 30:236-243. [PMID: 31204141 DOI: 10.1016/j.wem.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/16/2019] [Accepted: 03/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Professional mountain guides face significant occupational health risks, including injuries, accidents, environmental exposures, chronic musculoskeletal strain, and psychological stressors. This study aims to investigate these risks and their impact on the quality of life of a group of international British mountain guides. METHODS This self-reported online survey included demographics; acute and chronic occupational conditions; and questions on general health, lifestyle, symptoms of post-traumatic stress disorder (PTSD), and quality of life based on the World Health Organization quality of life [WHOQOL-BREF] questionnaire. RESULTS Responses were received from 67 (32%) of the approached guides. Knee pain (75%), back and neck pain (62%), hand/upper extremity problems (51%), and lower limb injuries (49%) were the most commonly reported individual occupational health problems. Chronic eye problems were reported by 8%, and 5% reported skin cancer. Twenty-nine percent were on regular medications, which were mainly analgesics for chronic musculoskeletal complaints. Mountain guides have a healthy lifestyle, with lower rates of being overweight/obese, alcohol consumption, and smoking than the average UK population. Fourteen (61%) of the 23 guides responding to the PTSD questions reported experiencing life-threatening traumatic incidents, and 4 (25%) of this subgroup appear to have had some symptoms of PTSD. The quality of life assessment showed that the studied mountain guides have a high quality of life. CONCLUSIONS Musculoskeletal problems are the main occupational health problems experienced by the study group. New findings include a low but important prevalence of ultraviolet radiation-associated conditions. One in 3 guides have experienced significant psychological trauma, and one quarter of these had symptoms of PTSD.
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Affiliation(s)
- Christian Harkensee
- Paediatric Immunology and Infectious Diseases, Queen Elizabeth Hospital, Gateshead, UK
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Abstract
The evolution in communication and digital technologies is revolutionising the practice of medicine. A physician is now able to oversee provision of healthcare at a distance. In this paper, we argue that practice of telemedicine is an essential and evolving aspect of high altitude and expedition medicine. We acknowledge the lack of international consensus, limited legislation as well as possible reservations towards telemedical practice. Given some unique social and medical aspects of participation in remote, high altitude expeditions we propose a number of guiding principles for those involved in provision of telemedical services for such endeavours.
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Affiliation(s)
- Piotr Szawarski
- Department of Anaesthesia and Intensive Care, Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK
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Drastig J, Hillebrandt D, Rath W, Küpper T. Pregnant Women in Sport Climbing - Is there a Higher Risk for Preterm Birth? Z Geburtshilfe Neonatol 2017; 221:25-29. [PMID: 28103619 DOI: 10.1055/s-0042-119654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sport climbing is a popular recreational sport with an increasing proportion of female athletes. International recommendations emphasize the physical and mental benefits of regular sport activity during any uncomplicated pregnancy. In this context, sport climbing is associated with a high risk potential.The aim of this study was to examine if there is a higher risk for preterm birth in active climbing athletes.Original manuscript.A retrospective self-report online survey in the German language collected data between September 2012 and November 2013. In addition to anthropometric and demographic data, data on climbing experience, preferred climbing discipline, skill level and changes of climbing habits during pregnancy, known risk factors for preterm birth and information on delivery and the newborn were requested. The rate of preterm birth of the survey was tested with Fisher's exact test with information from the German Federal Statistical Office.Sample size was 32. 72% had a university degree, 81% were primiparous, all were singleton pregnancies. A 33rd questionnaire was excluded because of described preeclampsia. Age ranged between 21 and 39 years, climbing experience before pregnancy between 2 and 24 years, and skill level before pregnancy between 4 and 7 on the UIAA scale (International Climbing and Mountaineering Federation). Half of the women climbed until the 36th week and 90% adjusted their climbing habits mostly by reducing climbing difficulty and doing more top roping. 2 preterm births in the 36th week of gestation were found (2 from 15, p=0.36). According to the data from the German Federal Statistical Office, 8.9% births in the year 2013 in Germany were preterm.This is the first study investigating the risk of preterm birth in recreational sport climbing athletes. No significantly higher proportion of preterm birth could be found. Limitations are small sample size and high social status of participants. What is known about the subject: Sport climbing is not a high-risk sport, but it is regarded as a dynamic whole-body exercise and has been shown to be a valuable therapy for various physical and mental diseases. Higher performance levels are associated with overuse damage to the upper extremity, especially the fingers. What this study adds to existing knowledge: This is first study investigating climbing-related risk of preterm birth. When continuing sport climbing as a recreational activity during an uncomplicated pregnancy, experienced athletes do not have a higher risk of adverse events.
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Affiliation(s)
- Jan Drastig
- Department for Rehabilitation, German Statutory Pension Insurance, Berlin, Germany
| | - David Hillebrandt
- Medical Committee of the Union Internationale des Associations d'Alpinisme (UIAA MedCom), Berne, Switzerland
| | - Werner Rath
- Institute of Gynaecology & Obstetrics, RWTH Aachen University, Germany
| | - Thomas Küpper
- Institute of Occupational and Social Medicine, RWTH Aachen University, Germany
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Donegani E, Paal P, Küpper T, Hefti U, Basnyat B, Carceller A, Bouzat P, van der Spek R, Hillebrandt D. Drug Use and Misuse in the Mountains: A UIAA MedCom Consensus Guide for Medical Professionals. High Alt Med Biol 2016; 17:157-184. [PMID: 27583821 DOI: 10.1089/ham.2016.0080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Donegani, Enrico, Peter Paal, Thomas Küpper, Urs Hefti, Buddha Basnyat, Anna Carceller, Pierre Bouzat, Rianne van der Spek, and David Hillebrandt. Drug use and misuse in the mountains: a UIAA MedCom consensus guide for medical professionals. High Alt Med Biol. 17:157-184, 2016.-Aims: The aim of this review is to inform mountaineers about drugs commonly used in mountains. For many years, drugs have been used to enhance performance in mountaineering. It is the UIAA (International Climbing and Mountaineering Federation-Union International des Associations d'Alpinisme) Medcom's duty to protect mountaineers from possible harm caused by uninformed drug use. The UIAA Medcom assessed relevant articles in scientific literature and peer-reviewed studies, trials, observational studies, and case series to provide information for physicians on drugs commonly used in the mountain environment. Recommendations were graded according to criteria set by the American College of Chest Physicians. RESULTS Prophylactic, therapeutic, and recreational uses of drugs relevant to mountaineering are presented with an assessment of their risks and benefits. CONCLUSIONS If using drugs not regulated by the World Anti-Doping Agency (WADA), individuals have to determine their own personal standards for enjoyment, challenge, acceptable risk, and ethics. No system of drug testing could ever, or should ever, be policed for recreational climbers. Sponsored climbers or those who climb for status need to carefully consider both the medical and ethical implications if using drugs to aid performance. In some countries (e.g., Switzerland and Germany), administrative systems for mountaineering or medication control dictate a specific stance, but for most recreational mountaineers, any rules would be unenforceable and have to be a personal decision, but should take into account the current best evidence for risk, benefit, and sporting ethics.
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Affiliation(s)
- Enrico Donegani
- 1 Department of Cardiovascular Surgery, Sabah Al-Ahmed Cardiac Center , Al-Amiri Hospital, Kuwait, State of Kuwait
| | - Peter Paal
- 2 Department of Anaesthesiology and Critical Care Medicine, Innsbruck University Hospital , Innsbruck, Austria .,3 Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, United Kingdom .,4 Perioperative Medicine, St. Bartholomew's Hospital , London, United Kingdom
| | - Thomas Küpper
- 5 Institute of Occupational and Social Medicine, RWTH Aachen University , Aachen, Germany
| | - Urs Hefti
- 6 Department of Orthopedic and Trauma Surgery, Swiss Sportclinic , Bern, Switzerland
| | - Buddha Basnyat
- 7 Oxford University Clinical Research Unit-Nepal , Nepal International Clinic, and Himalayan Rescue, Kathmandu, Nepal
| | - Anna Carceller
- 8 Sports Medicine School, Instituto de Medicina de Montaña y del Deporte (IMMED), Federació d'Entitats Excursionistes (FEEC), University of Barcelona , Barcelona, Spain
| | - Pierre Bouzat
- 9 Department of Anesthesiology and Critical Care, University Hospital, INSERM U1236, Neuroscience Institute, Alps University, Grenoble, France
| | - Rianne van der Spek
- 10 Department of Endocrinology and Metabolism, Academic Medical Center Amsterdam, University of Amsterdam , Amsterdam, The Netherlands
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Szawarski P, Hillebrandt D. Patient-centred mountain medicine. Postgrad Med J 2016; 92:482-3. [PMID: 27234206 DOI: 10.1136/postgradmedj-2016-134096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/07/2016] [Indexed: 11/03/2022]
Abstract
Venturing into the mountains, doctors have accompanied expeditions to provide routine care to the teams, undertake research and occasionally take on a rescue role. The role of doctors practicing mountain medicine is evolving. Public health issues involving concepts of health and safety have become necessary with the coming of commercial and youth expeditions. Increasingly individuals with a disability or a medical diagnosis choose to ascend to high altitudes. Doctors become involved in assessment of risk and providing advice for such individuals. The field of mountain medicine is perhaps unique in that acceptance of risk is part of the ethos of climbing and adventure. The pursuit of mountaineering goals may represent the ultimate conquest of a disability. Knowledge of mountain environment is essential in facilitating mountain ascents for those who choose to undertake them, in spite of a disability or medical condition.
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Affiliation(s)
- Piotr Szawarski
- Department of Anaesthesia and Intensive Care Medicine, Wexham Park Hospital, Wexham, UK
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Hillebrandt D, Richards P, Clark A, Jean D. Zika Virus Advice for Mountaineers: A UIAA Medcom Consensus Advice Sheet. High Alt Med Biol 2016; 17:70-1. [PMID: 27081746 DOI: 10.1089/ham.2016.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hillebrandt, David, Paul Richards, Andy Clark, and Dominique Jean. Zika virus advice for mountaineers: A UIAA Medcom consensus advice sheet. High Alt Med Biol. 17:70-71, 2016.-With the current media coverage of the spread of Zika virus from Africa and Asia to Central and South America and its possible relationship with fetal abnormalities, UIAA Medcom has produced an advice sheet for mountaineers visiting risk areas.
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Affiliation(s)
- David Hillebrandt
- 1 Derriton House , Holsworthy, United Kingdom .,2 UIAA Medical Commission , UIAA, Bern, Switzerland
| | - Paul Richards
- 3 South Essex Travel Clinic , Billericay, Essex, United Kingdom
| | | | - Dominique Jean
- 5 Centre Hospitalier Universitaire de Grenoble , Centre Pluridisciplinaire de Diagnostic Prénatal, Grenoble, France
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Mellor A, Dodds N, Joshi R, Hall J, Dhillon S, Hollis S, Davis P, Hillebrandt D, Howard E, Wilkes M, Langdana B, Lee D, Hinson N, Williams TH, Rowles J, Pynn H. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine. Extrem Physiol Med 2015; 4:22. [PMID: 26629337 PMCID: PMC4665843 DOI: 10.1186/s13728-015-0041-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/04/2015] [Indexed: 06/05/2023]
Abstract
To support leaders and those involved in providing medical care on expeditions in wilderness environments, the Faculty of Pre-Hospital Care (FPHC) of The Royal College of Surgeons of Edinburgh convened an expert panel of leading healthcare professionals and expedition providers. The aims of this panel were to: (1) provide guidance to ensure the best possible medical care for patients within the geographical, logistical and human factor constraints of an expedition environment. (2) Give aspiring and established expedition medics a 'benchmark' of skills they should meet. (3) Facilitate expedition organisers in selecting the most appropriate medical cover and provider for their planned activity. A system of medical planning is suggested to enable expedition leaders to identify the potential medical risks and their mitigation. It was recognised that the scope of practice for wilderness medicine covers elements of primary healthcare, pre-hospital emergency medicine and preventative medicine. Some unique competencies were also identified. Further to this, the panel recommends the use of a matrix and advisory expedition medic competencies relating to the remoteness and medical threat of the expedition. This advice is aimed at all levels of expedition medic, leader and organiser who may be responsible for delivering or managing the delivery of remote medical care for participants. The expedition medic should be someone equipped with the appropriate medical competencies, scope of practice and capabilities in the expedition environment and need not necessarily be a qualified doctor. In addition to providing guidance regarding the clinical competencies required of the expedition medic, the document provides generic guidance and signposting to the more pertinent aspects of the role of expedition medic.
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Affiliation(s)
- Adrian Mellor
- />Academic Department of Military Anaesthesia and Critical Care, RCDM, Birmingham, UK
- />Cardiothoracic Anaesthesia, James Cook University Hospital, Middlesbrough, TS4 3BW UK
- />Carnegie Institute for Sport and Human Performance, Leeds Beckett University, Leeds, UK
| | - Naomi Dodds
- />Academic Critical Care Foundation Doctor, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Raj Joshi
- />Centre for Health and Human Performance, London, UK
- />Summerfield Urgent Care Centre, Birmingham, UK
| | - John Hall
- />Department of Emergency Care, University of Birmingham, Birmingham, UK
- />Faculty of Pre Hospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK
| | - Sundeep Dhillon
- />The Centre for Altitude Space and Extreme Environment Medicine (CASE Medicine), Institute for Sport, Exercise and Health (ISEH), London, UK
- />Medical Cell, The Royal Geographical Society, 1 Kensington Gore, London, UK
| | - Sarah Hollis
- />Primary Care and Occupational Medicine, Ministry of Defence, London, UK
- />Ultimate Travel Company, London, UK
| | - Pete Davis
- />Department of Emergency Medicine, Defence Medical Services, Whittington, UK
- />Department of Emergency Medicine, Queen Elizabeth University Hospital and Emergency Medical Retrieval Service, Glasgow, UK
| | - David Hillebrandt
- />UIAA Medcom, Manchester, UK
- />British Mountaineering Council, Manchester, UK
| | - Eva Howard
- />Queen Elizabeth Hospital, Birmingham, UK
| | - Matthew Wilkes
- />Adventure Medic Ltd, Edinburgh, UK
- />Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Burjor Langdana
- />Adventure Medic, Edinburgh, UK
- />Expedition and Wilderness Medicine, Devon, UK
| | | | | | | | | | - Harvey Pynn
- />Department of Emergency Medicine, Defence Medical Services, Whittington, UK
- />Department of Emergency Medicine, University Hospitals Bristol, Bristol, UK
- />Great Western Air Ambulance, Bristol, UK
- />Wilderness Medical Training, Kendal, UK
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Timmermann LF, Ritter K, Hillebrandt D, Küpper T. Drinking water treatment with ultraviolet light for travelers -- Evaluation of a mobile lightweight system. Travel Med Infect Dis 2015; 13:466-74. [PMID: 26616307 DOI: 10.1016/j.tmaid.2015.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The SteriPEN(®) is a handheld device for disinfecting water with ultraviolet (UV) radiation. The manufacturer claims a reduction of at least 99.9% of bacteria, viruses, and protozoa. The present study intends to verify the general effectiveness of the device. Furthermore, the influence of bottle geometry and water movement is examined and the issue of user safety with regard to UV-C radiation is addressed. METHODS The device was applied on water containing a known number of microorganisms (Escherichia coli, Staphylococcus aureus, and the spore of Geobacillusstearothermophilus) and the survival rate was examined. Three different types of bottles commonly used among travelers served as test containers. All tests were conducted with and without agitating the water during irradiation. Furthermore, a spectral analysis was performed on the light of the device. RESULTS The SteriPEN(®) reached a mean reduction of more than 99.99% of bacteria and 99.57% of the spores when applied correctly. However, the results of the trials without agitating the water only yielded a 94.98% germ reduction. The device's maximal radiation intensity lies at 254 nm which is the wavelength most efficient in inactivating bacteria. The UV-C fraction is filtered out completely by common bottle materials. However, when applied in larger containers a portion of the UV-C rays exits the water surface. CONCLUSIONS If applied according to the instructions the device manages a satisfactory inactivation of bacteria. However, it bears the danger of user errors relevant to health. Therefore, education on the risks of incorrect application should be included in the travel medical consultation. Also there are still aspects that need to be subject to further independent research.
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Affiliation(s)
- Lisa F Timmermann
- Institute of Occupational & Social Medicine, RWTH Aachen University, Aachen, Germany.
| | - Klaus Ritter
- Institute of Medical Microbiology, RWTH Aachen University, Aachen, Germany.
| | - David Hillebrandt
- Medical Commission of the Union Internationale des Associations d׳Alpinisme (UIAA MedCom), Bern, Switzerland.
| | - Thomas Küpper
- Institute of Occupational & Social Medicine, RWTH Aachen University, Aachen, Germany; Medical Commission of the Union Internationale des Associations d׳Alpinisme (UIAA MedCom), Bern, Switzerland.
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Affiliation(s)
- Paul Richards
- Centre for Altitude, Space and Extreme Environmental Medicine, University College, London, United Kingdom
- South Essex Travel Clinic, The Surgery, Wickford, Essex, United Kingdom
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Pattenden HA, Shah NM, Hillebrandt D, Rodger M, Windsor JS. Response to letter. J Travel Med 2013; 20:138. [PMID: 23464726 DOI: 10.1111/jtm.12006_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ravens-Sieberer U, Ottova V, Hillebrandt D, Klasen F. Gesundheitsbezogene Lebensqualität und psychische Gesundheit von Kindern und Jugendlichen in Deutschland: Ergebnisse aus der deutschen HBSC-Studie 2006-2010. Gesundheitswesen 2012; 74 Suppl:S33-41. [DOI: 10.1055/s-0032-1312641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- U. Ravens-Sieberer
- Forschungssektion Child Public Health, Universitätsklinikum Hamburg-Eppendorf
| | - V. Ottova
- Forschungssektion Child Public Health, Universitätsklinikum Hamburg-Eppendorf
| | - D. Hillebrandt
- Forschungssektion Child Public Health, Universitätsklinikum Hamburg-Eppendorf
| | - F. Klasen
- Forschungssektion Child Public Health, Universitätsklinikum Hamburg-Eppendorf
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Ottova V, Hillebrandt D, Kolip P, Hoffarth K, Bucksch J, Melzer W, Klocke A, Richter M, Ravens-Sieberer U. [The HBSC Study in Germany--study design and methodology]. Gesundheitswesen 2012; 74 Suppl:S8-S14. [PMID: 22836897 DOI: 10.1055/s-0032-1312642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of the HBSC-Study is to collect data on the physical and mental health and health behaviour of children and adolescents and to gain a deeper insight into their situation and the specific environment they grow up in. The HBSC-study is an international school-based cross-sectional survey conducted in collaboration with the World Health Organization (WHO). The survey takes place every 4 years since 1982 and is based on a standardised protocol. In Germany the survey was first conducted in 1994 as a pilot study in North Rhine-Westphalia. The German sample is based on a random sample of classes in all public schools in Germany. 11-, 13-, and 15-year-old pupils are surveyed by means of a paper and pencil questionnaire. The questionnaire comprises a broad selection of -topics, including sociodemographics, health and risk behaviours, family, school and peers. The reported trends in the supplement are based on the data from surveys in 2002 (N=5.650), 2006 (N=7.274) and 2010 (N=5.005). The representative samples for each of the survey years are defined as follows: in 2002 the data is based on information collected in 4 Federal States (Berlin, Hesse, North Rhine-Westphalia, Saxony); in 2006 5 states define the German data file (Berlin, Hamburg, Hesse, North Rhine-Westphalia, Saxony). The data from the 2010 survey comprises data from 15 Federal States. The HBSC-data contributes towards a better understanding of the relationship between health and living conditions of young people. The papers in this supplement deliver important insights into the living context of young people and in doing this they provide important information about their health and the long-term effectiveness of public-health-measures.
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Affiliation(s)
- V Ottova
- Zentrum für Psychosoziale Medizin, Klinik für Kinder und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Forschungssektion Child Public Health, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, Hamburg
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Ottova V, Hillebrandt D, Ravens-Sieberer U. Trends in der subjektiven Gesundheit und des gesundheitlichen Wohlbefindens von Kindern und Jugendlichen in Deutschland: Ergebnisse der Health Behaviour in School-aged Children (HBSC) Studie 2002 bis 2010. Gesundheitswesen 2012; 74 Suppl:S15-24. [DOI: 10.1055/s-0032-1312640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- V. Ottova
- Forschungssektion Child Public Health Universitätsklinikum Hamburg-Eppendorf
| | - D. Hillebrandt
- Forschungssektion Child Public Health Universitätsklinikum Hamburg-Eppendorf
| | - U. Ravens-Sieberer
- Forschungssektion Child Public Health Universitätsklinikum Hamburg-Eppendorf
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Abstract
High altitude commercial expeditions are increasingly popular. As high altitude illnesses are common on ascent to altitude, this study aimed to ascertain whether medications for these conditions were carried by commercial operators who run high altitude expeditions. Despite recommendations, it appears that drugs to treat high altitude illnesses are not routinely carried by commercial operators.
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Affiliation(s)
- T. Küpper
- Institute of Occupational and Social Medicine, Aachen Technical University, Aachen, Germany
| | | | - N. Mason
- International Porter Protection Group, United Kingdom
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Windsor JS, Rodway GW, Hillebrandt D. Dexamethasone Improves Maximal Exercise Capacity of Individual's Susceptible to High Altitude Pulmonary Edema at 4559 m. High Alt Med Biol 2011; 12:411; author reply 413. [DOI: 10.1089/ham.2011.1057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Frostbite is a thermal injury that can occur when temperatures drop low enough for tissue to freeze. On rewarming the tissues, an inflammatory process develops which is often associated with tissue loss. The extent of the tissue loss reflects the severity of the cold exposure and includes factors such as temperature, duration, wind chill, altitude, and systemic hypothermia. This review discusses the epidemiology, the pathophysiological processes involved, and the clinical management of frostbite injuries. Practical advice is given on both the field and hospital management and how to seek expert advice from remote situations. The review also discusses newer developments in frostbite treatment such as intra-vascular thrombolysis and adjunctive treatments such as the use of intravenous vasodilators.
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Abstract
The incidence of acute mountain sickness can be reduced by ascending slowly to altitude. We compared a recommended ascent rate with those offered by commercial companies to three of the most popular high-altitude destinations in the world. While the majority complied with the recommended ascent rate, ascents on Kilimanjaro did not.
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Affiliation(s)
- Neeraj M Shah
- King's College London School of Medicine, London, UK.
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Hillebrandt D. Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness—A View From the Other Side of the Atlantic. Wilderness Environ Med 2010; 21:383-4; author reply 384-5. [DOI: 10.1016/j.wem.2010.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 03/28/2010] [Accepted: 04/01/2010] [Indexed: 11/24/2022]
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Windsor J, van der Kaaij J, Ellerton J, Oxer H, Hillebrandt D, Rodway G. Methoxyflurane as an analgesic for prehospital use at high altitude. High Alt Med Biol 2009; 10:201-2. [PMID: 19519222 DOI: 10.1089/ham.2008.1075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- P R Davis
- Southern General Hospital, Glasgow G51 4TF.
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Abstract
A review of six patients requiring medical assessment prior to joining commercial mountaineering trips. Medical problems encountered include malaria risk with immunosuppression, renal transplant recipients climbing at altitude, coronary artery disease risk at altitude, cardiac pacemaker function at altitude, and diabetes with remote-area travel. Cases also illustrate personal and commercial risk assessment and potential international differences in legal duty of care. It is hoped that these cases will stimulate debate and thought regarding the preventive aspects of altitude-related medical problems. This can be achieved by education of the general mountaineering population in altitude- and expedition-related medical matters, combined with individual pretrip advice for patients.
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Abstract
The purpose of this paper is to outline one U.K. doctor's experience as advisor to a British commercial high altitude expedition company. Within the United Kingdom, this is pioneering work, and various aspects of the job are outlined that have evolved in response to the current medical needs and market forces. The U.K. medicolegal aspects of the work are considered in the light of there being no current case law to guide doctors in this role. With more people worldwide making use of commercial companies for expeditions with the associated duty of care, it is hoped that this will stimulate further debate on some potentially delicate issues that cross international boundaries.
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Hillebrandt D, Müller KM, Sommer A. [Experience with the epidiascope "Sofort-Presenter DP 30" in lectures on general and systemic pathology]. Pathologe 1999; 20:297-9. [PMID: 10501928 DOI: 10.1007/s002920050360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Additions and use of an epidiascope are described, which may be used after minor modifications for presenting whole organs and organ slices in lectures on general and systemic pathology, saving the installation of sophisticated video equipment with additional lighting etc.
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Affiliation(s)
- D Hillebrandt
- Berufsgenossenschaftliche Kliniken, Bergmannsheil Universitätsklinik, Institut für Pathologie, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum
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Hillebrandt D. Payment in kind finances refresher course. West J Med 1995. [DOI: 10.1136/bmj.311.7005.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hillebrandt D. Legal problems of a locum GP in Australia. West J Med 1982. [DOI: 10.1136/bmj.284.6311.275-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hillebrandt D. Points from letters: The third man. West J Med 1976. [DOI: 10.1136/bmj.1.6006.402-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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