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PubMed2002

Morbidity on youth expeditions to developing countries.

OBJECTIVE: To document the frequency of illness and injury on youth expeditions and to compare this information with published data concerning other travelers. METHODS: During July and August 1996, 945 young people aged 15 to 20 years traveled to the developing world with a single expedition company, World Challenge Expeditions Ltd. All groups were supervised by adult leaders. Leaders recorded all episodes of illness or injury occurring on the expedition on medical cards. We report a retrospective analysis of these medical cards. RESULTS: There were no deaths or emergency repatriations for the entire group of 65 expeditions. A complete set of medical cards was received from 47 of 65 expeditions (72%). Data were available for 644 individuals (309 male and 335 female). Local medical advice was sought on 17 occasions (1% of all episodes); 2 expeditioners required admission to a hospital. Four hundred eighty individuals (75%) experienced 1646 recorded health problems during their expedition. The most common problems were headache (18% of individuals), diarrhea (33%), nausea and/or vomiting (20%), and respiratory tract symptoms (14%). CONCLUSIONS: This study suggests supervised travel to the developing world is safe for young people. The incidence of gastrointestinal and respiratory symptoms was similar to that in travelers of other age groups, and trauma or serious injury was much less common in this group than is reported in other travelers. Headache was more common than in older travelers and indicates that preexpedition briefing should focus on the assessment and potential significance of this symptom in the younger age group, particularly at high altitude (above 2500 m).

Adolescent↗
PubMed1996

A case study on energy balance during an expedition through Greenland.

A 59-year-old man who had always been lean was submitted to overfeeding for two months in preparation for a 3-week expedition through Greenland, during which a considerable negative energy balance was expected. The overfeeding protocol consisted of an estimated energy surplus of 2000 kJ per day and this induced body weight and fat gains of 4.7 and 3.6 kg, respectively. Whole-body indirect calorimetry measurements following 4 and 8 weeks of overfeeding showed that there was no change in the subject's daily energy expenditure. Ad libitum energy intake measured during a buffet-type meal was substantially increased during overfeeding. As expected, the expedition induced a negative energy balance which reduced body weight below the pre-overfeeding level. Daily energy expenditure measured 12 days after the expedition, when the subject had recovered his initial body weight, was decreased by 1.4 MJ/day. The increase in ad libitum energy intake observed during the pre-expedition overfeeding persisted after the expedition. These adaptations tended to persist three weeks and four months after the end of the expedition. These results suggest that both energy expenditure and intake were modified after the expedition to prevent a subsequent body energy deficit.

Body Composition↗
PubMed2002

Trends in mucosal immunity in Antarctica during six Australian winter expeditions.

The mucosal immune status of Australian Antarctic personnel was monitored during six wintering expeditions at two Australian Antarctic Research Stations, Casey in 1992, 1993, 1994, and Mawson in 1992, 1995, 1996. Salivary immunoglobulin and albumin levels were examined for differences between stations and expeditions, and for monthly changes over the expedition year. Salivary IgA and IgM concentrations were on average higher for the 1993 Casey expeditioners, and all salivary protein levels were lower for 1996 Mawson expeditioners compared to levels of the other expeditions. The change in salivary IgA and IgM concentrations over the 1-year period revealed a consistent pattern between expeditions. Salivary IgA levels were lower in March, April and May compared to other months of the year (P = 0.0002). Salivary IgM levels were lowest in the first 4 months of the year, with peak levels in June and July (P < 0.0001). There were no changes in salivary IgG and albumin concentrations over the expedition year. Though the cause of the changes in salivary IgA and IgM levels over the year is unknown, the changes could reflect alterations in mucosal immunity in response to stressors associated with isolation.

Adult↗
PubMed2000

Effects of a 21-day expedition to 6,194 m on human skeletal muscle SR Ca2+-ATPase.

We investigated the effects of a 21-day expedition to the summit of Mount Denali, Alaska (6,194 m) on selected Ca2+ sequestration properties of sarcoplasmic reticulum (SR) calcium pump in vastus lateralis muscle. Muscle samples were obtained by biopsy from 5 male climbers (peak oxygen consumption, VO2peak = 52.3 +/- 2.1 mL.kg(-1).min(-1)) approximately 7 days prior to (PRE) and 4 days following (POST) the expedition. A comparison of PRE versus POST measures of maximal Ca2+-ATPase activities (117 +/- 8.5 vs. 97.6 +/- 5.6 nmol.mg protein(-1).min(-1)) and Ca2+-uptake (204 +/- 15 vs. 161 +/- 11 nmol.mg protein(-1).min(-1)) measured in crude homogenates obtained from pre-exercised muscle, indicated only an effect (p < 0.05) of the expedition on Ca2+-uptake. The reduction in Ca2+-ATPase activity, representing 16.6%, was not significant (p = 0.089). The sarco endoplasmic reticulum calcium (SERCA)-ATPase isoforms, measured using Western blotting techniques, revealed a small reduction (p < 0.05) in SERCA 1 (-4.6 +/- 1.9%), but not in SERCA 2a (+2.0 +/- 1.4%). Prior to the expedition, both Ca2+-ATPase activity and Ca2+-uptake were reduced (p < 0.05) by approximately 34 and 18%, respectively, following 40 min of a two-step continuous cycling task (20 min at 59% VO2peak and 20 min at 74% VO2peak). The exercise-induced reduction in Ca2+-ATPase activity was independent of fiber type. Only in the case of Ca2+-uptake was a lower exercise response (p < 0.05) observed following the expedition, an effect that was due to the lower resting value. It is concluded that acclimatization as experienced during a mountaineering expedition induces changes in the properties of the SR Ca2+-pump, and particularly to Ca2+-sequestering function.

Acclimatization↗
PubMed2000

Expedition health and safety: a risk assessment.

Little has been published on the risks of participating in an expedition. A questionnaire survey was conducted to quantify those risks and to determine how expedition organizers plan for medical mishaps. 246 expeditions, taking 2381 participants to more than one hundred countries, were studied retrospectively. 65 expeditions (26%) reported no medical incidents; the remaining 181 reported 835 in 130,000 man-days (6.4 per 1000 man-days). 59% of the medical incidents seen on expeditions were preventable, one-third of these being due to gastrointestinal upsets. 78% of medical incidents were classified as minor and only 5% (40) as serious. There was no excess of serious incidents in any particular organizational group or environment. The findings of this survey suggest that the health risks of participating in a well-planned expedition are similar to those encountered during normal active life.

Adolescent↗
PubMed1996

The expedition to Peru and Chile (1777-1788): inventory of scientific production.

The aim of this work is to provide an inventory of the scientific corpus produced by the Spanish members of the Expedition to Peru and Chile (1777-1788). This material is divided into six large sections. The first section covers the different versions of the diary of the journey taken by the Expedition. The second section covers the drafts and workbooks used by the Expedition members for the writing of "Flora Peruviana et Chilensis," the manuscripts and published editions of this work, the materials used in the preparation of both the "Prodromus" and the "Systema Vegetabilium," the contributions of the assistants on the Expedition and some monographs of taxonomic interest. The third section is dedicated to quinological studies and other pharmacological works undertaken by Hipólito Ruiz López and José Pavón Jiménez. The fourth section includes the writings concerning Ruiz's dispute with Antonio José Cavanilles. The fifth section contains texts which set forth the botanical thought of the members of the Expedition. The sixth and final section includes the Expedition members' writings on various subjects, from anthropology and ethnography to others of a purely historical nature.

Botany↗
PubMed2005

Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection.

BACKGROUND: Many sex partners of persons with gonorrhea or chlamydial infections are not treated, which leads to frequent reinfections and further transmission. METHODS: We randomly assigned women and heterosexual men with gonorrhea or chlamydial infection to have their partners receive expedited treatment or standard referral. Patients in the expedited-treatment group were offered medication to give to their sex partners, or if they preferred, study staff members contacted partners and provided them with medication without a clinical examination. Patients assigned to standard partner referral were advised to refer their partners for treatment and were offered assistance notifying partners. The primary outcome was persistent or recurrent gonorrhea or chlamydial infection in patients 3 to 19 weeks after treatment. RESULTS: Persistent or recurrent gonorrhea or chlamydial infection occurred in 121 of 931 patients (13 percent) assigned to standard partner referral and 92 of 929 (10 percent) assigned to expedited treatment of sexual partners (relative risk, 0.76; 95 percent confidence interval, 0.59 to 0.98). Expedited treatment was more effective than standard referral of partners in reducing persistent or recurrent infection among patients with gonorrhea (3 percent vs. 11 percent, P=0.01) than in those with chlamydial infection (11 percent vs. 13 percent, P=0.17) (P=0.05 for the comparison of treatment effects) and remained independently associated with a reduced risk of persistent or recurrent infection after adjustment for other predictors of infection at follow-up (relative risk, 0.75; 95 percent confidence interval, 0.57 to 0.97). Patients assigned to expedited treatment of sexual partners were significantly more likely than those assigned to standard referral of partners to report that all of their partners were treated and significantly less likely to report having sex with an untreated partner. CONCLUSIONS: Expedited treatment of sex partners reduces the rates of persistent or recurrent gonorrhea or chlamydial infection.

Adult↗
PubMed1998

[High altitude retinal hemorrhages in the expeditions to 8,000 meter peaks. A study of 10 cases].

BACKGROUND: Retinal haemorrhages are common at high altitude. Their pathogenesis is unknown. It has been suggested that they are less frequent in sherpas, and that possible predisposing factors might be the abscence of previous high-altitude experience, the extent of the high-altitude hypoxic exposure, polycythemia (because of hyperviscosity), history of cough and Valsalva manoeuvres during the expedition, existence of severe forms of mountain sickness (high-altitude pulmonary oedema and high-altitude cerebral oedema) and use of antiinflammatory drugs. The aim of this study is to know the incidence of retinal haemorrhages in the expeditions to mountains higher than 8.000 m and their relationship to the previously referred possible predisposing factors. SUBJECTS AND METHODS: Funduscopy was performed on 17 healthy subjects taking part in expeditions to Cho-Oyu (8.201 m) and to Shisha Pangma (8.046 m) and on six of their Nepali coworkers. RESULTS: Retinal haemorrhages were found in 10 of the European (59%) and in none of the Nepali mountaineers (p = 0.019). Other 2 Spanish climbers had tortuosity and engorgment of the retinal veins. No statistical association was found between retinal haemorrhages and maximal altitude attained prior to the expedition, maximal altitude reached during the present expedition, number of nights spent at extreme altitude, weight loss as an expression of chronic exposure to hypoxia, haemoglobin, history of cough or Valsalva manoeuvres during the expedition, existence of severe forms of mountain sickness or use of drugs. CONCLUSIONS: These results do not allow us to state that the mentioned factors predispose to high-altitude retinal haemorrhages.

Adult↗
PubMed2006

Cognitive deterioration associated with an expedition in an extreme desert environment.

BACKGROUND: Prolonged exposure to extreme environments may result in cognitive changes that may influence decision making ability and increasing risk of injury or death. OBJECTIVE: To measure the cognitive performance of a healthy man as he completed a 17 day desert expedition. METHOD: A computer based cognitive test battery, subjective cognitive rating scale, and measures of physical characteristics were used. Objective cognitive performance was compared with the performance of eight age matched men who remained in their own homes. RESULTS: The speed of psychomotor, attentional, and executive functions decreased as the expedition progressed, but the accuracy of performance remained unaffected. Although some impairments were large, they resolved completely once the expedition was completed. Subjective ratings indicated that the subject had insight into his failing cognitive performance during the expedition. CONCLUSIONS: Cognitive performance can be measured repeatedly throughout an expedition in an extreme environment. Cognitive impairment may occur.

Adult↗
PubMedDate not supplied

[Calculation of energy losses in the participants of the skiing expedition to the North Pole].

During the expedition to the North Pole, the food consumption rates were calculated on a regular basis. The mean daily energy losses of the participants of the expedition, the energy losses during skiing with a rucksack across the drifting ice were estimated and the energy metabolism curve by days was built up. The body weight of the participants averaged 78 +/- 5 kg. This made it possible to perform an overall calculation per whole group. The total energy supply with food was appraised from the total amount of the food consumed during the expedition. The total body weight loss of the participants was 11.5 kg, the energy consumption being 100.000 kkal. The total (for 7 men) energy consumption during skiing without a rucksack was calculated according to the formula: [(2,770 kkal X 28.5 days)]+ +[(2,385 kkal X 35.5 days)]. It was thus found to be equal to 1.145.300 kkal. The total energy consumption during skiing with a rucksack was calculated according to the formula: (7 men X X 449 h) and was found to be equal to 1.883.200 kkal. The total energy consumption during the expedition amounted to 3.237.500 kkal. During the expedition, the daily energy deficiency per man was 1.300-1.500 kkal. This deficiency was compensated for during rest. The maintenance of such an energy supply pattern made it possible to preserve a high level of work fitness.

Arctic Regions↗
PubMed1993

Semiquantitative analysis of cerebral blood flow by means of 99Tcm-HMPAO SPECT in individuals before and after a high altitude Himalayan expedition.

Nine members of the 'Belgian Tibet Expedition 1991' underwent a 99Tcm-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission computed tomographic study before and after their stay at high altitude. Cerebral and cerebellar activity were analysed in three circumference profiles, representing the lower, middle and upper transaxial sections of the brain. The count value of each volume element (VE) was normalized to the maximum cerebellar value. In order to compare individual regional cerebral blood flow (rCBF) before and after the expedition, the relative differences in rCBF were calculated for each VE as: rel delta (%) = 100 x (value after expedition - value before expedition)/value before expedition. In 4/9 cases regional rel delta values were negative in most cortical regions; in 3/9 individuals nonsignificant changes were found and 2/9 climbers showed a positive rel delta value in most cortical regions. For the group as a whole there was (1) a mean decrease of 1.7% in global cortical CBF and (2) a significantly (P < 0.01) diminished rCBF was observed in both temporal and the left frontotemporal areas.

Adult↗
PubMed1980

An intensive Alpine climbing expedition and its influence on some anthropometric measurements.

The effects of an intensive 4 week Alpine climbing expedition on percentage body fat, absolute body fat and lean body mass was investigated in 14 adult male students. Anthropometric measures were taken on two occasions during the training period prior to the expedition, twice during the expedition and finally eight weeks after the expedition had returned home. There was a 3% reduction in percentage body fat between the first testing occasion and the fourth taken towards the end of the expedition. Over the same interval there was a mean reduction of 2.6 kg in absolute body fat and a reduction in lean body mass of 2.47 kg. All three criterion mean values on the final testing session returned to or exceeded those taken on session one.

Adipose Tissue↗
PubMed1996

Effect of altitude on body composition during mountaineering expeditions: interrelationships with changes in dietary habits.

Loss of body weight occurs during high mountain expeditions but whether it is due to inadequate diet or other factors is unknown. Moreover the composition of the weight loss is unclear. The aim of our study was to compare the nutritional, anthropometric and metabolic changes during a mountaineering expedition in two groups of climbers, whose dietary energy intake was ad libitum, one given a lacto-fish-ovo-vegetarian diet and one an omnivorous diet. The intake of various nutrients, body weight, body composition and metabolic variables were evaluated before and during high altitude exposure and after the return to low altitude. The two groups were matched for age, body mass index and gender. No significant differences were found for nutritional variables between the two groups. Energy, animal and vegetable protein and fiber intake were significantly lower at climbing quote than before the beginning of the expedition. Significant differences between before the beginning and base camp in all variables were found. Energy and animal protein intake, but not vegetable protein and fiber intake, were significantly lower at climbing quote than at base camp. All subjects significantly reduced body weight, body mass index, waist and hip circumferences but not fat-free mass and fat mass. Metabolic variables significantly improved after the mountaineering expedition. Our study seems to confirm that a mountaineering expedition decreases energy and protein intake, reduces body weight and improves metabolic variables. Because our subjects spontaneously tended to have the same food intake despite the different dietary recommendations, our study failed to observe any differences between the two groups. However, our study shows that a low protein diet, in which the type of protein is mostly vegetable protein, could be adapted for climbers determining only a small decrease of fat-free mass.

Altitude↗
PubMed2004

[The real philanthropic expedition of the smallpox vaccine: monarchy and modernity in 1803].

Smallpox resulted in the death of 30 % of those who acquired it, so the preventive method discovered by Edward Jenner (London, 1798) spread very quickly. At the request in 1803 of Carlos IV, king of Spain, his government evaluated offers to carry smallpox vaccine to the colonies. The selected proposal, by doctor Francisco Xavier de Balmis, sought to take the lymph to America and Asia in a chain of arm to arm vaccination of foundlings. The Expedition set sail from Corunna on November 30, 1803, stopped in the Canary Isles, Puerto Rico, and Venezuela and after Caracas (1804) split in two groups. Balmis led some members of the Expedition to Cuba and Mexico. For the trip to the Philippines, in 1805, parents lent their children in exchange for economic compensation and the promise that the boys would be returned home. The Expedition returned to Mexico in August, 1807, but Balmis separately took vaccine to China and returned to Spain. Another contingent of the Expedition, under vice-director José Salvany, took vaccine to what we know as Colombia, Ecuador, Peru and Bolivia. His assistant Manuel Grajales reached the Chilean Patagonia in 1811. This article also comments on three principal themes - the institutional management of the scientific project, the conflicts that characterized its course, and the children's experience. The Vaccine Expedition was a brave and humanitarian endeavor, but also an extraordinary sanitary and administrative success. It was not until the twentieth century that a global eradication campaign eliminated smallpox in the world.

History, 19th Century↗
PubMed2005

Variations in the level of some trace elements in hair of participants in the Italian expeditions in Antarctica.

As a part the Italian National Programme of Research in Antarctica (PNRA) a monitoring study has been undertaken to quantify the concentrations of some selected trace elements in human hair of participants in the Antarctic expeditions. Such concentrations may vary as a consequence of the extreme environmental conditions and changes in lifestyle experienced by participants in the expeditions, as some evidence in previous investigations seems to suggest. The present study regards samples collected on the occasion of the 2002-2003 expedition to the Italian Base of Terra Nova Bay (now Mario Zucchelli Base), i.e., just before the expedition and about one month later. Seven essential elements were taken into account, namely, Ca, Cu, Cr, Fe, Mg, Mn and Mo. Determinations were performed by Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) and Dynamic Reaction Cell Inductively Coupled Plasma Mass Spectrometry (DRC-ICP-MS). Data obtained were statistically treated by using the non-parametric Friedman test. The concentrations of Ca, Cu and Mg were found to decrease (P < 0.05). The stress caused by the severe environmental conditions might well play a role in the observed decrease.

Antarctic Regions↗
PubMed2004

Prelude to Everest: Alexander M. Kellas and the 1920 high altitude scientific expedition to Kamet.

Following his untimely death due to illness during the early stages of the first Mount Everest Reconnaissance Expedition in 1921, Alexander M. Kellas has received relatively little attention in either mountaineering or scientific literature. He remains an obscure figure despite his noteworthy contributions to high altitude physiology and exploration. He can be considered not only one of the finest exploratory Himalayan mountaineers in history, but also the first person to apply state-of-the-art knowledge of high altitude physiology to field investigations at altitudes over 6000 m. By the time of his death, it is extremely likely that Kellas had spent more time above 6000 m than anyone on Earth, undertaking no fewer than eight Himalayan expeditions between 1907 and 1921. This article revisits and examines in some detail the most ambitious high altitude physiological field study undertaken through the second decade of the 20th century, A. M. Kellas and Henry T. Morshead's 1920 Kamet Expedition. This undertaking by Kellas and Morshead was unique because it specifically emphasized investigation of the practical difficulties inherent in climbing at very high altitudes. During this endeavor, Kellas carried out the first rigorous tests of the value of supplementary oxygen for climbing at high altitude. The results of the field studies conducted during the 1920 Kamet Expedition provided strong support for the use of supplementary oxygen at high altitude. However, after Kellas died on the approach march to Everest the following year, the British mountaineering establishment did not again have a similar proponent or exponent of extreme altitude field research until physiologist Griffith Pugh once again took up the challenge in the early 1950s.

Altitude Sickness↗
PubMed1995

Doctor on a mountaineering expedition.

Doctors are welcome members on mountaineering expeditions to remote areas, but practical advice on how to prepare and what kit to take can be difficult to find. This article is a ragbag of useful advice on diverse topics. It explains the necessary preparation, provides tips for a healthy expedition, and summarises the common disorders encountered at high altitude. The comprehensive drug and equipment lists and first aid kit for climbers were used for the 1992 Everest in winter expedition. They are there to be sacrificed to personal preference and the experience and size of individual expeditions.

Altitude Sickness↗
PubMed1992

Medical planning for expeditions.

Medical planning requires the expedition physician to draw from many aspects of the knowledge base of wilderness and environmental medicine and to learn and use lessons from those that have gone before. The medical plan is dependent on parameters of the expedition objective, scope, and resources and is developed cooperatively with the overall operational plan. The gathering of medical intelligence is crucial to the planning process and includes data specific to the location of the objective area and the expedition party itself. Medical screening of individual participants should be done for extended- or high-performance ventures. Medical training of both medical and nonmedical expedition party members is the responsibility of the medical planner. The contents, configuration, and deployment of medical kits depends on several variables and must be tailored to the individual venture. Protocols for preventive medicine measures, medical communications, and casualty evacuation are all included in the medical plan. It is hoped that with the focus of attention and effort that appropriate medical planning requires, unnecessary suffering and death will be less frequent as the boundaries of human exploration continue to expand.

Emergency Medicine↗