Wilderness & Environmental Medicine最新文献

IntroductionFemales are underrepresented in the expedition environment. There are no published studies exploring females' concerns relating to their health in this environment. There is no guidance in key medical texts on preparing females during the pre-expedition phase. This study asked to what extent female-specific health concerns are a barrier and why.MethodsThis cross-sectional study used an electronic survey distributed to females aged 18 to 40 y. Individuals from both the expedition community and those with no related experience were invited to participate via WhatsApp and Posters in local workplaces. Questions explored attitudes around toilet facilities, period health (PH), and strategies females use to manage periods on expeditions.ResultsTwo hundred and eighty-one individuals completed the survey. Lack of toilets is a barrier to participation in adventure tourism and expeditions (AT&E) for 24% of respondents. PH concerns were a barrier for 26%, and only 12% had no concerns with managing PH. Concerns regarding toilets or PH have stopped 11.4% from taking part in expeditions. When looking for information regarding PH and AT&E, 14% of participants were unable to find useful information, and only 10% of respondents felt that school education was adequate.ConclusionsFemale health concerns are a barrier to participation in AT&E, and currently, the expedition community and education are not equipping individuals to overcome those barriers. For >10% of participants, these barriers have caused them to miss life-affirming opportunities. Better pre-expedition resources are needed for females, and further research is needed across a wider age range, including perimenopausal and teenage populations.

IntroductionPreventing illness and maintaining hygiene in the genital and anal regions are concerns when hikers spend extended time in the backcountry. This cross-sectional survey study assessed prevention and hygiene strategies used by female long-distance backpackers and whether these approaches are associated with an increased incidence of symptoms of diarrhea, urinary tract infection, vaginitis, and dermatitis.MethodsA total of 868 long-distance backpackers who hiked in 2021 completed a survey about the prevention and hygiene strategies they used, and results were divided by anatomic sex. Chi-squared and effect sizes were used to determine if any practices were associated with a change in the frequency of adverse health outcomes. Thematic analysis of open-ended comments facilitated interpretation of the findings.ResultsThere were 620 respondents reporting female anatomy. Reusable products often were used for menstrual management and for postelimination hygiene. Several hygiene management practices and some reusable products were associated with increased reports of ill health effects. Hikers with more on-trail experience and a consistent hygiene routine were less likely to report adverse effects.ConclusionsLong-distance hikers use a variety of strategies to manage genital and perianal hygiene while in the backcountry, with reusable products being popular. Most strategies had little adverse effect on health. Maintaining a consistent hygiene routine appeared to be protective. More study is needed to understand whether the use of female urinary devices leads to more urinary tract infections or if minor modifications in their application could prevent such symptoms.

This case report details 2 recent fatal leopard attacks on herdsmen at Zobidao Ranches in Botswana aged 24 y and 58 y. The younger man was attacked while searching for cattle, and the older man was killed while pursuing the leopard. Both men sustained multiple deep and superficial injuries to their necks, scalps, and limbs consistent with leopard attack patterns, leading to death from massive blood loss due to multiple injuries. The findings reinforce the potentially lethal nature of leopard attacks and the need to educate humans to avoid leopard territories as well as not to engage with them.

To provide guidance to clinicians about best practices in caring for burn patients in remote settings, the Wilderness Medical Society convened an expert panel to develop an evidence-based clinical practice guideline. Recommendations for field-expedient care are made, with recommendations being graded using the American College of Chest Physicians criteria for the quality of supporting evidence and balance of risks and potential harms of treatment.

Introduction-The purpose of this study was to evaluate pediatric skiing and snowboarding fracture injuries at a large ski resort, comparing injury patterns in those who sustained fracture injuries at a single site against those with injuries in multiple sites. Given the more serious nature of multisite injuries, this information may give healthcare providers insight into injury patterns when assessing a patient in snow sport settings.Methods-Radiographs of 797 patients aged 3 to 17 y diagnosed with at least 1 skiing- or snowboarding-related fracture at a large ski resort were reviewed by a sports medicine fellowship-trained physician. Descriptive information about regions of injury was provided, and Bonferroni-corrected multivariable logistic regression modeling and χ² tests were used.Results-Of the total, 756 patients had single-site fractures, whereas 41 patients had fractures with a secondary injury. Upper extremity fractures were the most common primary injury site in both groups at 61%. The head/neck was the most common location of a second injury, with concussions being the most common injury type. Collision with an object or person and being transferred to a local hospital were independently associated with higher odds of a multisite injury. No significant differences were found when comparing age, sex, self-rated ability, or terrain.Conclusions-One must maintain a high index of suspicion for concussions/head injuries following any fracture injury and have a low threshold for working up internal organ injuries with fractures in the torso.

IntroductionFreshwater sources (eg, lakes, ponds, rivers, or streams) can be contaminated by pathogens. Ingesting water from these sources can cause illness if the water is insufficiently treated.MethodThe Waterborne Disease and Outbreak Surveillance System (WBDOSS) collects data on waterborne disease outbreaks associated with drinking water, recreational water, other nonrecreational water, and undetermined exposures to water. We analyzed outbreaks reported to WBDOSS that involved ingesting water from freshwater sources in outdoor settings.ResultFrom 2000 through 2022, public health officials in 16 jurisdictions reported 32 outbreaks associated with ingesting water from insufficiently treated freshwater sources. These outbreaks resulted in 437 illnesses, 4 hospitalizations, and no reported deaths. Giardia was implicated in 69% of outbreaks, and Campylobacter was implicated in 28% of total cases. Water from rivers or streams was implicated in 75% of outbreaks. In half the reported outbreaks, water treatment was not attempted. Individuals were primarily exposed in outdoor recreational areas (eg, public outdoor areas, state parks, campgrounds), with most illnesses occurring in those aged 10-19 years.ConclusionThis is the first summary dedicated to outbreaks associated with ingesting freshwater. These outbreaks can be mitigated using potable water sources, when available, or appropriate water treatment. Public health and provider efforts could include engaging the public-especially those who spend time in the backcountry-regarding health risks and encouraging hygiene, safe disposal of feces, and recommended water treatment methods. Healthcare providers should be encouraged to ask individuals about potential exposure to water from outdoor freshwater sources when presenting with gastrointestinal illness.

IntroductionWe examined the physiologic alterations in respiratory and cardiovascular parameters during and after acute exercise under controlled woodsmoke inhalation conditions.MethodsThis study involved 20 recreationally active participants (10 males and 10 females) divided into groups based on their sensitivity to the cold pressor test (CPT⁺ vs CPT^-) and their chronotype, as assessed by the Morningness-Eveningness Questionnaire. Participants completed a 120-min stationary cycling session at 50% VO₂max while exposed to woodsmoke at a concentration of 250 μg·m^-3. Assessments of heart rate variability, pulse wave velocity, blood pressure, pulmonary function testing, and oxidative stress were performed before, immediately after, and 24 h after exercise.ResultsIn the CPT⁺ group, significant alterations were noted in the pulse wave velocity variable, augmentation index, and heart rate variability metrics of logarithmic transformation of high- and low-frequency powers of heart rate variability immediately following exercise, whereas no such changes were observed in the CPT^- group.ConclusionClassification of participants indicated a potentially susceptible subpopulation when exposed to a single acute exercise session in the presence of woodsmoke.

IntroductionAlthough rock climbing is approaching gender parity in participation, female representation in rock climbing research remains to be investigated. We evaluated the gender distribution of study participants and authorship in the rock climbing literature.MethodsWe conducted a systematic review with PubMed and Embase to identify original research articles involving rock climbers. We categorized articles by and extracted data on the sex (female and male) of study participants and authors. Author gender was classified with Genderize.io, an automated probability-based assessment software.ResultsWe identified 298 original research articles from 1973 to 2023. Among the 266 articles that reported study participant gender, females comprised 36% of climber participants. Eighty-two articles (31%) had all-male climber participants, whereas 7 articles (3%) had an all-female cohort. Female climbers were the most underrepresented in articles investigating chronic climbing injuries (13% female), imaging studies (15%), and injury rehabilitation (20%). Female representation was highest in studies about youth climbing (43%) and epidemiology (36%). Of 1360 total authorships, 290 (21%) were female. Females were first authors for 54 articles (18%) and last authors for 53 articles (18%). Articles with female first authors had a higher proportion of female study participants than those with male first authors (39 vs 36%; P<0.001), whereas the proportion was similar between female and male last authors (36 vs 36%; P=0.592).ConclusionsFemale representation in climbing research and authorship is limited. Most research has studied male climbers, limiting the ability to apply these results to female climbers.

The king cobra (Ophiophagus hannah s str) is feared for its large size and highly toxic venom because its bite can result in severe envenoming and life-threatening injuries. We report a case involving a 50-y-old male from the mountainous town of Yunnan Province who experienced cardiopulmonary arrest after being bitten by a king cobra on his left index finger, followed by myocardial injury, pulmonary infection, and serologic reactions. During treatment, the patient received Bungarus multicinctus antivenom and cobra antivenom to neutralize the toxin, intubation, mechanical ventilation, antibiotics, anticholinergic drugs, and antiallergy therapy. After active treatment, the patient ultimately recovered. This case analysis highlights the multiple toxic reactions caused by the bite of the king cobra. It emphasizes the critical importance of timely and effective antivenom therapy and a comprehensive treatment strategy in managing snakebite injuries.