Wilderness & Environmental Medicine最新文献

Mosquito-borne infections are a common cause of illness among returning travelers. Frontline healthcare providers should maintain a high degree of suspicion for these infections when evaluating ill returning travelers. This narrative review provides an overview of the most common mosquito-borne infections in travelers. We conducted a search of the medical literature for updates in the past 5 y. We reviewed resources of the US Centers for Disease Control (Yellow Book, Advisory Committee on Immunization Practices), and US Food and Drug Administration. Arboviral infections and malaria are the most frequently diagnosed mosquito-borne infections in returning travelers. Among the mosquito-borne arboviral infections, chikungunya, yellow fever, and Japanese encephalitis are all vaccine preventable. Dengue fever, although the most common arboviral infection worldwide, does not yet have a vaccine approved for use in US travelers. The incidence of Zika virus infection has decreased substantially in recent years, including a reduced frequency of infections reported in travelers. The risk of mosquito-borne illnesses can be reduced by behavioral changes and use of insect repellent, screens, netting, and insecticide-impregnated clothing. Malaria can be further prevented through the appropriate use of chemoprophylaxis.

Hammerhead worms are becoming increasingly common in the southeastern United States as the invasive species continues to spread. Limited data exist on this species acting as a pseudoparasite, with only 3 documented cases found on literature review of Bipalidae species living inside human hosts. We present one such case from Shreveport, Louisiana, of a patient who arrived at the emergency department after a hammerhead worm was expelled from his sinus passage. A 13-y-old male with a history of autism and developmental delay had been complaining of headache for 2 to 3 d. He had a spontaneous nosebleed from his right nostril on the morning of presentation to the emergency department. On blowing his nose, a large hammerhead worm was evacuated from his sinuses. Imaging studies and direct visualization did not reveal any significant damage or remaining helminths in the sinus passages. Due to patient risk factors for parasitic infection, while definitive identification of the worm species was still pending, a course of albendazole was prescribed. The patient was discharged from the emergency department in good condition. As this invasive species becomes more common in warm and humid areas of the United States, infection with these pseudoparasites may become more prevalent as well. Fortunately, this appears to be a rare occurrence, and clinical sequelae appear to be minimal after removal of the organism.

In 1911, Mabel Purefoy FitzGerald (1872-1973) conducted a study in the mountains of Colorado that offered invaluable insights into how the body responds to chronic hypoxia. Researchers awarded the Nobel Prize for Physiology or Medicine 2019 cited her work as critical in unravelling the hypoxia sensing system. The astounding career situation in which FitzGerald found herself while conducting this study offers important insights into the challenges faced by women in science at the turn of the twentieth century. Like Ginger Rogers dancing with Fred Astaire, FitzGerald did the equivalent of everything her male colleagues did, only backward and in high heels. Although it is tempting to believe that such inequities for women are relegated to history, the career challenges faced by 2023 Nobel Laureate Katalin Karikó highlight evidence that the struggle for equality of women in science remains a significant problem.

IntroductionRock climbing has recently gained popularity, particularly among females. There are no current studies evaluating pelvic floor dysfunction among female climbers. This cross-sectional study seeks to investigate the prevalence of incontinence and pelvic floor disorders among female rock climbers in the United States.MethodsThis study utilized an online survey distributed via social media platforms to assess the prevalence of pelvic floor disorders. Participants were queried about demographic information, climbing habits, pregnancy history, and pelvic floor symptoms. Data analysis involved descriptive statistics and inferential analysis where applicable.ResultsA total of 343 participants completed the study, with a median age of 34 years, lean body mass, and the majority identifying as White or Caucasian. The most common pelvic floor disorder was overactive bladder (n = 314, 91.5%), and the least common was pelvic organ prolapse (n = 6, 1.7%). Rope climbers were significantly more bothered by pelvic organ prolapse and anal incontinence symptoms than boulderers (4, p < .01 and 1.44, p < .01, respectively). Parous climbers reported significantly higher bothersome symptoms of OAB and SUI (1.43, p = .01 and 2.71, p < .01, respectively) than their nulliparous counterparts.ConclusionsAlthough rock climbing represents a relatively low-impact sport and our sample was largely comprised of young, healthy, nulliparous women, female rock climbers demonstrated higher rates of pelvic floor disorders than a normative population, with rope climbers at higher risk than boulderers. Clinicians should be aware of the need for more frequent pelvic floor disorder screening in active women.

IntroductionUltramarathon races cover distances greater than 42.2 km. They are often held on mountain trails with significant challenges, such as inclement weather and rough terrain. Female participation in this sport is on the rise, but potential gynecologic health impacts, such as menstrual changes and pelvic floor dysfunction, are not well characterized.MethodsA convenience sample of female participants at New River Trail 50-km and Promise Land 50-km races were surveyed to determine the gynecologic health impacts of ultra running on female athletes as compared with the general female population.ResultsEighty participants were surveyed. The mean age was 38 y, with 92% premenopausal participants and 50% with a history of childbirth. Irregular menstrual cycles were reported by 46% of the premenopausal females, which is significantly higher than in the general population (P<0.001). Secondary amenorrhea was reported by 29%, which is higher than in the general population, and was associated with age ≥40 y (odds ratio=8.83, P=0.008). Urinary incontinence (UI) was reported by 39% of runners, a significantly higher prevalence than in the general population (P<0.001). There was no association between secondary amenorrhea or UI between number of marathons run and number of previous births.ConclusionsThis cohort of female ultramarathon runners had significantly higher rates of irregular periods and secondary amenorrhea than the general population. UI trended toward an increase in the >40 y age group. These results highlight the need for further research into gynecologic outcomes among female ultra-endurance athletes in wilderness and endurance sports.