Extreme sleep fragmentation for 11 consecutive days and nights does not significantly alter total sleep time, and sleep stage distribution, during the continuous alpine downhill skiing world record

Introduction: Extreme levels of sleep deprivation, fragmentation and management, are major problems in many sportive disciplines, ultramarathons, polar or extreme altitude expeditions, and in space operations. Material and methods: Polysomnographic (PSG) data was continuously recorded (total sleep time and sleep stage distribution) in a 34-year-old male whilst performing the new world record in long-term downhill skiing. He napped only during the short ski lift rides for 11 days and nights. Results: After an initial period of complete sleep deprivation for 24 hours, total sleep time and the total times of non-REM and REM achieved during the lift rides returned to standard values on the second day. PSG data revealed an average sleep time per 24 hours of 6 hours and 6 minutes. During daylight sleep was rarely registered. The subject experienced only two minor falls without injury and immediately resumed skiing. Conclusion: In a healthy, trained, elite male athlete, sleep fragmentation over 11 consecutive days did not significantly impair the sleep, motor or cognitive skills required to perform a continuous downhill skiing world record after an initial adaptation phase.

Professional competence of health educators with special consideration of physiotherapists

Health education consists in developing human knowledge, attitudes and skills and abilities, as well as in affecting human conduct in order to maintain or improve their state of health, whereas health promotion comprises propagation of a fit and healthy lifestyle including implementation of some prophylactic measures preventing the development of complaints, illnesses or diseases. Physiotherapists, who become health educators, play a significant role in attaining those objectives through undertaking some preventive measures; they also play a key part in encouraging their clients/patients to change their lifestyle and implement pro-health attitude towards life.

Plasmatic hemostasis at very high altitude — a thrombelas-tometric approach

Introduction: Changes in blood coagulation during exposure to high altitude are not well understood and studies of activation and consumption of specific coagula-tion factors in hypoxic humans have yielded conflicting results. In this study we used thrombelastometry (TEM) which allows a global evaluation of clot formation and lysis process to study blood coagulation profiles in volunteers exposed to pro-longed hypobaric hypoxia at extreme altitudes. Material and methods: We conducted a prospective, observational study in 39 healthy volunteers during a research expedition up to an altitude of 7050 m. Plasma based thrombelastometric measurements and standard coagulation parameters were performed at different altitudes. Results: TEM measurements showed an increase in clotting time (CT) and maxi-mum clot firmness (MCF) at high altitudes, paralleled by an increase in international normalized ratio (INR) and activated partial thromboplastin time (aPTT). Fibrinogen concentration increased until 6022 m. D-Dimer and Thrombin-Antithrombin complex (TAT) increased with time exposed to severe hypoxia. For both measurements highest levels were found at 4844 m after acclimatization; in contrast, lower values were observed again at 7050m in the group of summiteers. Activated protein C resistance (APC-R) was slightly lowered at all altitudes. Conclusion: Our results suggest that activation of the coagulation and fibrinolytic system occurs with increasing hypobaric hypoxia with concurrent use of coagula-tion factors indicating the occurrence of a consumption-coagulopathy phenotype.

Femoral neck stress fracture during sport climbing

While the epiphyseal stress fracture of the finger’s middle phalanx is a known sport-specific injury occurring only in adolescent climbers, and in other locations it’s rare, no femoral neck stress fracture (FNSF) in sports climbing has yet been reported. An experienced female sport climber (37y, 160 cm, 45 kg, BMI 17.5) suffered from pain in the left inguinal region while climbing, and later, also required a stick to walk. Routine radiography missed the FNSF and it was many weeks before a MRI accurately provided that diagnosis. The time between the X-ray and MRI should have been minimized as it resulted in a delayed diagnosis, unnecessary pain and delayed healing. In this situation the initial clinical investigation, the patient’s history and the X-ray did not lead to a clear diagnosis, and the initial treatment was ineffective. Further investigation by MRI and / or CT scans should have taken place sooner and would have been essential.

Patient satisfaction with tele-advice during the COVID-19 pandemic

Introduction: The coronavirus pandemic has shed a whole new light on telehealth, which has become an alternative for diagnosis, monitoring, treatment and support without physical contact between patient and healthcare professional. The aim of this study was to examine patient satisfaction with medical services provided with tele-advice during the Covid-19 pandemic. Material and methods: The study was conducted using our own questionnaire via Google Form that was correctly completed by 133 individuals between the ages of 18 and 76 years (mean 33.1 ± 13.1 years) who received medical services via tele-advice. Results: Patients with chronic conditions were statistically more likely to seek specialist services via tele-advice (p = 0.003). Slightly less than one-third of respondents (n = 39; 29.3%) were asked during the tele-advice to attend the clinic / office in person to complete the visit with a physical examination. The vast majority of subjects (n = 95; 71.4%) responded that their health status had not changed since the pandemic and the introduction of tele-advice. Nearly half (n = 64; 48.1%) believed that their health problem had been solved via tele-advice. Only 4.5% of the respondents (n = 6) strongly agreed with the statement that “tele-advice enables proper diagnosis and matching of effective treatment”, 18.0% (n = 24) tended to agree. The vast majority of respondents believed that everyone should be able to choose between tele-advice and a traditional medical visit (n = 121; 91.0%). Conclusions: The majority of people surveyed did not perceive a difference in their health since the pandemic and the introduction of tele-advice. Nearly half of respondents believed that their health problem had been resolved with a telemedicine consultation, with even fewer people convinced that “tele-advice allows for proper diagnosis and matching of effective treatment.” Patients would mostly like to have a choice between tele-visit and in-person visits, with no clear indication of the superiority of one or the other. Continuous improvement of current solutions will certainly contribute to increased patient satisfaction with the medical services provided.

Adventure travel and the Covid-19 pandemic — recommendation of the Medical Commission of the Union Internationale des Associations d’Alpinisme (UIAA)

Lots of information is available by news, internet, social media, press and medical papers. However there is a lack of specific information on how to manage the COVID risk while mountaineering. The paper should assist mountaineers and agencies to fulfill safety procedures en route.

24th Annual Meeting of the German Society for Travel Medicine (DFR) Bremerhaven, Germany, 16–18 September 2021

This year the Annual Meeting off the German Society of Travel Medicine took place in Bremerhaven, September 16th to 18th. This traditional harbour town where thousands of Germans were embarking hundred years ago facing an uncertain future, the so-called “climate house” (an exihibtion about several aspects of the world’s climate) and the Alfred-Wegener Institute for Arctic Research were a fantastic setting for the meeting’s motto “traveling under extreme conditions”. After a brillant introduction by Stefan Kröpelin about research in the Sahara two weeks away from the next pharmacy and a fascinating lecture by Eberhard Kohlberg how to organize expeditions to Antarctica and how to work and to live there several lecturers illuminated a wide field of travel medicine in more or less extreme conditions.

Periodic health examinations during a pandemic

Introduction: The coronavirus pandemic has changed daily lives. These changes affect many aspects of lives including periodic health examinations. Specialists warn that in the era of the pandemic people abandon examinations. This is a very dangerous phenomenon, which can negatively affect health and general well-being. The aim of this study was to determine the frequency of periodic health examinations during the pandemic period including the use of telephone advice services. Material and methods: The study was carried out in March 2021 among 147 people (120 women and 27 men), in the age range of 18-76 years. The study was carried out by the method of diagnostic survey, with the use of questionnaire technique (authors’ questionnaire). Questions included knowledge of prevention, frequency of periodic health examinations, and health services received by the respondents during the pandemic. Analysis of the survey results provided information on current health problems, time of diagnosis, and course of treatment to date. Results: During the pandemic, the majority of respondents had the opportunity to use a telephone advice, with women more likely to use the telephone advice than men (64.2% vs. 37.0%; p = 0.010). 36.9% of the respondents were satisfied with the service. The main reasons for dissatisfaction with the telephone advice included: inability to examine (33.3%), short telephone advice time (24.2%), misdiagnosis or ineffective treatment (21.2%), long waiting time, difficult contact with the facility (15.2%). Among telephone advice users, 39.1% had chronic diseases; among non- telephone advice users, the percentage was lower at 18.3%. Telephone advice users were significantly less likely to say they did not have periodic health examinations or did not remember when they had them done compared to non- telephone dvice users (p = 0.019). Conclusions: During the pandemic, the majority of respondents had the opportunity to use telephone advice. Only 1/3 were satisfied with the telephone advice, and the main reasons for dissatisfaction were as follows: inability to examine, short telephone advice time, misdiagnosis or ineffective treatment. Telephone advice users were significantly less likely to say they did not have periodic examinations or could not remember when they had them done compared to non-telephone advice users.

Sportspecific performance diagnosis in ski mountaineering — comparison of a sportspecific cardiopulmonary exercise test on a treadmill versus outdoors and at altitude, a pilot study

Background: Ski mountaineering is a competitive sport that has gained popularity during the last years. As most competitions are held in altitudes between 1500 m and 3500 m, a considerable amount of training occurs at various hypobaric hypoxia degrees. It was establishing a sport-specific cardiopulmonary exercise protocol using standard ski mountaineering equipment on a treadmill. This study investigated altitude’s effects on a self-regulated incremental exercise field test at 3100 m with this protocol. Methods: Six athletes were tested (24.2 ± 4.2 years) from the German Ski Mountaineering National Team with a portable telemetric cardiopulmonary exercise test equipment. First, an incremental indoor step test with skis on a treadmill (altitude 310 m) and four days later outdoor on glacier snow (3085 m) after three days of acclimatization. All athletes were exposed to repetitive intermittent hypoxia during the weeks before the test. Standard cardiopulmonary exercise parameters were recorded while individual training zones were defined according to ventilatory thresholds. Results: In highly trained athletes, mean V̇ O2peak (72/ml kg KG/min) was reduced by 25% or 9% per 1000 m altitude gain and by 18% and 23% at the first and second ventilatory thresholds, respectively. Mean maximum heart rate and the heart rate at the ventilatory thresholds were reduced at altitude compared to sea-level, as was the O2 pulse. Conclusion: Due to distinctive individual reactions to hypoxia, cold, etc., an individual and sport-specific field performance analysis, representing the daily training environment, is highly useful in world-class athletes for precise training control. Our self-regulated cardiopulmonary field protocol could well prove to serve in such a way.

Influence of moderate physical activity, including physical activity during menstruation, on the course of menstrual cycle among nullipara — an attempt to evaluate

This study is specifically concerned with the effect of regular physical activity during menstruation on the course of menstrual cycle among nullipara. Based on the author’s questionnaire, the 152 women participating in the study were divided into three groups A, B and C – depending on their level of physical activity. The physical activity at a moderate level does not significantly affect the regularity of menstrual cycles. The cultivation of moderate physical activity during menstruation does not significantly affect the duration of bleeding. Moderate physical activity is irrelevant to the abundance of menstrual bleeding. Moderate physical activity has no significant effect on menstrual pain and its duration. Women who are physically active at a moderate level throughout their menstrual cycle are less likely to experience symptoms of premenstrual syndrome (PMS) than women who are only physically active outside of menstruation and are not physically active, which may indicate that moderate physical activity during menstruation prevents symptoms of premenstrual tension syndrome. Based on the results achieved, it is not possible to clearly determine the relevance of promoting moderate physical activity, with particular emphasis on that during menstruation, among women. The study needs to be continued with particular attention paid to physical activity during the day, the influence of environmental factors and stress on the examined women, and with attention paid to the intensity of pain accompanying bleeding. However, it can be assumed that there is no justification for limiting physical activity during the menstrual bleeding phase.