Objective.—Maximum aerobic capacity decreases at high altitude. This study was conducted to compare the changes in maximum aerobic capacity in men and women mountaineering trainees on induction to high altitude at 4350 m by trekking.

Methods.—Eight men and 8 women mountaineering trainees in a mountaineering course were selected for the study. The initial study was conducted at 2100 m (586 mm Hg) and then during 6 to 7 days of sojourn at 4350 m (435 mm Hg). Maximum oxygen consumption (Vo_2max), maximum heart rate (HR_max), pulse arterial oxygen saturation (Sao₂), and maximum ventilation (VE_max) were measured.

Results.—Vo_2max, HR_max, duration of work (minutes), and Sao₂ saturation decreased significantly (P < .05) with increasing altitude in both sexes. Conversely, VE_max and ventilatory equivalent (VE/ Vo₂) increased significantly (P < .05). Men showed a relatively higher value of maximum exercise variables (total exercise time, exercise intensity, and Vo₂) than women trainees at both altitude locations. The decrement of Vo_2max was 13% in women and 17% in men (P < .05).

Conclusions.—The results indicate that the decrement of maximum aerobic capacity at 4350 m was less in women than in men under similar modes of ascent.

Objective.—To describe the prevalence of childhood overweight and obesity in rural high- and low-altitude populations of southwestern Saudi Arabia and to identify specific at-risk groups within these populations.

Methods.—A cross-sectional study was conducted on 912 school children and adolescents aged 6–15 years born and living permanently at high altitudes (2800–3150 m) and 972 children and adolescents of comparable ages born and living permanently at low altitudes (≤500 m). Height and weight were measured. For children <10 years, the weight-to-height index according to World Health Organization (WHO) standards was used for assessing overweight and obesity. For adolescents 10–15 years, overweight and obesity were assessed by age and gender-specific percentiles for body mass index based on the WHO/National Centre for Health Statistics reference population. A questionnaire was used for measuring parents' socioeconomic status.

Results.—The overall prevalence of overweight and obesity at high and low altitudes was 10%. The study showed that some school children and adolescents were at a significantly higher risk of developing overweight and obesity. Significant risk factors included moderate-to-high parental income, age ≥10 years, high-altitude birth and residence, and female sex (crude odds ratio 3.2 [95% CI, 1.8– 5.5], 2.3 [95% CI, 1.6–3.2], 2.1 [95% CI, 1.5–2.9], and 1.9 [95% CI, 1.4–2.6], respectively). A multivariate analysis using the direct binary logistic regression model revealed that moderate-to-high parental income, age ≥10 years, female sex, and high-altitude birth and residence were significant independent predictors of childhood overweight and obesity. (adjusted OR 3.2 [95% CI, 1.6–2.6], 2.6 [95% CI, 1.8–3.8], 2.0 [95% CI, 1.6–2.9], and 1.8 [95% CI, 1.3–2.6]), respectively.

Conclusion.—The present study identified risk factors for childhood overweight and obesity in Saudi Arabia. Among these, high altitude was a significant and independent factor. Future research is warranted to evaluate the exact mechanism by which a high-altitude environment may contribute to childhood overweight and obesity.

Objective.—To identify the emergency medical service (EMS) workload and trends associated with search and rescue (SAR) operations in Utah's National Park Service (NPS) units.

Methods.—Data for this study were collected from the Annual Emergency Medical Services Report and the Annual Search and Rescue Report for National Park Service units in Utah from 2001–2005.

Results.—There were 4762 EMS incidents reported between 2001 and 2005, including 79 fatalities (50 traumatic; 29 nontraumatic). The most common EMS transportation method was ground (1505) and helicopter (553) transport. The heaviest trauma, medical, and cardiac workload was at Glen Canyon National Recreation Area (GLCA) and the heaviest first aid workload was at Zion National Park (ZION). There were 1190 SAR operations between 2001 and 2005 involving 67 fatalities, 623 ill or injured visitors, 1813 non-ill or non-injured visitors, and 92 saves. GLCA and ZION accounted for 47% and 21% of all SAR operations. The total cost of SAR operations was $1 363 920. SAR operations most commonly occurred on weekends, involved male visitors (59%), visitors aged 20–29 years (23%), and 40–49 years (20%), and visitors participating in day hiking (221), motorized boating (196), and canyoneering (98) activities. Most SAR operations were in lake (226), desert (147), and canyon (140) environments and were resolved within 24 hours.

Conclusions.—GLCA and ZION experienced heavy use of EMS resources that should be noted by EMS administrators and planners. GLCA and ZION also reported the most SAR operations. The development of techniques to prevent the need for SAR at GLCA and ZION would likely have the most potential to reduce the financial impact of SAR incidents and morbidity and mortality to visitors.

Objective.—The purpose of this study was to compare the effects of a water electrolyte solution versus plain water on changes in drinking behaviors, hydration status, and body temperatures during wildfire suppression.

Methods.—Eight participants consumed plain water, and eight participants consumed water plus an electrolyte additive during 15 hours of wildfire suppression. Participants wore a specially outfitted backpack hydration system equipped with a digital flow meter system affixed inline to measure drinking characteristics (drinking frequency and volume). Body weight and urine-specific gravity were collected pre- and postshift. Ambient, core, and skin temperatures were measured continuously using a wireless system. Work output was monitored using accelerometry.

Results.—There were no differences between groups for body weight, drinking frequency, temperature data, activity, or urine-specific gravity (1.019 ± 0.007 to 1.023 ± 0.010 vs. 1.019 ± 0.005 to 1.024 ± 0.009 for water and water electrolyte groups pre- and postshift, respectively; P < .05). There was a main effect for time for body weight, demonstrating an overall decrease (78.1 ± 13.3 and 77.3 ± 13.3 kg pre- and postshift, respectively; P < .05) across the work shift. The water group consumed more total fluid (main effect for treatment) than the water electrolyte group (504 ± 472 vs. 285 ± 279 mL·h⁻¹ for the water and water electrolyte groups, respectively; P < .05).

Conclusion.—The addition of an electrolyte mixture to plain water decreased the overall fluid consumption of the water electrolyte group by 220 mL·h⁻¹ (3.3 L·d⁻¹). Supplementing water with electrolytes can reduce the amount of fluid necessary to consume and transport during extended activity. This can minimize carrying excessive weight, possibly reducing fatigue during extended exercise.

Introduction.—Despite ample evidence in the literature of the correlation between sports participation in general and self-esteem, there is a dearth of information regarding the probable impact of specific sporting activities on self-concept. We, therefore, sought to assess the effect of mountaineering on self-esteem and its correlates in university students.

Methods.—This longitudinal study recruited 54 students (male 26%, female 74%) from different universities in the capital city of Iran, Tehran. The students participated in a mountaineering program in Mt. Damavand in July 2006. The Rosenberg Self-Esteem Scale (RSES), SF-36, and Hospital Anxiety and Depression Scale (HADS) were completed by all the participants before and after this activity. Their demographic data and mountaineering experience were also collected.

Results.—Mean RSES after climbing was significantly higher than before the experience (24.78 ± 2.4 vs. 23.67 ± 3.3; P = .002). Self-esteem was correlated with bodily pain, and its improvement was correlated with mental health and depression (P < .05). Self-esteem and its improvement were not significantly correlated with age, sex, marital status, prior personal and family history of mountaineering, past history of mountain sickness, and reaching the summit (P > .05).

Conclusion.—This study showed that participation in a single mountaineering program improved students' sense of self-esteem. We suggest that taking up this activity might have benefits for students with depression.

The “crisis in anti snake venom supply” has been an enduring problem. Despite the frequency with which it appears in the literature, it remains unquantified and an enigma. If there is a serious shortage of anti snake venom (ASV), why has this not been resolved? Anti snake venoms are produced, and yet many suppliers are described as leaving the market. There appears to be a problem in the call for highly effective, high-quality, and cheap anti venoms that contributes to this result of suppliers leaving the market. Private companies are tasked with achieving adequate shareholder returns and by doing so ensure continued supply. Efforts should therefore target a means of lowering production cost by introducing whole immunoglobulin G (IgG) antivenoms with greater antibody yields, reducing the drive to eliminate adverse reactions, for which there are other more cost-effective treatments, as well as a means of introducing good manufacturing processes, with care based on demonstrable need. In order to ensure sustainability of supply, a private company supplier providing a whole IgG antivenom that effectively neutralizes venom is the most credible option. The need for ASV in areas of shortage mandates the need for clear decisions regarding the type of ASV and the recognition that the market requires acceptable returns for producers if supply is to be sustainable. This paper reviews the economic realities of ASV production and suggests a pragmatic, sustainable approach to the problem of supplying ASV to developing countries.

This article reports for the first time the medical significance of the Levantine viper (Macrovipera lebetina) in India. This snake is found in India in the mountainous regions of Jammu and Kashmir and is capable of causing necrosis and hemostatic manifestations, as seen in the case reported here. It is thus a class II snake of medical significance, as defined by the World Health Organization grading scale. This finding reinforces the recent decision by the Indian Government to abandon the term “Big Four” to describe important venomous species in India. Levantine viper venom is not included in the manufacture of Indian polyvalent anti–snake venom; thus, there is no current antidote for this species. Recommendations are to manage confirmed bites from this species without Indian anti-snake venom. In areas where this snake is found to be a significant contributor to envenomations, alternative anti-snake venoms can be sourced from outside India for use in high-risk groups. Continuing attention to preserving dead snakes brought with the victim for reliable identification remains a high priority.

Recent studies in normal participants have shown that right to left shunt blood vessels in the lung open up during exercise. We describe the first field study to investigate this phenomenon at altitude. This study aimed to assess the effect of altitude and partial acclimatization on inducible right to left shunting at rest and with exercise. A contrast-enhanced transcranial Doppler imaging technique to detect microbubbles after injection of blood and saline agitated with air was used to measure right to left shunting in 10 normal participants at rest and immediately after exercising to maximum oxygen consumption (Vo_2max) at 80 m, on acute exposure to 3450 m, and finally after a week above 3450 m. At 80 m, exercising resulted in right to left shunting via patent foramen ovale in 2 participants, but there was no evidence of shunting in the remaining 8 participants. Cerebral microbubbles were detected at rest in the 2 participants with patent foramen ovale on acute exposure to 3450 m, and the shunting increased on exercise (P = .04). In 5 of the remaining 8 participants without patent foramen ovale, cerebral microbubbles were detected on exercise (P = .04) but not at rest. Partial acclimatization had minimal effect on the prevalence or magnitude of the intrapulmonary or intracardiac shunts. Oxygenation was similar in those with shunts compared with those without shunts. Intrapulmonary shunting occurs on exercise at altitude, but the clinical and physiologic significances have yet to be determined. Despite the occurrence of shunting in most participants, our results suggest that this phenomenon is not a significant factor in altitude and exercise-induced hypoxia.