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Hüfner, Katharina, Fabio Caramazza, Evelyn R. Pircher Nöckler, Agnieszka E. Stawinoga, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Ken Zafren, Hermann Brugger, and Barbara Sperner-Unterweger. Association of pre-existing mental health conditions with acute mountain sickness at Everest Base Camp. High Alt Med Biol. 23:338-344, 2022. Background: Mental health disorders are common, but limited data are available regarding the number of people with a past medical history of psychiatric diagnoses going to high altitude (HA). It is also unknown whether mental health conditions are associated with an increased risk of acute mountain sickness (AMS). Methods: We analyzed data from a previous study at Everest Base Camp. Participants self-reported their past medical history and history of substance use and had a brief history taken by a physician. AMS was assessed using the self-reported 2018 Lake Louise AMS Score. Results: Eighty-five participants (66 men and 19 women, age 38 ± 9 years) were included. When questioned by a physician, 28 participants reported prior diagnoses or symptoms compatible with depression (23%), anxiety disorder (6%), post-traumatic stress disorder (1%), and psychosis/psychotic experiences (9%). The prevalence of psychiatric diagnoses in the past medical history was much lower in the self-reported data (2/85) compared to data obtained via physician assessment (28/85). Increased risks of AMS were associated with a past medical history of anxiety disorder (odds ratio [OR] 22.7; confidence interval [95% CI] 2.3-220.6; p  < 0.001), depression (OR 3.6; 95% CI 1.2-11.2; p  = 0.022), and recreational drug use ever (OR 7.3; 95% CI 1.5-35.5; p  = 0.006). Conclusions: Many people who travel to HA have a past medical history of mental health conditions. These individuals have an increased risk of scoring positive for AMS on the Lake Louise Score compared with people without a history of mental health conditions.

During the beginning of the Covid-19 pandemic, cities became large residential consumers of energy. In general, energy demand has decreased, but the users who used the most energy during the pandemic were the people in their homes creating a change compared to the past. How have household habits changed affecting energy use during the lockdown? Has energy demand changed equally in all homes? What factors help explain the change in daily household habits and the change in energy use? Via distribution of a questionnaire completed by 3519 people living in Italy during the first lockdown #StayAtHome, the change in daily habits and consequent energy use were investigated. It collected data on socio-demographic and household characteristics and the material context in which people live. The results were interpreted according to the social practice approach that has been used in the past to analyse energy habits and use of households, for example, for cooking. The results can support the interpretation of energy demand studies in the pandemic period and address decisions and policymaking for sustainable energy transition., (© 2021 The Authors.)

The present work constitutes the sequel to the analysis of data from an online survey administered to 464 home workers in London in January 2021 during the COVID-19 lockdown. Perceived affective quality of indoor soundscapes has been assessed in the survey through a previously developed model, as the combination of two perceptual dimensions, one related to comfort (a comfortable - annoying continuum) and the other to content (a full of content - empty continuum). Part I of the study reported on differences in comfort , content , and soundscape appropriateness based on the activity performed at home during the lockdown, i.e. working from home (WFH) and relaxation. Moreover, associations between soundscape dimensions and psychological well-being have been highlighted. Part II of the study deals with the exploration of the influences of several acoustical, building, urban and person-related factors on soundscape dimensions and well-being. A mixed-method approach has been adopted by combining multivariate regression of questionnaire scores with the qualitative analysis of spontaneous descriptions given by respondents. Results showed that several sound sources, urban features, housing characteristics, working modes and demographic factors can influence (positively and negatively) soundscape dimensions differently depending on the task at hand. Notably, the perceived dominance of neighbours' noises during relaxation, moderated by noise sensitivity, and the number of people at home were common factors negatively affecting both comfort and well-being, that partially explained the association between comfortable indoor soundscapes and better mental health. The discussion points out the importance of considering the different impacts that acoustical factors (e.g. sound typology), building (e.g., house size), urban (e.g., availability of a quiet side), situational (e.g., number of people at home), and person-related factors (e.g., noise sensitivity) can provide on building occupants depending on the specific activity people are engaged with at home and the opportunities to foster people's well-being through building, urban and acoustic design., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jian Kang reports financial support was provided by Chartered Institution of Building Services Engineers., (© 2021 The Authors.)

Hüfner, Katharina, Fabio Caramazza, Agnieszka E. Stawinoga, Evelyn R. Pircher Nöckler, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Barbara Sperner-Unterweger, and Hermann Brugger. Assessment of psychotic symptoms in individuals exposed to very high or extreme altitude: A field study. High Alt Med Biol. 22:369-378, 2021. Background: Symptoms of psychosis such as hallucinations can occur at high or extreme altitude and have been linked to accidents on the mountain. No data are available on how to assess such symptoms in the field and what their prevalence or predisposing factors might be. Methods: In this field study at Everest Base Camp (5,365 m) in Nepal, 99 participants of organized expeditions underwent 279 assessments: The High Altitude Psychosis Questionnaire (HAPSY-Q), the Prodromal Questionnaire, 16-items (PQ-16), and the Mini International Neuropsychiatric Interview (M.I.N.I., psychosis section) were collected together with further clinical data. Statistical analysis was done for each phase, that is, altitude range of the climb, and overall data. Results: One of 97 climbers fulfilled the M.I.N.I. diagnostic criteria for psychosis during one acclimatization climb. At least one endorsed item on the HAPSY-Q and the PQ-16, indicating the presence of symptoms of psychosis in the absence of a psychotic disorders, were identified in 10/97 (10.3%) and 18/87 (20.7%) participants respectively. The scores of the HAPSY-Q and the PQ-16 were correlated ( r  = 0.268, p  < 0.001). Odds ratio analysis identified an increased risk for accidents in individuals with endorsed items on the HAPSY-Q. Conclusions: The diagnosis of high altitude psychosis is rare in climbers during organized expeditions. Nevertheless, subdiagnostic symptoms of psychosis occurred in a significant proportion of climbers. Future research is needed to validate these pilot findings.

Since the outbreak of the COVID-19 pandemic, as a result of the adoption of worldwide lockdown measures, the home environment has become the place where all the daily activities are taking place for many people. In these changed social and acoustical contexts, we wanted to evaluate the perception of the indoor acoustic environment in relation to traditional and new activities performed at home, i.e., relaxation, and working from home (WFH). Taking London as a case study, the present paper presents the results of an online survey administered to 464 home workers in January 2021. The survey utilized a previously developed model for the assessment of indoor soundscapes to describe the affective responses to the acoustic environments in a perceptual space defined by comfort (i.e. how comfortable or annoying the environment was judged) and content (i.e., how saturated the environment is with events and sounds) dimensions. A mixed-method approach was adopted to reinforce result validity by triangulating data from questionnaires and spontaneous descriptions given by participants. In this first part of the study, the main objectives were: (1) evaluating differences in soundscape evaluation, in terms of comfort and content dimensions, based on the activity performed at home, (2) identifying appropriate conditions for WFH and relaxation, and (3) investigating associations between psychological well-being and indoor soundscapes. The results showed that the environments were perceived as more comfortable and slightly fuller of content when rated in relation to relaxation than for WFH, thus suggesting a stricter evaluation of the acoustic environment in the latter case. As regards the second objective, spaces that were more appropriate for relaxation had high comfort , whereas spaces appropriate for WFH resulted more private and under control, i.e. with high comfort and low content scores. Lastly, better psychological well-being was associated with more comfortable soundscapes, both for WFH (r s  = 0.346, p < .0005), and relaxation (r s  = 0.353, p < .0005), and with lower content while WFH (r s  = -0.133, p = .004). The discussion points out the need of considering the implications of changed working patterns to rethink the design of soundscapes in residential buildings, also in relation to potential well-being outcomes that will be further investigated in the Part II of the study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Aims: Psychotic symptoms during exposure to high altitude (HA) have been linked to accidents or near accidents on the mountains. It is thus of great importance to directly identify psychotic symptoms in individuals who are exposed to HA quickly and reliably on the mountain, even in the absence of experienced medical personnel. Psychotic features at HA frequently include positive psychotic symptoms such as hallucinations, delusions, or disorganized thinking/speech. The aim of the current study was to develop the first self-administered questionnaire (High Altitude Psychosis [HAPSY] Questionnaire), which individuals may use in the future to self-assess altitude-related psychotic symptoms on the mountain. Methods: We utilized two existing self-rating questionnaires for psychotic symptoms (the Psychotomimetic States Inventory, PSI and the Cardiff Anomalous Perception Scale, CAPS) as the basis for a two-round Delphi process. As part of this process, additional statements were suggested by the 40 Delphi participants. Results: Eleven self-administered statements-all of them related to positive psychotic symptoms-were identified to be most useful for the self-detection of HA-related psychotic symptoms on the mountain. Conclusion: This is the first self-administered questionnaire that allows the identification of HA-related psychotic symptoms on the mountain. A subsequent validation study is needed to address the psychometric properties of this questionnaire. Clinical validation will have to be performed in a field study.

Introduction: Educational projects in mountain rescue in Nepal have a long tradition. They are usually led by Western experts who train their Nepalese colleagues using teams of people with diverse cultural background. To better understand the challenges of these encounters, we conducted a prospective cohort study during the first mountain rescue instructor course in Nepal., Methods: Western instructors (WIs) and Nepalese instructor candidates (NICs) were asked to self-assess their intercultural competence with the help of questionnaires. The responses were compared and analyzed for differences between WIs and NICs and differences in a pre-post assessment of the WIs. In addition, semistructured interviews were conducted with randomly selected NICs., Results: We found significant differences in communication styles between NICs and WIs: NICs showed a preference to establish relationships before discussing business and not to speak openly in conflict situations. WIs were much more direct and preferred dispassionate exchanges. In an assessment after the course, WIs had changed their attitude toward the host culture., Conclusions: We found differences in communication styles between WIs and NICs that are relevant to globalized medical education. Faculty members should be prepared before implementing medical training abroad and should have time to experience the host culture.

Background: Psychotic episodes during exposure to very high or extreme altitude have been frequently reported in mountain literature, but not systematically analysed and acknowledged as a distinct clinical entity., Methods: Episodes reported above 3500 m altitude with possible psychosis were collected from the lay literature and provide the basis for this observational study. Dimensional criteria of the Diagnostic and Statistical Manual of Mental Disorders were used for psychosis, and the Lake Louise Scoring criteria for acute mountain sickness and high-altitude cerebral oedema (HACE). Eighty-three of the episodes collected underwent a cluster analysis to identify similar groups. Ratings were done by two independent, trained researchers (κ values 0.6-1).FindingsCluster 1 included 51% (42/83) episodes without psychosis; cluster 2 22% (18/83) cases with psychosis, plus symptoms of HACE or mental status change from other origins; and cluster 3 28% (23/83) episodes with isolated psychosis. Possible risk factors of psychosis and associated somatic symptoms were analysed between the three clusters and revealed differences regarding the factors 'starvation' (χ2 test, p = 0.002), 'frostbite' (p = 0.024) and 'supplemental oxygen' (p = 0.046). Episodes with psychosis were reversible but associated with near accidents and accidents (p = 0.007, odds ratio 4.44)., Conclusions: Episodes of psychosis during exposure to high altitude are frequently reported, but have not been specifically examined or assigned to medical diagnoses. In addition to the risk of suffering from somatic mountain illnesses, climbers and workers at high altitude should be aware of the potential occurrence of psychotic episodes, the associated risks and respective coping strategies.

Introduction: To explore baseline knowledge about avalanche guidelines and the Avalanche Victim Resuscitation Checklist (AVReCh) in Italy and the knowledge acquisition from a standardized lecture., Methods: Standardized lecture material discussing AVReCh was presented during 8 mountain medicine courses from November 2014 to April 2016 in different regions of Italy. To determine the knowledge acquisition from the lecture, a pre- and postlecture survey was utilized., Results: A total of 193 surveys were analyzed. More than 50% of the participants had never participated in lectures/courses on avalanche guidelines, and less than 50% of the participants knew about the AVReCh before the lecture. The correct temporal sequence of reportable information in the basic life support section of the AVReCh was selected by 40% of the participants before the lecture and by 75% after the lecture (P<0.001). Within subgroups analysis, most groups saw significant improvement in performance (P<0.05). The selection of the correct burial time increased from 36 to 84% (P<0.05)., Conclusions: Health care providers and mountain rescue personnel are not widely aware of avalanche guidelines. The standardized lecture significantly improved knowledge of the principles of avalanche management related to core AVReCh elements. However, the effect that this knowledge acquisition has on avalanche victim survival or adherence to the AVReCh in the field is yet to be determined., (Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)