Psychological Care Augmented by Telemedicine after a Polar Bear Encounter at an Arctic Research Station: A Case Report.

Background: Psychologically stressful events can be particularly challenging in the wilderness or extreme environments due to a lack of immediate medical or psychological support. Telemedicine consultations may provide a means to supply medical providers in austere environments with expertise when confronted with these situations. Methods: In this study, we detail a case of psychological care imparted to residents at a remote, arctic research station after they encountered a polar bear. The health care provider at the camp was not a dedicated mental health professional but was able to deliver psychological care with assistance from a trained provider through use of telemedicine. We provide a brief overview of the evidence behind psychological first aid and incident support sessions for the treatment of stress injuries. We also review the evidence for telemedicine for psychological care in wilderness situations and describe its use in this scenario. Results: All station residents were able to resume regular arctic activities. Resident feedback was that the sessions were advantageous. Conclusions: We anticipate the need for psychological care in austere situations to increase in the future, and further training in this field and the advancement of telemedicine consultation will be of benefit to wilderness providers.

Frostbite-A Case Series From Arctic Greenland.

Greenland is not only the largest island in the world, it is also the least densely populated country on the globe. The majority of Greenland's landmass lies within the Arctic Circle. Weather conditions in Arctic areas can be extreme, thus exposing locals and visitors to a high risk of acquiring frostbite injuries. More than two thirds of Greenland is covered by a permanent ice sheet, and temperatures can drop to below -70°C. In addition, frequent storms, occupational exposure, and alcohol all contribute to an increased risk for frostbite injury. Frostbite may cause major morbidity, including tissue loss and limb amputation. Hence, proper diagnosis and treatment of frostbite injuries is of utmost importance. We present 6 cases of frostbite injuries in Greenland, ranging from mild to severe frostbite in both locals and foreign visitors. The cases illustrate some of the known risk factors for frostbite injuries. The etiology, pathophysiology, clinical presentation, and recommended management of frostbite are summarized. Novel treatments for frostbite and frostbite sequelae are discussed in the context of the Greenlandic healthcare system. Furthermore, cultural aspects and reasons for a seemingly low incidence of frostbite injuries in Greenland are explored.

Altered sensorimotor activation patterns in idiopathic dystonia-an activation likelihood estimation meta-analysis of functional brain imaging studies.

Dystonia is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures. Functional neuroimaging studies have yielded abnormal task-related sensorimotor activation in dystonia, but the results appear to be rather variable across studies. Further, study size was usually small including different types of dystonia. Here we performed an activation likelihood estimation (ALE) meta-analysis of functional neuroimaging studies in patients with primary dystonia to test for convergence of dystonia-related alterations in task-related activity across studies. Activation likelihood estimates were based on previously reported regional maxima of task-related increases or decreases in dystonia patients compared to healthy controls. The meta-analyses encompassed data from 179 patients with dystonia reported in 18 functional neuroimaging studies using a range of sensorimotor tasks. Patients with dystonia showed bilateral increases in task-related activation in the parietal operculum and ventral postcentral gyrus as well as right middle temporal gyrus. Decreases in task-related activation converged in left supplementary motor area and left postcentral gyrus, right superior temporal gyrus and dorsal midbrain. Apart from the midbrain cluster, all between-group differences in task-related activity were retrieved in a sub-analysis including only the 14 studies on patients with focal dystonia. For focal dystonia, an additional cluster of increased sensorimotor activation emerged in the caudal cingulate motor zone. The results show that dystonia is consistently associated with abnormal somatosensory processing in the primary and secondary somatosensory cortex along with abnormal sensorimotor activation of mesial premotor and right lateral temporal cortex. Hum Brain Mapp 37:547-557, 2016. © 2015 Wiley Periodicals, Inc.