Comparison of clinical features in patients with vestibular migraine and migraine.

Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM.

Association of Depression With Susceptibility and Adaptation to Seasickness in the Military Seafarers.

BACKGROUND: Although depression and motion sickness are prevalent in military personnel and seafarers, the association between depression and seasickness has been not yet elucidated. We aimed to evaluate the relationship of depression with initial susceptibility and adaptation to seasickness amongst military seafarers. METHODS: This retrospective cohort enrolled Navy seafarers who started seafaring between 2017 and 2019. Three groups were established according to the Beck Depression Inventory (BDI) score: no depression (BDI score of 0), minimal depression (BDI score 1-9), and mild-to-moderate depression (BDI score 10-29). The occurrence of seasickness requiring treatment was observed as the prescription of medication for the first 30 distant seafaring days. Considering adjustment period, the two different outcomes were defined. The susceptibility to seasickness was evaluated via at least one day suffered from seasickness requiring treatment during the early period (the first 5 seafaring days), and adaptation ability to seasickness was defined by more than 10% of the ratio, calculated days suffered from seasickness requiring treatment/days of seafaring during the late period (the 6-30th seafaring days). Binary logistic regression was further evaluated to estimate the odds of BDI groups and BDI score adjusted for age and workplace whether outside visual perception was possible. RESULTS: Among the 185 recruits, 179 participants (97%) sailed for more than 5 days were included in the study. Of the participants, 36% was susceptible to seasickness in the early and 17% was poorly adapted to seasickness in the late period. Multivariable model revealed that mild-to-moderate depression had elevated risk of poor adaptation (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.31-16.98) whereas the results were not statistically significant for susceptibility to seasickness in the early period BDI score was independently associated with increased odds of poor adaptation (OR, 1.10; 95% CI, 1.04-1.18). CONCLUSION: The present study suggests that depression is associated with poor adaptation to seasickness in Navy seafarers. Depression screening tool might be helpful for providing preventable strategies for population at risk.

Factors Affecting Car Sickness of Passengers Traveled by Vehicles in North Shewa Zone, Oromia, Ethiopia.

INTRODUCTION: Car sickness is the state of being unhealthy as a result of motions that occur while traveling by vehicles. Passengers traveled by vehicles had experienced car sickness not only as a result of the biological effects but also other associated factors. Therefore, this study aimed to identify sociocultural, individual behavioral factors and situational factors resulting in car sickness of passengers traveling by minibus or bus or both. METHODS: This study was designed in a cross-sectional study and employed a quantitative approach to collect data among 384 passengers. Primary data were collected by a survey method. Both adult male and female passengers without any confirmed disease participated in the study. Car sickness was measured as whether a passenger traveling by vehicle in the past six months had at least one of the signs and symptoms either vomiting, nausea, headache, and (cold) sweating. Quantitative data were analyzed using descriptive statistics, bivariate analysis, and binary logistic regression. The multivariate logistic regression model was employed and used to execute the associated risk factors by declaring all statistical tests significantly at p-value ≤0.05. RESULTS: The results indicated that being older (aOR = 0.972, 95% CI: 0.947, 0.999) and male passengers (aOR = 0.357, 95% CI: 0.190, 0.673) significantly decreased occurrences of car sickness. However, sleep deprivation (aOR = 8.540, 95% CI: 2.575, 28.328), eating heavy meals before starting traveling (aOR = 4.147, 95% CI: 1.659, 10.366), the aggressiveness of drivers (aOR = 5.467, 95% CI: 2.456, 12.172), and travel with other passengers in overcrowded vehicles (aOR = 9.5212, 95% CI: 5.194, 17.455) were significantly contributed to car sickness. CONCLUSIONS: The findings suggested that younger passengers should take medications that reduce the sensation of car sickness before starting traveling and female passengers should reduce unpaid domestic work before their travels. In order to prevent or reduce the sensation of car sickness, passengers should take enough physical rest, sleep well, and avoid eating heavy meals before a journey. Furthermore, passengers should strongly advise or kindly request aggressive drivers to drive slowly and uniformly. Last, the passengers should avoid traveling with other passengers in overcrowded vehicles as much as possible.

Oxidative stress and motion sickness in one crew during competitive offshore sailing.

Competitive Offshore Ocean Sailing is a highly demanding activity in which subjects are exposed to psychophysical stressors for a long time. To better define the physiological adaptations, we investigated the stress response of subjects exposed to 3-days long ocean navigation with disruption of circadian rhythms. 6 male subjects were involved in the study and provided urine and saliva samples before setting sail, during a single day of inshore sailing, during 3-days long ocean navigation, and at the arrival, to measure oxidative stress, cortisol, nitric oxide metabolites (NOx) and metabolic response. Motion Sickness questionnaires were also administered during the navigation. The crew suffered a mean weight loss of 1.58 kg. After the long navigation, a significant increase in ROS production and decrease in total antioxidant capacity and uric acid levels were observed. Lipid peroxidation, NO metabolites, ketones, creatinine, and neopterin levels were also increased. Furthermore, a significant increase in cortisol levels was measured. Finally, we found a correlation between motion sickness questionnaires with the increase of NOx, and no correlation with cortisol levels. Physical and psychological stress response derived from offshore sailing resulted in increased oxidative stress, nitric oxide metabolites, and cortisol levels, unbalanced redox status, transient renal function impairment, and ketosis. A direct correlation between motion sickness symptoms evaluated through questionnaires and NOx levels was also found.

Motion Sickness Lessons from the Southern Ocean.

BACKGROUND: The objectives were to assess the prevalence, severity, and medication taken, and to look for predictive factors in order to better identify characteristics of passengers at risk of motion sickness during transport from Hobart in Tasmania to the French polar stations in Antarctica. METHODS: There were 239 passengers who were surveyed over 4 yr with 4 round trips per year using the Motion Sickness Susceptibility Questionnaire (MSSQ), Simulator Sickness Questionnaire (SSQ), state-trait anxiety test (STAI-Trait and STAI-State), and general parameters (age, gender, number of trips, jet-lag, direction of the trip), medication, calculation of the distance of each passengers cabin to the center of gravity (CoG). RESULTS: While the passengers had a low intrinsic sensitivity to motion sickness (MSSQ), 94 reported at least one SSQ symptom of motion sickness, and 38 vomited. Five associated factors were discovered: greater initial sensitivity (MSSQ), anticipation of being ill, younger age, higher level of anxiety at midtrip, and greater distance from the CoG. Of the passengers, there were 54 who took anti-motion sickness medication at different times of the trip, however, these passengers experienced more nausea. This could be due to self-selection since they were more sensitive to motion sickness. CONCLUSION: We identified three predictive factors of motion sickness (greater intrinsic susceptibility, younger age, and greater cabin distance from the CoG). For preventive purposes, two associated factors of MS (anticipation of being ill, MSSQ score) were determined to classify three groups of risk of MS to improve passenger care during the trip. Besnard S, Bois J, Hitier M, Vogt J, Laforet P, Golding JF. Motion sickness lessons from the Southern Ocean. Aerosp Med Hum Perform. 2021; 92(9):720727.

Sea Voyage Training and Motion Sickness Effects on Working Ability and Life Quality After Landing.

BACKGROUND: The effects of seasickness on working performance during motion exposure have been reported, while the aftereffects on working ability and life quality decline (WLD) still remain unclarified.METHODS: Two cohorts of healthy male Chinese subjects received either a single (SSV) or repeated (RSV) sea voyage training program on different vessels. A seasickness incidence (SSI) questionnaire was administered to assess the prevalence of seasickness symptoms (vomiting, nausea, other, or no symptoms). A WLD questionnaire was used to survey the general feeling of WLD (severe, moderate, slight, and none) by a 4-point score as well as the incidence rate (IR) of specific WLD items within 24 h after landing.RESULTS: The RSV cohort had lower overall IR of WLD than the SSV cohort (54.64% vs. 63.78%, N 657 for both cohorts). The landing ship trainees in both cohorts showed higher general WLD score and higher IRs of physical fatigue, sleep disorder, and spontaneous locomotion decrement than those trained on the small vessels. Subjects with vomiting or nausea had higher general WLD score and higher IRs of concentration distraction, physical fatigue, anorexia, and spontaneous locomotion decrement than those with no symptoms. Higher IRs of firing accuracy decline (SSV: 21.35% vs. 7.13%, 9.14%; RSV: 22.11% vs. 9.28%, 5.27%), equipment operation disturbance (SSV: 16.85% vs. 3.57%, 6.85%; RSV: 20.47% vs. 7.85%, 7.03%) were also observed in the vomiting subjects than those with other symptoms and no symptoms.DISCUSSION: Significant WLD after landing was associated with transportation types, seasickness severity, and habituation during sea voyage training.Qi R-R, Xiao S-F, Su Y, Mao Y-Q, Pan L-L, Li C-H, Lu Y-L, Wang J-Q, Cai Y-L. Sea voyage training and motion sickness effects on working ability and life quality after landing. Aerosp Med Hum Perform. 2021; 92(2):9298.

Time Course of Simulator Sickness in Asian Military Pilots.

INTRODUCTION: This study sought to determine the incidence, severity, and time-course of simulator sickness (SS) among Asian military pilots following flight simulator training.METHODS: A survey was conducted on Republic of Singapore Air Force pilots undergoing simulator training. Each subject completed a questionnaire immediately after (0H), and at the 3-h (3H) and 6-h (6H) marks. The questionnaire included the simulator sickness questionnaire (SSQ) and a subjective scale to rate their confidence to fly.RESULTS: In this study, 258 pilots with a median age of 31.50 yr (range, 2155 yr) and mean age of 32.61 6.56 yr participated. The prevalence of SS was 48.1% at 0H, 30.8% at 3H, and 16.4% at 6H. Based on a threshold of an SSQ score >10, the prevalence of operationally significant SS was 33.3% at 0H, 13.2% at 3H, and 8.1% at 6H. The most frequent symptoms were fatigue (38.1%), eye strain (29.0%), and fullness of head (19.9%). There was no significant difference in mean scores between rotary and fixed wing pilots. Older, more experienced pilots had greater scores at 0H, but this association did not persist. A correlation was found between SSQ score and self-reported confidence.DISCUSSION: To our knowledge, this study is the first to report the prevalence of operationally significant SS in Asian military pilots over serial time points. Most pilots with SS are able to subjectively judge their fitness to fly. Sensitivity analysis suggests the true prevalence of SS symptoms at 3H and 6H to be closer to 23.8% and 12.0%, respectively.Loi JEQ, Lee MLL, Tan BBC, See B. Time course of simulator sickness in Asian military pilots. Aerosp Med Hum Perform. 2020; 91(11):892896.

Exploring the Participant-Related Determinants of Simulator Sickness in a Physical Motion Car Rollover Simulation as Measured by the Simulator Sickness Questionnaire.

Physical motion driving simulators serve as a valuable research and training tool. Since many simulator participants suffer from simulator sickness (SS), we aimed to gain a better understanding of participant-related variables that may influence its incidence and severity. The study involved a 2-min mobile-platform car rollover simulation conducted in a group of 100 healthy adult participants. SS was measured with the Simulator Sickness Questionnaire immediately before and after the simulation. We investigated how the symptomatology of SS varies with gender, as well as with participants' previous experiences such as extra driving training or car accidents. Although many SS symptoms occurred already before the simulation, all the symptoms except burping had a significantly greater incidence and severity after the simulation. Before the simulation, men reported disorientation symptoms more often than women, while participants with prior experiences of extra driving training or car accidents scored significantly higher in three out of four Questionnaire components: nausea symptoms, oculomotor symptoms, and the total score. The study offers interesting insights into associations between SS and prior experiences observed by means of high-fidelity real-motion simulations. More research is needed to determine the nature of these associations and their potential usefulness, for example, in helping accident survivors to cope with the distressing or even potentially disabling psychological consequences of accidents.

Patterns of illness and injury on Antarctic research cruises, 2004-2019: a descriptive analysis.

BACKGROUND: Before the impact of the coronavirus disease 2019 pandemic, cruise travel had experienced exponential growth in the preceding decade. Travel medicine practitioners were increasingly called upon to provide pre-cruise travel advice and medical clearance. Demand for these services will return at some time in the future. METHODS: The clinical conditions seen in those presenting for care on six small-vessel scientific cruises to Antarctica were analysed. RESULTS: Personnel presented on 196 occasions resulting in 257 consultations (when initial plus all follow-up consultations were included). Personnel presented with a clinical condition at a rate of 17.9 per 1000 person-days at sea. The total consultation rate was 23.5 per 1000 person-days at sea. Injury accounted for 24% of all presentations at a rate of 4.3 per 1000 person-days at sea. Dermatological, soft tissue and musculoskeletal, general malaise and motion sickness were the four most common presentations. CONCLUSIONS: Pre-cruise advice for travellers planning small-vessel cruises to polar regions needs to include skin care, prevention and management of sea sickness and how to reduce the risk of injury. Those providing medical care on such cruises should be prepared to manage a wide range of clinical presentations.

Severe motion sickness in infants and children.

INTRODUCTION: Susceptibility to severe motion sickness has not been well described in the pediatric population, particularly in very young children. This study aimed to describe and evaluate risk factors and treatment responses in a group of children with severe motion sickness, including infants and toddlers. METHODS: We conducted a retrospective review of patients less than 18 years of age seen in our pediatric vestibular program for evaluation of motion sickness over a 6-year period. RESULTS: A total of 23 patients with motion sickness were identified. Age of onset ranged from 0 to 15 years old, with a mean age of 6.6 ± 4.2 years. Eleven patients (47.8%) were diagnosed with a migraine variant. Vestibular deficits were identified in four out of 17 patients (23.5%) who underwent formal vestibular testing. Other frequent comorbid conditions included recurrent/chronic otitis media (n = 9; 39.1%) and a history of motor delay (n = 7; 30.4%). A high proportion of patients reported symptom improvement when treated with meclizine, ondansetron, cyproheptadine, or vestibular rehabilitation. DISCUSSION: Motion sickness can impact children even in infancy. Common comorbid conditions that may contribute to pediatric motion sickness include migraine disorders, vestibular impairment, otitis media, and motor delay. Treatments such as cyproheptadine and vestibular rehabilitation may be helpful but require further study.

The Relationship Between Vestibular Migraine and Motion Sickness Susceptibility.

OBJECTIVES: To determine the relationship between vestibular migraine (VM) and motion sickness (MoS) susceptibility and their comorbidity in a large student population, and to assess whether experiencing MoS is associated with higher susceptibility for VM. METHODS: Surveys including Motion Sickness Susceptibility Questionnaire (MSSQ) and questions assessing migraine-related symptoms as well as family history of motion sickness and migraine headache were distributed to the university undergraduate students through Facebook and email. Diagnosis of definite VM (dVM) was based on the criteria of the International Classification of Headache Disorders. RESULTS: Of 277 survey responders, 148 (53%) were found to be susceptible to MoS in which 74 (50%) met the criteria for dVM. Only childhood MSSQ score was significantly higher in participants with dVM compared with those without dVM (25.78 ±â€Š15.89 versus 20.77 ±â€Š14.28, p = 0.04); however, its significance faded out by regression analysis. Multivariate logistic regression showed having 1st degree relative with migraine headache (p = 0.02), neck stiffness (p = 0.001), and sinus pain, facial pressure, or headache with wind exposure (p = 0.02) to be independently associated with presence of dVM in MoS subjects. CONCLUSIONS: Though participants with MoS and dVM had significantly greater rates of migraine-related symptoms and family history of migraine headache compared with those with MoS only, childhood and adulthood MSSQ scores were similar. This and the high prevalence of dVM in our MoS cohort may suggest an existing association between MoS susceptibility and VM.

Cardiovascular testing of seasickness in healthy volunteers on life rafts.

OBJECTIVES: The role of the cardiovascular system in the development of seasickness remains uncertain. MATERIAL AND METHODS: Overall, 18 healthy students (10 males and 8 females) aged 18-24 years volunteered in the project, spending 2-7 h on life rafts. The cardiovascular system was examined with impedance cardiography. Susceptibility and symptoms of seasickness were evaluated by the Motion Sickness Susceptibility Questionnaire Shortform (MSSQ-Short) and the Motion Sickness Assessment Questionnaire (MSAQ). The Visual Analogue Scale (VAS), ranging 0-10, was used to assess nausea, dizziness and mood. The parameters were assessed at 2 time points. RESULTS: Differences in the heart rate (HR), the thoracic fluid content index (TFCI), the stroke index (SI) and the Heather index (HI) before launching the life rafts and after leaving them were observed (78.6, 20.8, 55.6 and 15.9 vs. 70.1, 19.7, 60.5 and 17.9, with p-values of 0.002, <0.001, 0.003 and 0.004, respectively). Females reacted with changes in SI and HR more vividly, whereas males regulated more HI and TFCI. In addition, HR correlated significantly with the central and peripheral symptoms in MSAQ, stroke volume (SV) with peripheral and sopite-related ones, SI with overall ones, and pulse pressure with overall, gastrointestinal and central ones (Spearman's rank correlation coefficient [ρ] was -0.478, -0.711, 0.476, 0.472, 0.525, -0.476, -0.579 and -0.584, respectively). As regards MSSQ-Short, it correlated negatively with sopite-related symptoms in MSAQ (ρ= -0.486). Mood in VAS correlated significantly with gastrointestinal symptoms, SI and the cardiac index (CI) (ρ = -0.752, -0.492 and -0.489, respectively). CONCLUSIONS: It was found that HR correlated negatively, and SV/SI correlated positively, with the severity of seasickness symptoms measured with MSAQ. Gender is probably an independent factor influencing reactions to motion. Women react with SI increase whereas men react with increased heart contractility (HI rise). Negative mood in seasickness evaluated with VAS seems to be mostly determined by gastrointestinal symptoms assessed with MSAQ and diminished cardiovascular indices (both CI and SI). Int J Occup Med Environ Health. 2020;33(4):467-77.

Motion Sickness Predictors in College Students and Their First Experience Sailing at Sea.

INTRODUCTION: Individual motion sickness susceptibility can be rapidly estimated by the motion sickness susceptibility questionnaire (MSSQ), but its stability is affected by various factors. The purpose of this study was to investigate the involved predictive factors of motion sickness screened with uniform samples of Chinese college students and to verify the individual susceptibility difference in marine navigation.METHODS: A total of 1051 college students (719 men, 332 women; mean age: 18.32 ± 0.65 yr) completed the MSSQ. Another 42 men (mean age: 21.12 ± 1.10 yr) took part in 2 separate voyages. MSSQ data were collected before sailing and Graybiel motion sickness questionnaire (GMSQ) data were collected within 24 h after sailing and 24 h before landing.RESULTS: The internal consistency of the MSSQ was 0.685. The mean subscore of the MSSQ-A (18.47 ± 19.49) was significantly higher than that of the MSSQ-B (12.69 ± 14.97). Women had significantly higher MSSQ scores (38.29 ± 33.49) than men (27.87 ± 30.27). The mean MSSQ score of the inland subjects (33.97 ± 33.35) was significantly higher than that of the coastal subjects (27.81 ± 29.24). Nearly 93% of new seafarers experienced seasickness during their first navigation. The MSSQ score was positively correlated with seasickness symptoms (r = 0.706).CONCLUSION: Gender, age, and birthplace appear to be important predictors of motion sickness for Chinese college students. Specifically, women, younger people, and people who were born in inland China seem more prone to the syndrome. A high MSSQ score is a risk factor for seasickness. However, long-term voyages can lead to habituation, which reduces the occurrence of seasickness.Zhang X, Sun Y. Motion sickness predictors in college students and their first experience sailing at sea. Aerosp Med Hum Perform. 2020; 91(2):71-78.

Dynamic predictive model for postoperative nausea and vomiting for intravenous fentanyl patient-controlled analgesia.

Postoperative nausea and vomiting is the most common side-effect of opioid-based intravenous patient-controlled analgesia. Apfel's simplified risk score is popular but it has some limitations. We developed and validated a dynamic predictive model for nausea or vomiting up to 48 postoperative hours, available as an online web application. Fentanyl was used by 22,144 adult patients for analgesia after non-cardiac surgery under general anaesthesia: we randomly divided them into development (80%) and validation (20%) cohorts, repeated 100 times. We used linear discriminant analysis to select variables for multivariate logistic regression. The incidences of postoperative nausea or vomiting were: 0-48 h, 5691/22,144 (26%); 0-6 h, 2749/22,144 (12%); 6-12 h, 2687/22,144 (12%); 12-18 h, 2624/22,144 (12%); 18-24 h, 1884/22,144 (9%); and 24-48 h, 1082/22,144 (5%). The median (95%CI) area under the receiver operating characteristic curve was 0.72 (0.71-0.73) up to 48 postoperative hours compared with 0.65 (0.64-0.66) for the Apfel model, p < 0.001. The equivalent areas for 0-6 h, 6-12 h, 12-18 h, 18-24 h and 24-48 h were: 0.70 (0.69-0.72); 0.71 (0.69-0.73); 0.69 (0.68-0.71); 0.70 (0.67-0.72); and 0.69 (0.66-0.71), respectively. Our web application allows clinicians to calculate incidences of nausea and vomiting in patients receiving intravenous fentanyl for patient-controlled analgesia.

Survey of motion sickness susceptibility in children and adolescents aged 3 months to 18 years.

We conducted two representative, cross-sectional, population-based surveys on the susceptibility to motion sickness (MSS) in childhood: One was targeted at parents with children aged 6 months to 18 years (7569 households approached) and the other at parents with children aged 3 months to 5 years (12,720 households approached). In both surveys 3285 parents provided information on 5041 children. The main findings in the first survey were: 369 children (9.2%) were susceptible to motion sickness with a slight female preponderance, and in the second study 16 (1.2%) were susceptible; first occurrence of motion sickness (MS) below the age of 1 year was exceptionally rare (n = 2); if MS occurred after the age of 1 year it was more severe in the younger children, most pronounced between the age of 6 and 9 years; the frequency of MSS was highest in the range between the age of 4 and 13 years; in postpubertal children and adolescents MSS frequency declined. The course of MSS frequency from infancy to adolescence is an inverse U-shaped curve. It is characterised by three phases which may be related to the visual-vestibular mismatch theory, the major pathophysiological cause of MS. Phase one is a high resistance in the first year of life. In this phase infants may be less subject to visual-vestibular mismatch, because they do not yet use visual cues for self-motion perception. Phase two is a prepubertal peak. This is possibly due to an oversensitivity to a visual-vestibular mismatch, which reflects sensorimotor maturation. Phase three is a postpubertal decline. This can be explained by habituation through repetitive motion stimulation during various kinds of vehicle transportations.

Real-time visual feedback about postural activity increases postural instability and visually induced motion sickness.

BACKGROUND: Several studies have shown that the kinematics of standing body sway can be influenced by the provision of real time feedback about postural activity through visual displays. RESEARCH QUESTION: We asked whether real time visual feedback about the position of the body's center of pressure (COP) might affect body sway and the occurrence of visually induced motion sickness. METHODS: Standing participants (women) were exposed to complex visual oscillation in a moving room, a device that nearly filled the field of view. During exposure to complex visual oscillations, we provided real time feedback about displacements of the body's center of pressure through a visual display presented on a tablet computer. RESULTS: The incidence of motion sickness was greater than in a closely related study that did not provide real time feedback. We monitored the kinematics of the body's center of pressure before and during exposure to visual motion stimuli. Body sway differed between participants who reported motion sickness and those who did not. These differences existed before any participants experienced subjective symptoms of motion sickness. SIGNIFICANCE: Real time visual feedback about COP displacement did not reduce visually induced motion sickness, and may have increased it. We identified postural precursors of motion sickness that may have been exacerbated by the COP display. The results indicate that visual feedback about postural activity can destabilize postural control, leading to negative side effects. We suggest possible alternative types of visual displays that might help to stabilize posture, and reduce motion sickness.

Preparation and medical follow-up for a single-handed transatlantic rowing race.

BACKGROUND: A single-handed transatlantic rowing race was organised between Senegal and French Guyana (2600 nautical miles). During the race, rowers adjust their lifestyle to maintain an optimal level of performance. Nutrition, circadian rhythm disturbance, psychological state, pain and other medical problems impact on physical abilities and increase the occurrence of accidents. We surveyed the prevalence of medical complications during this race and the preparation that we could suggest for this kind of activity. MATERIALS AND METHODS: This is a descriptive, retrospective case series study. Follow-up consisted of sending out a questionnaire and performing individual interviews. RESULTS: A total of 23 participants including 1 woman and 22 men; mean age of 46.5 years (range: 35-59) entered the race. The race lasted for 39 to 52 days with participants rowing between 10 and 12 h/day. Nine participants dropped out. Energy intake was 4500 to 6000 kcal/day and fluid intake was 4 to 5.5 L/day. Mean weight loss was 13.3 kg. The resting period was 6 ± 1 h/24 h divided into 1.5 to 2 h periods essentially during darkness. A total of 92% of the racers required medical care for dermatological problems; other conditions requiring medical care were: tendinitis in 10 cases, diarrhoea in 4, moderate to severe seasickness in 4, hallucinations in 3, panic attacks in 2, burns in 2, and disembarkation syndrome ("land sickness") lasting from 45 min to 6 h in 13. CONCLUSIONS: Physiological and psychological impact of this type of event is still unclear. The most common medical problems are dermatological, rheumatological complications and minor trauma. Medical and psychological preparation should be offered to candidates for these competitions.

Predicting morphine related side effects in the ED: An international cohort study.

STUDY OBJECTIVES: Morphine is the reference treatment for severe acute pain in an emergency department. The purpose of this study was to describe and analyse opioid-related ADRs (adverse drug reactions) in a large cohort of emergency department patients, and to identify predictive factors for those ADRs. METHODS: In this prospective, observational, pharmaco-epidemiological international cohort study, all patients aged 18years or older who were treated with morphine were enrolled. The study was done in 23 emergency departments in the US and France. Baseline numerical rating scale score and initial and total doses of morphine titration were recorded. Logistic regression analysis was used to study the effects of demographic, clinical and medical history covariates on the occurrence of opioid-induced ADRs within 6h after treatment. RESULTS: A total of 1128 patients were included over 10months. Median baseline initial pain scores were 8/10 (7-10) versus 3/10 (1-4) after morphine administration. Median titration duration was 10min (IQR, 1-30). The occurrence of opioid-induced ADRs was 25% and 2% were serious. Patients experienced mainly nausea and drowsiness. Medical history of travel sickness (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.01-2.86) and history of nausea or vomiting post morphine (OR, 3.86; 95% CI, 2.29-6.51) were independent predictors of morphine related ADRs. CONCLUSION: Serious morphine related ADRs are rare and unpredictable. Prophylactic antiemetic therapy could be proposed to patients with history of travel sickness and history of nausea or vomiting in a postoperative setting or after morphine administration.