title: Illness and injury to travellers on a premium expedition to Iceland.
abstract: BACKGROUND
  Commercial expeditions provide an opportunity for travellers to undertake various specialised travel to more adventurous and extreme destinations in the relative security of an expeditionary group with medical cover provided by an expedition physician. Little is known about the illnesses and injuries occurring on premium expeditions. The present study was designed to investigate the prevalence of health problems suffered by travellers on a premium expedition to Iceland and the Arctic Circle.
  
  
  METHODS
  In 2004, the expedition physician diagnosed and recorded all illnesses and injuries amongst 45 travellers on a premium expedition to Iceland. Information recorded included age, sex, number of days into the expedition, the nature of the presenting illness, the assessment of the condition and the treatment employed. The period of the expedition was for 18 days and travel was by chartered aircraft, cruise ship and bus.
  
  
  RESULTS
  Thirty-one (69%) travellers sought medical advice at least once for a total of 54 consultations (mean=1.7). Fifty-six health presentations were reported and recorded amongst the travellers. Females presented on 70% occasions, with the average age of expeditioners presenting being 62 years. The types of primary illness diagnosed were largely those related to the following systems: respiratory 34%, gastrointestinal 30%, dermatological 14%, and musculoskeletal 9%, and other problems 13%. Of the gastrointestinal problems, seasickness was the most common single complaint on 27% of occasions, occurring between day 4 and 9, the cruise phase of the journey. In total, the cruise phase accounted for 43 medical presentations with the pre-cruise phase accounting for 11% of them and the post-cruise phase accounting for the remaining 46%. Presentations were highest on day 5. About one third of presentations (34%) were handled conservatively with 23% requiring antiemetics and 6% requiring antibiotics. There were no deaths or other major incidents requiring emergency evacuation or hospitalisation; although 6 accidents were reported. Interestingly, accidents were significantly more likely to occur earlier in the expedition (t-test; t=2.828, df=54, p=0.007).
  
  
  CONCLUSIONS
  On this premium expedition, the health problems encountered were largely similar to those reported for other expeditions. The most common problems included respiratory, gastrointestinal, dermatological conditions and musculoskeletal conditions in descending order. As well as being part of the service provided to travellers, the inclusion of an expedition physician on this premium expedition increased the independence of the travellers on this journey, yet decreased the reliance on local health services, a source which is often scarce or absent on more remote location expeditions.
authors.affiliation: Worldwise Travellers Health Centres of New Zealand, Auckland, New Zealand. doctors@worldwise.co.nz
authors.forename: Marc T M
authors.initials: MT
authors.lastname: Shaw
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leggat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001110:Arctic Regions / Q000453:epidemiology; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009041:Motion Sickness / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014195:Travel; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control