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epidemiological data system, similar tothesurveillance systems usedfordetecting adverse
drug reactions or environmental toxicity. Many of the questions regarding the interaction
ofaltitudewithage,disease,andpregnancyrequiresuchalarge-scaleapproach.Physicians
and other health professionals in high-altitude regions of North America and other contin-
ents that attract tourists are ideally situated for this type of investigation.
Inadditiontorecognizingimpactsofaltitudeonpreexistingconditions,focusedsurveys
of hotel and resort guests can yield data on prevalence of medical conditions in a general
population. Occupational health personnel, as well as local health care providers, could
make valuable contributions to an epidemiological survey assessing the health of individu-
als who live at high-altitude locations, particularly in the high-altitude locations of South
America andAsia.Focused,detailed studies ofselected medical conditions orpopulations,
such as the elderly and those with coronary artery disease investigated in the 10th Moun-
tainDivisionStudy,playanimportantroleinunderstandinghowspecificconditionsareaf-
fectedbyaltitude hypoxia.Thismodelcanbeappliedtoneonatal andpediatric agegroups,
pregnancy, and migraine sufferers, to name but a few of the more pressing problems need-
ing investigation. Such groups are also well suited for outcome studies.
Acute hypoxic stress tests need to be correlated with the effects of intermediate and
long-term acclimatization. Study of high-altitude natives will continue to provide inform-
ation of importance for sojourners. For example, intrauterine growth retardation in high-
altitude natives alerts us to the possible effects of hypoxia on the fetus of the sojourner;
understanding its mechanism would help assess its relevance for altitude visitors and help
determine whether such effects can be prevented or minimized.
Finally, as the molecular bases of adaptation to hypoxia and to disease unfold, new
breakthroughsmightminimizehypoxicstressandmaximizewellnessinthosepersonswith
medical conditions who choose to visit altitude because it adds to their enjoyment or qual-
ity of life.
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