Having chronic medical illnesses associated with AMS, visiting a high altitude destination in the previous 2 months, limiting physical activity soon after

arrival, modifying the diet on arrival, and using oxygen for prevention were retained by the backwards logistic regression analysis (likelihood ratio χ2 = 60.5, df 5, p < 0.01, Cox and Snell R2 = 0.67). Fifty-five of 456 (12.0%) subjects with AMS consulted another person about treatment for their symptoms. The sources for treatment advice were other travelers (23/54, 42.5%), local pharmacy personnel (19/54, 35.1%), tour guides (17/54, 31.4%), and physicians (10/54, 18.5%). Eleven of Ibrutinib cell line 54 (20.3%) consulted more than one source. Three of 54 (5.5%) subjects required hospital admission and one subject was evacuated urgently because PF 2341066 of concomitant pulmonary edema. Nearly half of the travelers visiting Cusco had symptoms compatible with AMS. One in five of these travelers had their travel plans affected by AMS. Despite the high prevalence of AMS and severe AMS, few used health services before travel or during travel. The prevalence of AMS among participants was significantly higher than that reported for non-mountaineer or trekker groups in the Andes and ski resorts at similar altitudes.[11-14] Rate of ascent may explain these differences. In our study, 75% of travelers flew from sea

level to Cusco (3,400 m) in 1 hour. Only 40% of the participants received pre-travel advice from a health care professional. This contrasts with other reported data showing higher rates of pre-travel advice among travelers to Cusco.[8] Data Etomidate suggest

that traveler’s age plays a role in pre-travel consultation. Provost and Soto studied predictors for pre-travel health consultation among Canadian travelers. In that study travelers less than 45 years of age were less likely to seek pre-travel health services.[15] Thus, low rates of consultation are not unexpected given the mean age of our study population. Cabada and colleagues reported that European travelers to Cusco were more likely to consult health care professionals before travel than travelers from North America.[16] The latter constituted half of our study sample and may also account for the lower rates of pre-travel consultation found. One quarter of the study participants who visited a health care professional before traveling reported not receiving recommendations on AMS prevention. Differences in the quality of pre-travel advice have been reported between different health care settings. Travel clinics usually provide better services and should be preferred when available.[17] Two thirds of those receiving advice on AMS prevention recalled acetazolamide use recommendations but only 16% of the participants actually used acetazolamide. Risk perception may play an important role in compliance with acetazolamide prophylaxis.