Restless Legs Syndrome in Aircrew.

INTRODUCTION: Restless legs syndrome (RLS) is characterized by an uncomfortable sensation on the legs, which causes the urge to move the legs. The main cause is unknown but there are many risk factors, including geographical properties and high altitude. Our objective was to explore the frequency of RLS in aircrew.METHODS: There were 301 Turkish aircrew who were admitted to Istanbul Medipol University Hospital Neurology Department for periodic examinations and 272 healthy (non-aircrew) subjects included in the study. The International RLS Study Group's Questionnaire and the International RLS Study Group Rating Scale (IRLSSGRS) were used to evaluate RLS. The participants filled the RLS questionnaire and then both groups were divided into two subgroups as having RLS or not. The subjects years in the profession, average flight duration in a month, daily sleep duration, smoking, and coffee consumption were recorded. None of the subjects had previously been diagnosed with RLS.RESULTS: The frequency of RLS was 6.7% in the aircrew group and 7.9% in the control group, and there was no significant difference between the two groups. Age, gender, daily duration of sleep, smoking, coffee consumption, family history of RLS, being a pilot or a flight attendant, years in profession, and monthly flight hours were similar in aircrew with and without RLS.DISCUSSION: The RLS frequency in aircrew was similar to that of the control group. We can conclude flying at high altitude wasnt a risk factor for RLS.Düz OA, Yilmaz NH, Olmuscelik O. Restless legs syndrome in aircrew. Aerosp Med Hum Perform. 2019; 90(11):934937.

Do airline pilots and cabin crew have raised risks of melanoma and other skin cancers? Systematic review and meta-analysis.

BACKGROUND: Airline pilots and cabin crew are potentially exposed to hazardous ultraviolet and cosmic radiation, which may increase their risk of melanoma and other skin cancers. OBJECTIVES: To establish precise risks of melanoma and keratinocyte cancer (KC) for airline pilots and for cabin crew based on all studies published to date. METHODS: We searched MEDLINE, ISI Science Citation Index, Embase, SCOPUS and CINAHL to June 2018. All studies of melanoma and KC risk and mortality in airline pilots and cabin crew compared with the general population were eligible. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were pooled using random effects models. RESULTS: From 5866 papers retrieved, we reviewed 44 full-text articles, of which 12 studies with data collected mostly between the 1970s and 1990s were eligible for inclusion. The pooled SIR (pSIR) for melanoma in pilots was 2.03 [95% confidence interval (CI) 1.71-2.40] and in cabin crew it was 2.12 (95% CI 1.71-2.62). For pilots, the pooled SMR for melanoma was 1.99 (95% CI 1.17-3.40) and for cabin crew it was 1.18 (95% CI 0.73-1.89). For KC, the pSIR was 1.86 (95% CI 1.54-2.25) in pilots and 1.97 (95% CI 1.25-2.96) in cabin crew. There was no evidence of study heterogeneity. CONCLUSIONS: The available evidence shows that airline pilots and cabin crew have about twice the risk of melanoma and other skin cancers than the general population, with pilots more likely to die from melanoma. However, most of the evidence was collected several decades ago and their relevance to contemporary levels of risk is uncertain.

Critical Care Air Transport Team Evacuation of Medical Patients Without Traumatic Injury.

BACKGROUND: Air Force Critical Care Air Transport Teams (CCATTs) provide fixed-wing aeromedical evacuation for combat casualties. Multiple studies have evaluated CCATT trauma patients; however, nearly 50% of patients medically evacuated from combat theaters are for nontraumatic medical illnesses to include stroke, myocardial infarctions, overdose, and pulmonary emboli. Published data are limited regarding illness types, in-flight procedures, and adverse events. OBJECTIVE: The objective of our study was to characterize patients with nontraumatic medical illnesses transferred via CCATT to include a description of in-flight procedures and events. STUDY DESIGN: We performed a retrospective review of CCATT medical records of patients with nontraumatic medical illnesses transported via CCATT from theater of operations to Landstuhl Regional Medical Center between January 2007 and April 2015. We abstracted data from CCATT records to include demographics, description of current illness, vital signs, labs, in-flight procedures and medications, and in-flight adverse events. Following descriptive analysis, comparative tests were performed based on service status of patients and primary diagnoses. RESULTS: We reviewed 672 records of critically ill medical patients transported via CCATT, most of whom were male (90%, n = 606). Approximately 56% of the patients were U.S. active duty members; the remainder included U.S. contractors and civilians, and foreign citizens or unknown. The three categories (active duty, contractor/civilian, foreign/unknown) significantly differed from one another in age. Over half of the patients received a primary or secondary cardiac diagnosis. The most common in-flight procedures and medications included supplementary oxygenation, anticoagulant/antiplatelet medications, analgesics, and ventilation. Up to 20% of patients required continuous medication infusions other than analgesics. Patients most frequently experienced in-flight complications related to their primary diagnoses. CONCLUSIONS: Fifty-six percent (672) of 1,209 CCATT records that were queried were of patients with medical conditions. The most common primary diagnoses of CCATT medical patients were cardiac, pulmonary, and neurological in etiology. Mechanical ventilation and continuous medication infusions were required in approximately 20% of patients. The data provided by this study may assist in guiding future CCATT training requirements and resource allocation, as well as clinical practice guideline development.

A study of airline pilot morbidity.

INTRODUCTION: It has long been believed that airline pilots are healthier than the general population. There are a number of reasons why this should be the case. However, there is very little evidence to support this belief as fact. This study investigates the health of the pilot population of an Oceanic based airline compared to the health of the general population. METHODS: Pilots who conducted their medical certificate renewal at the airline's medical unit between 1 November 2009 and 31 October 2010 were included. A medical questionnaire was completed by each pilot at the time of their medical certificate renewal. Data from the questionnaire was entered into a database as well as the pilot's BMI, blood pressure, lipid profile, and blood glucose level. The comparison population was the population who completed the New Zealand Health Survey (NZHS) between 2006-2007. Demographic, lifestyle characteristics, and health status data from the pilots was compared to the NZHS using a Chi-squared test. RESULTS: Included in the study were 595 pilots. With respect to most medical conditions, pilots had a lower prevalence when compared to the general population. Pilots had a higher prevalence of kidney disease (3.3% vs 0.6%) and melanoma skin cancer (19 per 1000 vs 0.4 per 1000). DISCUSSION: This study suggests that pilots in New Zealand are healthier than the general population with respect to most medical conditions. The two medical conditions that were identified as being overrepresented in pilots may be the result of the occupational environment.

Relationship between Brazilian airline pilot errors and time of day

Flight safety is one of the most important and frequently discussed issues in aviation. Recent accident inquiries have raised questions as to how the work of flight crews is organized and the extent to which these conditions may have been contributing factors to accidents. Fatigue is based on physiologic limitations, which are reflected in performance deficits. The purpose of the present study was to provide an analysis of the periods of the day in which pilots working for a commercial airline presented major errors. Errors made by 515 captains and 472 copilots were analyzed using data from flight operation quality assurance systems. To analyze the times of day (shifts) during which incidents occurred, we divided the light-dark cycle (24:00) in four periods: morning, afternoon, night, and early morning. The differences of risk during the day were reported as the ratio of morning to afternoon, morning to night and morning to early morning error rates. For the purposes of this research, level 3 events alone were taken into account, since these were the most serious in which company operational limits were exceeded or when established procedures were not followed. According to airline flight schedules, 35 percent of flights take place in the morning period, 32 percent in the afternoon, 26 percent at night, and 7 percent in the early morning. Data showed that the risk of errors increased by almost 50 percent in the early morning relative to the morning period (ratio of 1:1.46). For the period of the afternoon, the ratio was 1:1.04 and for the night a ratio of 1:1.05 was found. These results showed that the period of the early morning represented a greater risk of attention problems and fatigue.

Cosmic radiation increases the risk of nuclear cataract in airline pilots: a population-based case-control study.

BACKGROUND: Aviation involves exposure to ionizing radiation of cosmic origin. The association between lesions of the ocular lens and ionizing radiation is well-known. OBJECTIVE: To investigate whether employment as a commercial airline pilot and the resulting exposure to cosmic radiation is associated with lens opacification. METHODS: This is a population-based case-control study of 445 men. Lens opacification was classified into 4 types using the World Health Organization simplified grading system. These 4 types, serving as cases, included 71 persons with nuclear cataracts, 102 with cortical lens opacification, 69 with central optical zone involvement, and 32 with posterior subcapsular lens opacification. Control subjects are those with a different type of lens opacification or without lens opacification. Exposure was assessed based on employment time as pilots, annual number of hours flown on each aircraft type, time tables, flight profiles, and individual cumulative radiation doses (in millisieverts) calculated by a software program. Odds ratios were calculated using logistic regression. RESULTS: The odds ratio for nuclear cataract risk among cases and controls was 3.02 (95% confidence interval, 1.44-6.35) for pilots compared with nonpilots, adjusted for age, smoking status, and sunbathing habits. The odds ratio for nuclear cataract associated with estimation of cumulative radiation dose (in millisieverts) to the age of 40 years was 1.06 (95% confidence interval, 1.02-1.10), adjusted for age, smoking status, and sunbathing habits. CONCLUSION: The association between the cosmic radiation exposure of pilots and the risk of nuclear cataracts, adjusted for age, smoking status, and sunbathing habits, indicates that cosmic radiation may be a causative factor in nuclear cataracts among commercial airline pilots.

Cosmic radiation exposure and cancer risk among flight crew.

Nearly 20 epidemiologic or related studies of cancer incidence and mortality have been published during or since 2000, with several reporting increased risks of female breast cancer among flight attendants and melanoma among both pilots and cabin crew. Occasionally, excesses of other cancers have been observed, but not consistently. Although the real causes of these excess cancer risks are not known, there is concern that they may be related to occupational exposures to ionizing radiation of cosmic origin. It is possible that confounding risk factors may partially or totally explain the observed relationships, but several investigations are beginning to address lack of past adjustment for reproductive factors and sun exposure with improved study designs. With progress in aviation technology, planes will fly longer and at higher altitudes, and presumably the number of flights and passengers will increase. To respond responsibly to the real and perceived risks associated with flying, more extensive data are needed, but special efforts should be considered to ensure new projects can genuinely add to our current knowledge.

Cosmic radiation and cancer mortality among airline pilots: results from a European cohort study (ESCAPE).

Cosmic radiation is an occupational risk factor for commercial aircrews. In this large European cohort study (ESCAPE) its association with cancer mortality was investigated on the basis of individual effective dose estimates for 19,184 male pilots. Mean annual doses were in the range of 2-5 mSv and cumulative lifetime doses did not exceed 80 mSv. All-cause and all-cancer mortality was low for all exposure categories. A significant negative risk trend for all-cause mortality was seen with increasing dose. Neither external and internal comparisons nor nested case-control analyses showed any substantially increased risks for cancer mortality due to ionizing radiation. However, the number of deaths for specific types of cancer was low and the confidence intervals of the risk estimates were rather wide. Difficulties in interpreting mortality risk estimates for time-dependent exposures are discussed.

Survey of dry eye symptoms in Australian pilots.

In 1996, a questionnaire was distributed to 4000 Australian commercial pilots for the quantification of symptoms of dry eye. The 1246 respondents ranged in age from 18-71 years (mean age 40.4 years), and 98.2% were men. Symptoms of dry eye during flight were reported by 901 (72.3%, 95% CI = 69.7 74.8) while only 67 (5.4%, 95% CI = 4.2-6.8) reported dry eye independent of flight. In univariate analyses, the following factors were associated with dry eye in flight: age, use of distance glasses, smoking, average weekly number of flight hours, type of aircraft usually flown, and normal cruising altitude. In a multiple logistic regression model, only the class of aeroplane (large jets vs. propeller-driven planes) (OR = 1.75, 95% CI = 1.34-2.28) and estimated number of flight hours per week (OR = 1.58, 95% CI = 1.34-1.86) were related to dry eye symptoms. In conclusion, self-reported symptoms of dry eye are common in Australian pilots and are associated with aeroplane class and flying time.

Incidence of cancer among commercial airline pilots.

OBJECTIVES: To describe the cancer pattern in a cohort of commercial pilots by follow up through the Icelandic Cancer Registry. METHODS: This is a retrospective cohort study of 458 pilots with emphasis on subcohort working for an airline operating on international routes. A computerised file of the cohort was record linked to the Cancer Registry by making use of personal identification numbers. Expected numbers of cancer cases were calculated on the basis of number of person-years and incidences of cancer at specific sites for men provided by the Cancer Registry. Numbers of separate analyses were made according to different exposure variables. RESULTS: The standardised incidence ratio (SIR) for all cancers was 0.97 (95% confidence interval (95% CI) 0.62 to 1.46) in the total cohort and 1.16 (95% CI 0.70 to 1.81) among those operating on international routes. The SIR for malignant melanoma of the skin was 10.20, 95% CI 3.29 to 23.81 in the total cohort and 15.63, 95% CI 5.04 to 36.46 in the restricted cohort. Analyses according to number of block-hours and radiation dose showed that malignant melanomas were found in the subgroups with highest exposure estimates, the SIRs were 13.04 and 28.57 respectively. The SIR was 25.00 for malignant melanoma among those who had been flying over five time zones. CONCLUSIONS: The study shows a high occurrence of malignant melanoma among pilots. It is open to discussion what role exposure of cosmic radiation, numbers of block-hours flown, or lifestyle factors--such as possible excessive sunbathing--play in the aetiology of cancer among pilots. This calls for further and more powerful studies. The excess of malignant melanoma among those flying over five time zones suggests that the importance of disturbance of the circadian rhythm should be taken into consideration in future studies.

Survey of USAF flight surgeons regarding clinical preventive services, using CHD as an indicator.

BACKGROUND: A recent Department of Defense study revealed that nonpharmacologic therapy is not well documented in medical records of individuals identified at risk for coronary heart disease (CHD). Exercise and weight control are often underemphasized relative to dietary and medication interventions, even in medical journal review articles on management of dyslipidemia. METHODS: A literature review of interventions consisting of exercise alone or with diet is presented. A brief survey was developed to assess the knowledge and beliefs of USAF flight surgeons regarding training received for, and delivery of, clinical preventive services. In addition, the respondents were given a scenario patient with high cholesterol to manage. RESULTS AND DISCUSSION: The literature review demonstrates the beneficial effect of exercise alone or with dietary interventions on reducing total cholesterol and increasing high-density lipoprotein (HDL). The survey reveals that USAF flight surgeons believe that more preventive medicine training is needed in the USAF flight surgeon course, graduate medical education, and medical school. Given a scenario patient with hypercholesterolemia, the flight surgeons believe that nonpharmacologic therapy with consults to the base Health and Wellness Center (HAWC), along with follow-up by the physician, is appropriate initial medical treatment rather than pharmacologic therapy. CONCLUSIONS: The primary treatment for prevention of CHD should be an organized exercise and diet program. This treatment is proven effective through clinical trials and is supported by the flight surgeon survey results. Additional benefits of an organized exercise and diet program include decreased obesity with its associated complications, decreased incidence of hypertension, decreased cancer risk, and decreased risk for diabetes mellitus.

Mortality among aerial pesticide applicators and flight instructors: follow-up from 1965-1988.

BACKGROUND: Vital status followup for a retrospective cohort mortality study of 9,961 male aerial pesticide applicators was extended beyond a previous study (1965-1979) (Cantor et al. 1991), through December 31, 1988. METHODS: Rate ratios (RR) were used to compare directly adjusted mortality rates between applicators and a comparison cohort of 9,969 flight instructors. Standardized mortality ratios (SMR) were calculated for comparisons with the U.S. white male population. RESULTS: Among applicator pilots, there were 1,441 deaths, and among instructors, 1,045. In both groups, aircraft accidents were the major cause of death (446 applicators; 234 instructors). Compared with flight instructors, aerial applicator pilots were at significantly elevated risk for all causes of death (risk ratio = 1.34) and for malignant neoplasms (1.18), non-motor vehicle accidents (1.71), motor vehicle accidents (1.69), and stroke (1.91). Pancreatic cancer (2.71) and leukemia (3.35) were significantly elevated. Applicators were at lower risk of colon cancer (0.51) and multiple myeloma (0.23) mortality. Based on U.S. rates, the SMR for all causes of death among applicators was 111 (95% confidence interval (CI) = 105-117) and among instructors, 81 (CI = 76-85). CONCLUSIONS: Aircraft accidents were a major cause of mortality in both applicator and flight instructor cohorts. Several other causes of death, some possibly related to pesticide exposure, were also elevated among pesticide applicator pilots. Published 1999 Wiley-Liss, Inc.

Mortality among US commercial pilots and navigators.

The airline industry may be an occupational setting with specific health risks. Two environmental agents to which flight crews are known to be exposed are cosmic radiation and magnetic fields generated by the aircraft's electrical system. Other factors to be considered are circadian disruption and conditions specific to air travel, such as noise, vibration, mild hypoxia, reduced atmospheric pressure, low humidity, and air quality. This study investigated mortality among US commercial pilots and navigators, using proportional mortality ratios for cancer and noncancer end points. Proportional cancer mortality ratios and mortality odds ratios were also calculated for comparison to the proportional mortality ratios for cancer causes of death. Results indicated that US pilots and navigators have experienced significantly increased mortality due to cancer of the kidney and renal pelvis, motor neuron disease, and external causes. In addition, increased mortality due to prostate cancer, brain cancer, colon cancer, and cancer of the lip, buccal cavity, and pharynx was suggested. Mortality was significantly decreased for 11 causes. To determine if these health outcomes are related to occupational exposures, it will be necessary to quantify each exposure separately, to study the potential synergy of effects, and to couple this information with disease data on an individual basis.

[Occupational diseases in an airline company]. / Yrkesrelatert sykdom i et flyselskap.

617 cases of occupational health disorders in an average population of approximately 4,400 were reported by the Occupational Health Services of the Norwegian section of SAS during the period 1985 to 1996. Musculoskeletal disorders accounted for approximately 75% of all registered disorders. Wherever possible, occupational disorders should be registered and preventive measures initiated by the company. It is therefore of great importance that a registration system should include all occupational disorders. If we compare our figures with the official Norwegian figures from the Labour Inspectorate, we may conclude that only 3-4% of occupational disorders are reported to the Authorities. In particular it seems that many disorders which do not yield economic compensation (musculoskeletal disorders, and mental stress and burnout syndromes) are not reported at all, making it less likely that preventive measures are implemented. The Nordic figures indicate that inadequate reporting occurs more frequently in Norway than in Sweden, Denmark and Finland.

Reproductive health outcomes among female flight attendants: an exploratory study.

Recent studies have suggested that female flight attendants may experience increased rates of spontaneous abortion. We conducted a survey of female flight attendants who were pregnant at any time between January 1, 1990, and December 31, 1991 (n = 418) using a mailed self-administered interest survey (response rate, 60 %) and follow-up questionnaire regarding reproductive outcomes and potential risk factors for adverse outcomes (response rate, 64%). The cumulative hazard of spontaneous abortion was 17% when maternal age, smoking, alcohol use, and prior spontaneous abortions were control led for, using a Cox life-table regression model. Of the female flight attendants who worked outside the home, 47 of 321 (15%) experienced a spontaneous abortion, compared with 6 of 73 (8%) who did not work outside the home during the pregnancy period (odds ratio [OR] = 1.91, 95 % confidence interval [CI] = 0.78-4.66). Flight attendants who experienced a spontaneous abortion during their first pregnancy during the study period reported working significantly more flight hours per month during their pregnancy (74 hours per month) than did flight attendants who delivered a live birth (64 hours per month) (Student's t = -3.30, P = 0.002). We conclude that although the results of this study must be considered preliminary because of the relatively low overall response rate (38%), we did not find an overall increased risk for spontaneous abortion among flight attendants, compared with other working women (10%-20%). Women who continue working as flight attendants during pregnancy and those who work relatively higher numbers of flight hours during pregnancy may, however, be at increased risk for spontaneous abortion, compared with flight attendants who do not perform such work.

Cohort study of Air Canada pilots: mortality, cancer incidence, and leukemia risk.

Despite the special working environment and exposures of airline pilots, data on risk of death and cancer incidence in this occupational group are limited. The authors investigated a cohort of 2,740 Air Canada pilots who contributed 62,449 person-years of observation. All male pilots employed for at least 1 year on and since January 1, 1950, were studied. The cutoff date for outcome information was December 31, 1992. Standardized mortality ratio (SMR) and standardized incidence ratio (SIR) were used to compare mortality rates and cancer incidence rates of the cohort with the respective Canadian population rates. Ninety percent confidence intervals of the SMR and SIR were calculated. Statistically significant decreased mortality was observed for all causes (SMR = 0.63, 90% confidence interval (CI) 0.56-0.70), for all cancers (SMR = 0.61, 90% CI 0.48-0.76), and for all noncancer diseases (SMR = 0.53, 90% CI 0.45-0.62). Mortality from aircraft accidents was significantly raised (SMR = 26.57, 90% CI 19.3-35.9). Significantly decreased cancer incidence was observed for all cancers (SIR = 0.71, 90% CI 0.61-0.82), rectal cancer (SIR = 0.42, 90% CI 0.14-0.96), lung cancer (SIR = 0.28, 90% CI 0.16-0.46), and bladder cancer (SIR = 0.36, 90% CI 0.12-0.82). Prostate cancer (SIR = 1.87, 90% CI 1.38-2.49) and acute myeloid leukemia (SIR = 4.72, 90% CI 2.05-9.31) were significantly increased. The preferred relative risk model for radiation-induced nonchronic lymphoid leukemia (Beir V report) was applied to the cohort by using published estimates of in-flight radiation exposures. The estimated relative risk ranged from 1.001 to 1.06 and did not differ significantly from the observed SIR (SIR = 1.88, 90% CI 0.80-3.53). However, the incidence rate of acute myeloid leukemia was significantly increased. Monitoring of in-flight radiation exposure and long-term follow-up of civil aviation crew members is needed to further assess cancer incidence and leukemia risk in this special occupational group.

Permanent grounding and flying restrictions in Canadian Forces pilots: a 10-year review.

The medical files were reviewed of all Canadian Forces pilots in whom a permanent change in flying category was recommended during the period 1 January 1978 through 31 December 1987. In an average pilot population of 2,697 pilots, 60 permanent groundings (2.2 per thousand) and 209 permanent operational flying restrictions (7.7 per thousand) were assigned among 258 pilots. Coronary heart disease was the most common cause for permanent grounding (25% of total), followed by neurologic disorders including migraine (22% of total), other cardiovascular disorders, including mitral valve prolapse and arrhythmias (17%), and psychiatric problems (12%). Refractive errors were the most common basis for an operational flying restriction (25%), followed by orthopedic disorders (17%), mainly low back pain. The relevance of these observations is discussed in terms of medical selection and surveillance procedures.

Automating the flight surgeon's report, simplifying the investigative-reportage task, and enhancing the data quality and depth: a concept.

Current U.S. Navy medical officers' investigative reports concerning aviation mishaps are filed on paper form Flight Surgeon's Reports (FSRs). Typically, the investigating medical officer has not investigated many mishaps and needs guidance to assure the thorough collection and reportage of available information, including that which often might seem at first to be extremely insignificant. Additionally, the FSRs often contain errors capable of being detected and corrected, as well as entries that appear questionnable and require verification. Often the FSR is laced with blanks which cloud interpretation: are these blanks the result of an actual non-availability of information, losses of information, or simply errors of omission? A positive statement for each blank, even a statement that the data were not available, would greatly aid those who later use the reports for analyses. Proposed herein is an approach for reducing the investigating medical officer's problems in collecting, collating, and reporting information, thereby enhancing the quality and completeness of the data, reducing the cost of data entry into Naval Safety Center computers, and, ultimately, enhancing the knowledge of the aircrew automated escape system and aircrew life support system community concerning the conditions of use and the performance of their equipment in emergency situations. Such knowledge enhancement should result in significant improvements in aircrew equipment and the effectiveness and safety of the aircrews.