USAFSAM Aeromedical Consultation Service Medical Risk Assessment and Airworthiness Matrix.

INTRODUCTION: The 1% rule has long been a standard threshold for aerospace medical risk acceptance, but medical literature has noted multiple shortcomings with this threshold. Previous studies have suggested a risk matrix approach in aeromedical decision-making. General use of risk matrices for risk assessment is already codified in the U.S. Air Force (USAF). Based on this, the USAF School of Aerospace Medicine (USAFSAM) Aeromedical Consultation Service (ACS) generated and evaluated the ACS Medical Risk Assessment and Airworthiness Matrix (AMRAAM).METHODS: The ACS adapted existing USAF standards to build the AMRAAM, gathered expert feedback, and sampled 100 previously adjudicated cases to compare legacy case dispositions to AMRAAM dispositions using polychoric correlation.RESULTS: The AMRAAM disposition showed strong agreement with legacy dispositions (ρ* = 0.9424). One case was discarded as it did not meet inclusion criteria. Of the 99 remaining cases, 88 had perfect agreement between legacy and AMRAAM dispositions. With the AMRAAM, eight cases were less restrictive and three were more restrictive (two due to an erroneous omission in the legacy disposition).DISCUSSION: The AMRAAM produces disposition recommendations that are highly consistent with the legacy approach informed by the 1% rule, with discordant AMRAAM dispositions tending to be more permissive. The USAFSAM AMRAAM allows a more dimensional risk evaluation than the 1% rule, communicates aeromedical risk consistent with nonmedical USAF organizations, and harmonizes aeromedical risk with the level of risk the USAF has defined for all flying systems. The ACS will use the AMRAAM as standard practice in future aeromedical risk assessments.Mayes RS, Keirns CJ, Hicks AG, Menner LD, Lee MS, Wagner JH, Baltzer RL. USAFSAM Aeromedical Consultation Service Medical Risk Assessment and Airworthiness Matrix. Aerosp Med Hum Perform. 2023; 94(7):514-522.

Statins and Musculoskeletal Conditions in U.S. Air Force Active Duty Aviators.

BACKGROUND: The purpose of this study was to examine the association of statin use and musculoskeletal conditions within the population of U.S. Air Force active duty aviators. METHODS: The study was a retrospective cohort analysis of aviators between 2004-2014 as identified from personnel data. Based on pharmacy data, participants were divided into two groups: statin users (received a statin for at least 90 d) and nonusers (never received a statin throughout the study period). Using participants' baseline characteristics, a propensity score was generated and used to match statin users to nonusers in a 1:6 ratio. Conditional logistic regression was used to determine the odds ratio for a musculoskeletal condition. RESULTS: A total of 19,330 participants met study criteria (131 statin users and 19,199 nonusers). Of these, 112 statin users were matched to 672 nonusers. Among matched pairs, statin users were not at significantly increased risk (odds ratio: 1.239; 95% confidence interval: 0.768, 1.999) for musculoskeletal conditions. Likewise, there was no observed significant association between specific musculoskeletal disease diagnosis groups and statin use. CONCLUSIONS: In this aviator population, there was not an increased overall likelihood of musculoskeletal conditions for statin users relative to propensity score-matched nonusers. A well-designed prospective cohort analysis or clinical trial is needed to ascertain possible adverse effects of statins on performance in the aviation environment.Tvaryanas AP, Wagner JH, Maupin GM. Statins and musculoskeletal conditions in U.S. Air Force active duty aviators. Aerosp Med Hum Perform. 2018; 89(5):421-427.

Statins and Musculoskeletal Conditions in U.S. Air Force Active Duty Service Members.

BACKGROUND: This study examined the association of statin use and musculoskeletal conditions in statin users and nonusers within the population of U.S. Air Force active duty Service members in the military health care system. METHODS: The study was a retrospective cohort analysis of Service members between 2004 and 2014 as identified from personnel data having physical fitness and cardiac risk data available and who were free of musculoskeletal diagnoses for 6 months before the study period. Based on pharmacy data, participants were divided into two groups: statin users (received a statin for at least 90 days) and nonusers (never received a statin throughout the study period). Using participants' baseline characteristics, a propensity score was generated and used to match statin users to nonusers in a 1:3 ratio. Conditional logistic regression was used to determine the odds ratio (OR) for a musculoskeletal injury. FINDINGS: A total of 123,138 participants met study criteria (592 statin users and 122,546 nonusers). Of these, 516 statin users were propensity score matched to 1,548 nonusers. Among matched pairs, statin users had a higher OR (OR: 1.369; 95% confidence interval [CI]: 1.166-1.606) for musculoskeletal conditions. This association was driven by a higher frequency of back problems in statin users relative to nonusers. The number needed to be exposed for one additional person to be harmed was 20.104 (95% CI: 10.326-232.711). DISCUSSION: Statin use was associated with an increased likelihood of musculoskeletal conditions in the population of U.S. Air Force active duty Service members. Further investigations should evaluate the contribution of duty-related physical requirements as well as the duration of musculoskeletal condition-associated duty limitations.

Understanding racial disparities in HIV using data from the veterans aging cohort 3-site study and VA administrative data.

OBJECTIVES: We identified race-associated differences in survival among HIV-positive US veterans to examine possible etiologies for these differences. METHODS: We used national administrative data to compare survival by race and used data from the Veterans Aging Cohort 3-Site Study (VACS 3) to compare patients' health status, clinical management, and adherence to medication by race. RESULTS: Nationally, minority veterans had higher mortality rates than did white veterans with HIV. Minority veterans had poorer health than white veterans with HIV. No significant differences were found in clinical management or adherence. CONCLUSIONS: HIV-positive minority veterans experience poorer survival than white veterans. This difference may derive from differences in comorbidities and in the severity of illness of HIV-related disease.