Aerospace medicine and human performance最新文献

Background: Attention deficit/hyperactivity disorder (ADHD) in pilots is considered a threat to flight safety. The U.S. Federal Aviation Administration has recently revised assessment pathways for applicants with attentional problems because of an increasing recognition that ADHD is a clinical condition with a broad symptom spectrum; some individuals may have a historical diagnosis which has been in remission for several years, while others may be using psychostimulants to enhance mental focus. This commentary compares major depression as a reference and its Federal Aviation Administration certification/clearance policy with those policies associated with ADHD. Major depression can be considered a model example of a mental disorder where appropriate treatment strategies such as medication have been demonstrated not to have adverse effects upon aviation safety. We wish to highlight that when reviewing certification and assessment practice guidelines for the assessment of pilots with ADHD, decisions must be based upon robust scientific evidence that has been obtained in aviation. Vuorio A, Bor R, Gray A, Suhonen-Malm A-S. Attention deficit/hyperactivity disorder assessment and aviation safety using major depression as a reference. Aerosp Med Hum Perform. 2024; 95(11):873-875.

Background: Arterial gas embolism (AGE) may occur while breathing compressed air and failing to exhale during ascent to compensate for gas expansion as pressure decreases. Trauma to the lungs from over-pressurization may result in air bubbles entering the pulmonary veins and subsequently the systemic circulation, causing obstructed blood flow and inflammatory cascades. AGEs are known to always manifest within 10 min of surfacing from depth. In underwater egress training (UET), which is mandatory for U.S. Marines, service members learn to escape from a tilt-wing or rotor aircraft after it submerges and inverts in water.

Case report: We report a case of cerebral AGE in which the victim experienced neurological symptoms more than 1 h after completing UET at a depth between only 3.28-6.56 ft (1-2 m). The patient was treated with a U.S. Navy Treatment Table 6 and experienced complete resolution of symptoms.

Discussion: This case is one of only two AGEs reported with symptom onset occurring after 10 min of surfacing from depth to be published. AGE at depths between 1-2 m has only been reported on three other occasions, and dysbarism injuries during UET are also exceedingly rare. This case demonstrates a situation in which all three events occurred, highlighting the need for increased awareness and clinical consideration of delayed AGE in similar scenarios despite the commonly held belief that AGEs do not occur outside of 10 min of surfacing. Harvey SE, Reynolds RP, Fisher JF. Delayed-onset arterial gas embolism after underwater egress training. Aerosp Med Hum Perform. 2024; 95(11):867-870.

Introduction: As military environments integrate more complex technological systems, operators increasingly require more assistance from automation. When used properly, automation can significantly enhance performance; however, proper use is predicated on the operator's trust in the automation (TIA). TIA, like trust among people, is influenced by biological, psychosocial, and behavioral aspects. While options for measuring TIA have rapidly expanded in the past decade, there has been little consideration for how well these measures perform in operational environments.

Methods: A 10-yr literature review was conducted to identify TIA measures and rate their appropriateness for operational aeromedical environments. Articles from Google Scholar, EBSCO, and the Defense Technical Information Center databases were included, focusing on user-reported, physiological, and behavioral measures. Study quality was rated by aeromedical research scientists, while aeromedical appropriateness was evaluated by rated military pilots. Measures were categorized as High Recommendation, Cautious Recommendation, or Not Recommended based on these evaluations.

Results: Of the measures reviewed, 28 were recommended for operational use, 23 received cautious recommendations, and 6 were not recommended. The recommended measures demonstrated high research quality and suitability for aeromedical environments. The cautious recommendations highlighted measures with specific limitations that need to be considered in operational settings, while the not recommended measures lacked sufficient evidence for reliable use in these contexts.

Discussion: Several high-quality TIA measures appear suitable for operational aeromedical settings. While these recommendations offer a starting point for testing TIA in aeromedical settings, further research is required to test how well these measures perform in an operational environment. Ranes B, Wilkins J, Kenser E, Caid-Loos M. Trust in automation measures for aeromedical settings. Aerosp Med Hum Perform. 2024; 95(11):851-861.

Introduction: Undiagnosed depression in the aviation industry can have catastrophic consequences such as aircraft-assisted suicide. Depression is often underreported, especially when subjects are aware they are reporting on depression. The aim of the present study was to investigate whether scores on a depression screening tool would vary if it was disguised as a "life stress" questionnaire in a sample of Australian commercial pilots.

Methods: A total of 109 subjects were assigned into either a "Life Stress" survey or a "Depression" survey, both containing the Depression, Anxiety, Stress Scales depression screening tool among other questions relating to either depression or stress to determine any variation in depression scores.

Results: A statistically significant difference was found in which the covert group that completed a "life-stress" survey scored higher average depression scores than the control group completing an overt depression inventory. Prevalence of depression was consistent with the general population, with 25% of pilots meeting the threshold for depression within the control group, and this number increased to 41% when using a covert measure to assess depression.

Discussion: This research adds further weight to the potential underreporting of depression in pilots as a function of stigma and fear associated with the label "depression". Regulators and organizations must proactively minimize exposure to psychological harm, negating the reliance on self-reporting to control psychological risk and recruitment methods must aim to reduce bias against those with disabilities. Nonpunitive environments for pilots to self-assess and report psychological issues will allow better outcomes from expedited treatment. Minnock SDT, Thomas MJW. Underreporting of depression in Australian commercial pilots. Aerosp Med Hum Perform. 2024; 95(11):821-825.

Introduction: When a pilot is referred for nasal polyposis, his/her flight fitness may be questionable. The objective of this retrospective study was to describe a case series of barotrauma in a pilot population exhibiting nasal polyposis and to discuss the decisions about their flight fitness.

Methods: There were 17 pilots with nasal polyposis who were referred to the Head and Neck Department of the National Pilot Expertise Center. The study was declarative on the occurrence of ear and sinus barotrauma during the last 5 yr. Nasofibroscopy was performed to determine the stage of the nasosinus polyposis.

Results: Out of 17 pilots, 1 did not obtain flight fitness clearance. Among the 16 who received fitness clearance to fly, 2 had restrictions on their flight fitness. Out of 17 patients, 8 had sinus barotrauma and 13 had middle ear barotrauma. A total of 21 cases of sinus barotrauma were reported, 17 involving the frontal sinus and 4 involving the maxillary sinus. Also reported were 48 cases of middle ear barotrauma.

Discussion: Flight fitness was based on the recurrence of barotrauma episodes, their severity, in-flight incapacitation due to hyperalgesic sinusitis or otitis, and the failure of medical and/or surgical treatments. In our series, nasal polyposis did not seem to be a risk factor for severe barotrauma. The results made it possible to determine a patient's fitness to fly and any restrictions. The published studies on the resumption of flight for patients who have nasal polyposis and our experience suggest that nasal polyposis may allow a safe pursuit of aviation activity. Crambert A, Marchi Y, Pons Y, Podeur P, Allali L, Ballivet de Régloix S. Nasal polyposis and fitness to fly. Aerosp Med Hum Perform. 2024; 95(11):841-844.

Introduction: Strong neck muscles may decrease the risk of flight-induced neck pain and possible disability among fast jet pilots. The purpose of this study was to examine the intra- and interrater reliability of a commercial force gauge attached to a pilot's helmet for measuring isometric force production of the neck muscles.

Methods: A total of 41 subjects performed maximal isometric cervical flexion, extension, and lateral flexion in two measurement sessions for intrarater reliability, and 31 of these subjects participated in a third session for measuring interrater reliability. Delayed muscle soreness and neck pain were assessed using the Visual Analog Scale before and after each measurement session. The intraclass correlation coefficient (ICC) was used to compare values between the test and retest assessments.

Results: The overall interrater reliability was good (ICC 0.79-0.90), whereas the intrarater reliability varied from moderate to good (ICC 0.58-0.84). In both intra- and interrater reliability, the flexion test had good (ICC 0.84-0.89) reliability, while the lateral flexion test results had moderate to good (ICC 0.73-0.90) reliability. The extension test had the lowest reliability in both intra- (ICC 0.58) and interrater (ICC 0.79) tests. The average visual analog scale score (from 1-100 scale) prior to the second measurement session was 16 ± 18 in delayed muscle soreness and 0 ± 0 in neck pain.

Discussion: The present study demonstrated that the helmet-attached force gauge is a reliable, safe, and clinically applicable method to evaluate isometric neck strength in the flexion and lateral flexion directions. Honkanen T, Mattila V, Kinnunen O, Janhunen M, Sovelius R, Vaara JP, Kyröläinen H. Reliability of a flight helmet-attached force gauge in measuring isometric neck muscle strength. Aerosp Med Hum Perform. 2024; 95(10):788-793.

Introduction: With increased access to commercial spaceflight and space tourism, plus a push for longer duration spaceflights, it is especially important to understand the impact of spaceflight on musculoskeletal health. Upper extremity injuries are the most common musculoskeletal injuries in spaceflight. It is, therefore, vital to determine the changes to the upper extremities during spaceflight. The purpose of this study was to examine the state of knowledge on the impact of spaceflight on upper extremity orthopedic health, and to identify knowledge gaps and future areas of research.

Methods: A literature review was performed and studies and reports that amassed data on shoulder, elbow, wrist, and hand health were included.

Results: Spaceflight decreases bone mineral density in the upper extremities and increases risk of fracture, especially upon return to gravitational environments. Spaceflight does not uniformly affect all muscles; in the shoulder, the various muscles crossing the joint appear to be variably affected: the deltoid experiences a greater degree of atrophy than the rotator cuff muscles. Spaceflight additionally affects the peripheral nervous system, with astronauts experiencing hand numbness and loss of manual dexterity but cause of these symptoms is undetermined. Spacesuits have also been implicated in causing upper extremity injury, especially while training for or performing extravehicular activities.

Discussion: While upper extremity orthopedic health in spaceflight is incompletely understood, known adaptations increase risk for weakening and injury. Existing research provides valuable information for best practices, but there is still much to be discovered to optimize upper extremity health in spaceflight. Fiedler B, Jami M, Rakauskas T, Ahmed AS. Impact of spaceflight on upper extremity orthopedic health. Aerosp Med Hum Perform. 2024; 95(10):777-783.

Introduction: The global rise in aesthetic surgery has led to an increase in aesthetic medical tourism (AMT). As patients pursue surgical interventions abroad, concerns about the elevated complication rates in AMT have emerged. This study explores the complexities of AMT, emphasizing the intersection of plastic surgery and aerospace medicine, to elucidate the incidence of complications, identify associated variables, and introduce aeromedical considerations to proactively enhance patient safety.

Methods: A comprehensive retrospective observational cohort study was conducted using data spanning 2004 to 2023 from a private plastic surgery practice in Bogota, Colombia. The study included 3367 patients, of whom 26% were international patients. Sociodemographic and clinical variables, flight details, and surgical complications were analyzed. Statistical analyses involved descriptive statistics, odds ratios, and multiple regression analyses.

Results: Of the 865 AMT patients, 75 exhibited complications. Infection and wound dehiscence were the most prevalent; no severe complications or mortality was reported. The study revealed that AMT patients have a higher risk of complications compared to those locally treated (adjusted odds ratio = 4.6; 95% confidence interval = 2.6-8.2). Flight time exceeding 4 h was a factor associated with nonaesthetic complications.

Discussion: This study reveals that AMT is linked to a higher risk of nonaesthetic complications, with flight duration being a significant contributing factor. Despite the increased risk, complication rates for AMT patients did not surpass thresholds reported in the literature; this may be attributed to the safety protocols implemented. Aeromedical considerations played a crucial role in mitigating physiological stress associated with air travel. Hoyos AE, Ramirez B, Benavides J, Perez Pachon ME, Varela A. Aeromedical considerations for patient safety in aesthetic medical tourism. Aerosp Med Hum Perform. 2024; 95(10):765-770.