Aerospace medicine and human performance最新文献

Introduction: Asthma is a common diagnosis in the general population and, among military aviators, has the potential for significant aeromedical complications. The objectives of this study, undertaken by the North Atlantic Treaty Organization (NATO) Aviation Pulmonology Working Group (RTG299), were to determine: 1) the prevalence of asthma among trained NATO pilots; 2) agency screening procedures and policies for candidates with a history of asthma; and 3) aeromedical disposition of trained pilots diagnosed with asthma, including allowable medications.

Methods: A questionnaire was distributed to each participating NATO agency to retrieve information related to each of the above questions.

Results: Data were received from 7 agencies spanning over half a million pilot years (520,369). The prevalence of asthma among serving NATO pilots was surprisingly low at 0.04%, an order of magnitude lower than the general U.S. military (1-2%) and U.S. population in general (approx. 8%). The reported prevalence in U.S. Air Force pilots was inexplicably low at 0.007%. All agencies, apart from the U.S. Air Force, include pulmonary function screening for pilot candidates. Most agencies accept candidates with a history of childhood asthma if full and sustained remission is confirmed with enhanced screening. In trained pilots, most agencies permit the use of medications to control asthma, including inhaled corticosteroids and long-acting beta agonists.

Discussion: The incidence of asthma in NATO pilots was very low. Most NATO pilots diagnosed with asthma were retained on flying status, with some agencies imposing restrictions (generally from high-performance aircraft). Gray G, Bushby A, Frijters E, Guettler N, Lindgaard K, Naylor J, Regn D. Asthma in military pilots. Aerosp Med Hum Perform. 2025; 96(6):520-524.

Introduction: Given the unpredictability of personnel, equipment, and the aerospace environment, the alarm interface serves as a crucial tool for providing operators with diagnostic, predictive, or guiding information to enhance aerospace safety. The specific relationship between color attributes such as hue, brightness, and saturation of interface warning colors and human stress responses remains unclear.

Methods: A simulated space station warning interface color experiment was conducted with 80 volunteers possessing normal color vision using a head-down position. The selected 27 red warning colors were evaluated based on response time and performance accuracy metrics.

Results: The findings revealed that each individual variable (hue, brightness, and saturation) significantly affected reaction time, although they did not significantly influence response accuracy. Further analysis of reaction times under simulated microgravity conditions showed optimal reaction performance at a hue of H = 0 and a brightness level of 75%. Additionally, increased saturation was associated with improved color reaction performance.

Discussion: This research provides new empirical evidence regarding the effects of different warning color attributes on human performance in microgravity conditions, offering valuable insights for the design of warning systems in future spacecraft environments. Yao X, Gan Y, Jiang A, Shen Y. Spacecraft alarm interface color and human performance association. Aerosp Med Hum Perform. 2025; 96(6):478-484.

Introduction: From Mars, the Earth will appear as an insignificant dot in the heavens and two-way communication with family and mission control can take up to 44 min. The resulting impact of these restrictions on crewmembers may be termed the Earth-disconnect phenomenon. The literature suggests that seeing the Earth as a beautiful orb in space is an awe-inspiring experience (the Overview Effect), the loss of which may produce isolation and loneliness. Not being able to communicate with family and mission control in real time may produce emotional distress and impaired performance. Strategies to help crewmembers deal with these issues include using a telescope or virtual reality to better experience the Earth and suggesting future response topics and using more formal messaging techniques to improve communication efficiency. More study needs to be done using simulators, a space station, or the far side of the Moon to better understand this phenomenon. Kanas N. The Earth-disconnect phenomenon as a psychological stressor for Martian crewmembers. Aerosp Med Hum Perform. 2025; 96(6):530-532.

Introduction: Neck pain during military flight is well documented. Characterizing operationally relevant, specific pain location(s), severity, character, and exacerbating or relieving conditions is needed to develop musculoskeletal neck pain prediction models.

Methods: An anonymous, web-based questionnaire and weighted numerical response index was developed with the help of an expert clinical panel. The questionnaire was reviewed, approved, and disseminated to military pilots. Respondents reported their current neck and upper back musculogenic and neurogenic pain with a 5-level severity at 14 locations, pain onset time, duration, and relief measures, and three-axis neck mobility.

Results: Of 222 fixed and rotary wing pilot respondents, 117 completed questionnaires were used for index calculation. Bilateral moderate musculogenic and neurogenic pain in the 10 posterior muscle areas was most common. Flexor muscles were infrequently indicated. Typically, neck pain started within 30 min of flight or pilots were already in pain, pain duration was less than 7 d, and pain was relieved by rest with over-the-counter medications or by a chiropractor or physical therapist. Neck motion limitations were equally rated as very limited, slight, or no restriction. The normalized index was divided into five ranges where 78% were very mild to mild severity.

Discussion: This new approach differentiates between musculogenic and neurogenic pain by discrete location and severity, addressing pain pattern, structural involvement, and neck mobility changes beyond pain absence or presence. This information can help define necessary model complexity to simulate neck pain biomechanics. The index has potential medical use in tracking pain progression and treatment progress. Whitley PE, Shender BS, Shivers BL. Initial evaluation of the Operational Neck Pain Index. Aerosp Med Hum Perform. 2025; 96(5):367-377.

Introduction: Post-COVID-19, 10-20% of individuals may experience long-term symptoms (some having cognitive deficits), even after mild or nonsymptomatic infection. A sufficiently sensitive screening test of cognitive function, based on the typical cognitive effects of COVID-19 and skills considered most relevant to pilot performance, would be highly beneficial to be used alongside other performance checks. This study aimed to identify appropriate screening tests for post-COVID-19 cognitive dysfunction.

Methods: Initially, a systematic search and narrative review identified 13 screening tools that are likely to be effective in screening pilots for post-COVID-19 neurocognitive impairment. Following a more in-depth evaluation of the identified tools, five tests including the Trail Making Test, Symbol Digit Modalities Test, Stroop Color Word Test, Psychomotor Vigilance Test, and Paced Auditory Serial Addition Test were chosen for a Delphi evaluation exercise. A two-round modified Delphi process was undertaken with international aviation medicine and psychology experts to obtain a consensus on which of the identified tests would be appropriate to screen for cognitive dysfunction in pilots.

Results: Based on evaluation of literature review findings and Delphi consultation with subject matter experts, the Trail Making Test and Symbol Digit Modalities Test were identified as quick and suitable screening tests likely to detect post-COVID-19 cognitive dysfunction.

Discussion: These tools are objective, have good utility, are available in multiple versions, and assess cognitive abilities relevant to pilot performance. Their use for screening in aeromedical examinations would be further supported by confirming their ability to reliably detect neurocognitive impacts associated with COVID-19. Beka SG, Griffiths RF, Myers JA, Skirrow PM. Appropriate screening tests to assess post-COVID-19 cognitive dysfunction in aeromedical settings. Aerosp Med Hum Perform. 2025; 96(5):414-424.

Introduction: Fighter pilots face unique occupational challenges, including exposure to high G-forces in suboptimal seating postures and wearing heavy equipment around neck and head. These factors contribute to a high prevalence of neck and back complaints, which can impair flight performance and prevent deployment of pilots.

Methods: A cross-sectional survey was performed on the self-reported prevalence of neck and back pain among F-16 and F-35 pilots in the Royal Netherlands Air Force. Of the 121 pilots who were invited to participate, 50% (N = 61) were included. The questionnaire was based on prior research and adapted for military pilots. Differences between F-16 and F-35 pilots were analyzed.

Results: The subjects were 36 yr (IQR 30.0-46.0) of age and had 1900 flight hours (IQR 1000-2800). We observed a statistically significant higher prevalence of back pain among F-35 pilots compared to F-16 pilots (46% vs. 8%), whereas neck pain was higher but not statistically significant among F-35 pilots (51% vs. 38%). Contributing factors included seat angle, heavy (helmet-mounted) equipment, and specific flight maneuvers. A majority (83%) reported a negative impact on flight performance, with 38% stating it affected flight safety. Suggested preventive strategies include a multidisciplinary approach as well as adjustments of equipment.

Discussion: This study represents the first investigation into neck and back pain among F-35 pilots and shows a higher rate of both back and neck pain compared to F-16 pilots. Equipment and seat angle appear to be the main contributing factors. Targeted interventions are needed to prevent structural injuries, improve performance, and increase deployability. den Bult-van Wieren GB, van Rijswijk A, Kuypers MI, Steinman Y, Wingelaar TT, Nelissen RGHH. Increase in neck and back pain in fighter pilots after the introduction of the F-35 platform. Aerosp Med Hum Perform. 2025; 96(5):431-435.

Introduction: Coronary artery disease (CAD) is a major health concern in military aviation, representing one of the leading causes of flight disqualification. Traditional screening methods for CAD in military pilots include resting electrocardiograms and exercise stress tests, but these methods have limited sensitivity and specificity. This has prompted the search for more effective tools to assess cardiovascular risk and identify pilots at risk for CAD. One of the most promising tools in this regard is the Coronary Artery Calcium Score (CACS).

Methods: A comprehensive literature review was conducted using electronic databases, such as PubMed® and Google Scholar, focusing on the use of CACS in cardiovascular risk assessment, particularly in military populations. Relevant studies discussing the application of CACS in pilot screening protocols and clinical recommendations from aerospace medical regulatory bodies were included.

Results: The review highlights the advantages of using CACS over traditional screening tools, including its higher precision in evaluating cardiovascular risk and its ability to detect atherosclerotic lesions at an earlier stage. The findings also explore the potential of CACS to reduce the incidence of CAD-related flight disqualifications by improving early detection of disease among pilots.

Discussion: We discuss the current state of knowledge regarding the use of CACS in cardiovascular screening of military pilots and its potential to complement existing screening protocols. Finally, a diagnostic algorithm for incorporating CACS into the routine assessment of Polish Air Force pilots will be included, which may enhance the early detection of cardiac pathologies and improve flight safety. Kurek MA, Salacinska D, Rola M, Antoniak R. Optimizing cardiovascular screening in Polish Air Force pilots with coronary artery calcium score. Aerosp Med Hum Perform. 2025; 96(5):407-413.

Introduction: Female aviators and aircrew face unique occupational exposures, including noise, whole-body vibrations, toxic chemicals, intermittent hypoxia, and high gravitational forces. We evaluated associations between maternal occupations as aviators and aircrew during pregnancy and adverse pediatric health outcomes.

Methods: We conducted a retrospective cohort study of children born to female U.S. military officers from October 2002 to December 2019. Exposure was defined as the mother serving in an aviation or aircrew occupation at time of birth. Adverse health outcomes were identified by International Classification of Diseases codes. Cox proportional hazards regression was performed, adjusting for maternal age at delivery, maternal race and ethnicity, and marital status. A post hoc power analysis was performed.

Results: The study included 18,637 female officers. There were 1144 children of fixed-wing aviation officers and 25,889 children of non-aviation officers. There was decreased risk of adverse neurodevelopmental outcomes [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.68-0.95], speech delay (HR, 0.72; 95% CI, 0.59-0.89), and other and unspecified congenital anomalies (HR, 0.74; 95% CI, 0.60-0.90) for children of aviators. There was no increased risk for any of the adverse pediatric outcomes. Five outcomes had sufficient sample size to detect significance.

Discussion: Although this study suggests that children of military officers in aviation careers do not have an increased risk for adverse pediatric outcomes, it was underpowered and cannot conclusively imply safety of maternal aviation occupational exposures during pregnancy. Further research must evaluate how prenatal exposure to flight affects subsequent pediatric health outcomes. Royall M, Sorensen IS, Stark CM, Dorr M, Salzman S, Hisle-Gorman E, Dobson N, Brown J, Susi A, Huggins BH, Nylund CM. Pediatric health risks among children of female military aviation officers. Aerosp Med Hum Perform. 2025; 96(5):386-391.

Introduction: Long-duration space missions introduce stressors that can disturb the affective states of astronauts (e.g., isolation, workload). However, studies in space or in space-analog environments struggle to find a consensus on the affective impact of these stressors. Also, there is a lack of research using multiple measures to assess affective states in these conditions (e.g., positive and negative measures and physiological parameters). More research is needed to understand the psycho-physiological mechanisms during long-duration space-like missions. Our study was conducted during a space-analog confinement (SIRIUS-19). Throughout the mission, we assessed variations of affective states using subjective and physiological parameters. We expected interindividual variability, with transitory and chronic changes on the psychological and physiological dimensions of affective states.

Methods: Six subjects (three men/three women; four Russians/two Americans; age = 33.83 ± 6.37) performed the protocol once a month during the 4-mo confinement. Subjects completed various psychometric scales about their affective states (Self-Assessment Manikin, Positive and Negative Affective Schedule) and provided hair cortisol samples. Due to the small sample size, only individual values and descriptive statistics were used.

Results: Psychometric measures remained positive and stable. Hair cortisol levels increased at the beginning of the mission (from 31.79 ± 18.05 pg · mg-1 to 62.25 ± 31.99 pg · mg-1). Most of the measurements showed interindividual variability.

Discussion: The subjective affective states remained positive and relatively stable throughout the mission. The initial increase of hair cortisol is attributed to an adaptation phase of the crew. No affective variation seems to be related to this phase. Our results indicate effective affective adaptation to the confinement. Pauly J, Langlet C, Hainaut J-P, Yusupova A, Bolmont B. Affective states in a space-analog mission and insights from psychometric and hair cortisol measures. Aerosp Med Hum Perform. 2025; 96(5):436-442.