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PubMed1992

Underdiagnosis of asthma in young adults presenting for USAF basic training.

The underdiagnosis of asthma has not been well studied previously. The purpose of this study was to determine whether the diagnosis of asthma had been made previously in young adults who were subsequently shown to have asthma upon entering military service. Questionnaires were answered by all airmen basic referred to the Allergy-Immunology Clinic at Wilford Hall United States Air Force Medical Center over an 11-month period. There were 192 airmen basic referred to rule out asthma, primarily because of respiratory symptoms with exercise. These airmen were evaluated by history, physical examination, pulmonary function tests and, in 67%, by histamine or exercise challenge test also. In those diagnosed with asthma, the evaluating allergist then determined whether the diagnosis of asthma had been made previously considered or not considered. In airmen basic diagnosed by our clinic with asthma, the diagnosis had been made previously in 45%, considered in 25%, and not considered in 30%. Undiagnosed asthmatic airmen tended to have mild and primarily exercise-induced disease. We conclude that there is a high incidence of underdiagnosis of asthma in the population studied. Exercise-induced asthma accounted for most of the undiagnosed asthma.

Adolescent↗

PubMed2002

The use of contact lenses by U.S. civilian pilots.

BACKGROUND: Since 1976, the use of contact lenses by civilian pilots has been permitted to correct distant vision for obtaining a Federal Aviation Administration (FAA) aeromedical certificate. This study examined the civil airman population's experience with contact lens use for a 30-year period (1967 to 1997). METHODS: Population totals for airmen who carried pathology codes 161 (contact lens) and 158 (orthokeratology) from January 1, 1967 through December 31, 1997 were used to calculate prevalence rates by class of medical certificate and age. The National Transportation Safety Board and FAA databases were queried to determine if contact lens use had contributed to aviation mishaps. RESULTS: The prevalence of contact lens use grew faster for first-class medical certificate holders and airmen > or = 40 years of age during the period. The frequency of airmen with orthokeratology increased by 23 times in a 10-year period. Reports from five aviation accidents and one incident suggested that contact lens use was a contributing factor in these mishaps. CONCLUSIONS: Professional pilots and older airmen were found to be more inclined to use contact lenses. The increasing use of contact lenses and the rapid changes in contact lens technology warrant continued monitoring to ensure aviation safety.

Adult↗

PubMed1992

The prevalence and aeromedical certification considerations of contact lens use by civilian pilots.

Federal Aviation Regulations permit the routine use of contact lenses by civilian pilots to satisfy the distant visual acuity requirements for obtaining medical certificates. Specific information identifying the prevalence of contact lenses in the civil airman population is required to guide future medical certification decisions, policy changes, and education safety programs to aviation personnel. A descriptive, retrospective epidemiologic study was performed of active airmen by 5-year intervals for a 20-year period (1967-1987) using FAA data-bases and publications. The percentage of airmen who use contact lenses quadrupled during the study period. When stratified by class of medical certificate and age, the prevalence rates for airmen with first-class medical certificates and older airmen showed the largest increases. A summary is provided of aeromedical certification factors that an optometrist and/or ophthalmologist should consider while fitting an airman with contact lenses. The increasing use of contact lenses indicates a need for ongoing review of adverse changes and safety consequences for pilots. Key words: vision; contact lens; epidemiology; medical certification.

Adult↗

PubMed1985

Blood pressure levels of active pilots compared with those of air traffic controllers.

Currently some 15,212 active airmen are certified to fly with a diagnosis of hypertension. Federal Aviation Administrative blood pressure standards for certification of airmen are considered to be quite liberal. A systematic sample of pre-strike air traffic controllers was extracted from automated medical files maintained by the Aeromedical Certification Branch of the Civil Aeromedical Institute for comparison with airman data. Distributions of blood pressure by age were compared by using conventional non-parametric techniques for 10-year age intervals. Data were also compared with general population findings. Prevalence of hypertension is greater in the general United States population than found with any of the groups reported here. Prevalence of borderline and definite hypertension is seen to increase with age for all groups studied. Prevalence of any degree of hypertension is lower for airline pilots than either the all-airmen group or the air traffic controller group.

Adult↗

PubMed1978

Sociodemographic factors and military psychiatric hospitalization.

This study of race, rank, and psychiatric hospitalization was conducted to provie more information about the impact of social class factors on military inpatient treatment. A retrospective review of the charts of all commissioned officers admitted over a 16-month period along with control groups of airmen and sergeants matche for time of admission was undertaken at a large military training center. Groups were compared on sociodemographic variables (age, race, rank, sex, marital status, length of service, and education background) as well aa clinical variables (referral source, chief complaint, diagnosis, length of stay, and outcome). The implications of briefer hospitalizations for the youngest group of patients (the airmen) are discussed. The over-representation of black enlisted soldiers as psychiatric patients and organizational means of rectifying this situation are discussed.

Adult↗

PubMed1976

Paroxysmal and chronic atrial fibrillation in airman certification.

Of the 757,693 airmen with valid FAA medical certificates on Oct. 31, 1974, 125 (all males but one) had a history of paroxysmal atrial fibrillation. Episodes of paroxysmal atrial fibrillation occurred once in 91, twice in 14, and more than twice in 20 airmen, and were attributed to one or more of 23 factors in 72 of the medical records studied. Associated symptoms reported in 27 records were considered serious enough to produce pilot incapacitation. Chronic atrial fibrillation was idiopathic in all but one airman, who developed this arrhythmia following atrial septal defect repair. Medical records report no associated symptoms, and heart rates, resting and in response to exercise, were reported as within normal limits.

Aerospace Medicine↗

PubMed2004

Changing demographics and vision restrictions in civilian pilots and their clinical implications.

BACKGROUND: The Federal Aviation Administration guides policy decisions through the study of medical pathologies and visual disorders common to aviators. The purpose of this study is to examine demographic statistics present in the civil airman population, including vision restrictions, and their relevance to the clinical care of aviators. METHODS: Medical certification data were extracted from FAA publications and databases for all civil airmen who were active on December 31st of each year from 1976 to 2001. Frequency and medical restriction data were delineated into 5-yr increments and analyzed to identify population trends for the 25-yr study period. RESULTS: Although the total number of pilots has decreased over the study period (-17%), the population of male and female airmen holding first-class medical certificates has grown by 119% and 1,241%, respectively. The percentage of pilots > or = 40 yr of age has increased by 17%, and the average age rose from 36.8 to 42.3 yr. Additionally, the increase in near vision restrictions (13%) was more than double that of distant vision restrictions (6%) during the study period. As of 2001, 92% of all medical restrictions were vision related. CONCLUSION: The results of this study indicate that the increasing number of first-class certificate holders, gender-specific vision problems for female pilots, and the age-related changes in refractive error may present new challenges for eye-care practitioners tasked with advising aviators concerning the proper choice of refractive correction.

Adult↗

PubMed1994

Prior crash and violation records of pilots in commuter and air taxi crashes: a case-control study.

With a case-control design, this study examined the relationships of crash/incident history, violation history, pilot age, flight experience, and recent flight time with the likelihood of being involved in commuter aircraft and air taxi crashes. Cases (n = 725) were pilots who had been involved in commuter aircraft or air taxi crashes during 1983-88, identified from the National Transportation Safety Board aviation crash data base. From the Federal Aviation Administration (FAA) airmen information system, 1,555 pilots were randomly selected as controls. Controls were frequently-matched with cases on medical class and calendar year. Different data bases within the FAA's airmen information system were linked to ascertain information about crash/incident and violation records in the previous 3 years, age, total flight time, and flight time in the prior 6 months. Multivariate logistic regression models were fitted to estimate odds ratios and evaluate dose-response effects, non-linear relationships, and interactions. Cases had significantly higher prevalence rates of prior crash/incident and violation records. The estimated odds ratio of being involved in a commuter aircraft or an air taxi crash was 1.7 (95% confidence interval [CI], 1.3-2.4) for crash/incident history, and 1.6 (95% CI, 1.1-2.2) for violation history. A "dose-response effect" was found with both crash/incident history and violation history, with higher odds ratios for pilots with crashes versus incidents or with more serious violations. Total flight time showed a diminishing protective effect. Either very small or very large recent flight time increased the risk of being involved in a commuter aircraft or an air taxi crash.

Accidents, Aviation↗

PubMed1993

Aphakia and artificial lens implants in the civil airman population.

The Federal Aviation Administration allows civilian airmen with aphakia to fly with waivered certificates. This study analyzes, in the civil airman population, the distribution of aphakia and intraocular lens (I.O.L.) implant by type (unilateral, bilateral), class of airman medical certificate, and gender, for a 4-year period (1982-85). Medical records were individually evaluated for all certified airmen who were carrying FAA-specific codes for the pathology categories during the study period. The prevalence of both aphakia and I.O.L. increased most for bilateral type and second-class certificate holders. During the study period, the prevalence of aphakia increased most for males and I.O.L. increased most for females. The incidence declined in both pathology categories during the later years of the study period. Implications for aeromedical certification of the increasing prevalence of aphakia and I.O.L. in the civil airman population are discussed. The modification of surgical procedures for cataract extraction and evolution of I.O.L. devices strongly suggests continued specialized aeromedical certification and clinical research review.

Aerospace Medicine↗

PubMed1998

Clinical application of the new civil airman vision standards and certification procedures.

INTRODUCTION: The final rule revising the civil airman medical standards became effective September 16, 1996. The purpose of this study was to review changes in the vision standards and procedures and how they relate to the clinical optometrist. METHODS: Revision of Airman Medical Standards and Certification Procedures and Duration of Medical Certificates; Final Rule, (14 CFR, Parts 61 and 67) and the Guide for Aviation Medical Examiners, published by the Federal Aviation Administration's Office of Aviation Medicine, were reviewed, and those parts pertaining to the clinical optometrist were summarized. DISCUSSION: The uncorrected distance visual acuity standards for first- and second-class airmen have been deleted. New equivalent near-vision standards were established for all classes of airmen. A major change--for pilots > or = 50 years of age--was the addition of an intermediate vision requirement of 20/40 or better at 32 inches for both first- and second-class medical certificate holders. Although the third-class medical certificate is still valid for 24 months after the date of examination for those > or = 40 years of age, the certificate is now valid for 36 months for those < 40 years of age. CONCLUSION: The new vision standards primarily affect the elderly pilot. Ophthalmic considerations in the application of the new vision standards are reviewed.

Adult↗

PubMed1978

Drug abuses in the military: correlates of successful rehabilitation.

Investigated the relationships among motivation for drug abuse, successful rehabilitation, and personality/demographic variables. The Ss, 20 airmen who had completed successfully a local USAF Drug Abuse Rehabilitation Program, were administered the 16PF Qestionnaire, the Tennessee Self-Concept Scale, and the Sensation Seeking Scale. Multivariate correlative analyses showed that those Ss who progressed most rapidly through the rehabilitation program could be best identified by their scores on the Sensation Seeking Scale, while specific subscales of the Tennessee Self-Concept Scale and the 16PF contributed somewhat to the predictive value. It was concluded the the SSS has potential value in predicting successful rehabilitation of military drug abusers.

Adolescent↗

PubMed2000

Southeast Asia, promotability and dioxin's relationship to cancer incidence in operation ranch hand veterans.

Significant increases in systemic, melanoma, and presumedly total skin cancers are observed in Operation Ranch Hand veterans unexposed to dioxin. The spiked increase of excess systemic cancers and skin cancer incidence is the pattern expected from a 2- to 3-year exposure to cancer initiators in Southeast Asia during tours of duty coupled with brief or full promotability of initiated cells later in the United States. A discussion of promotability is undertaken. The exposure of these airmen to both Southeast Asia and dioxin is associated with a significant reduction of elevated systemic cancers and total skin cancers.

Dioxins↗

PubMed1998

Measuring fatigue in patients with cancer.

Our current state of knowledge of the fatigue experienced by patients with cancer is limited, and further development is hampered by the definitions of fatigue, which remain numerous, inconsistent, and varied according to the discipline of the author and the nature of the research. It is fairly well established within the healthcare literature that it is multidimensional in nature. This has implications for the reliable and valid assessment of this phenomenon. There are a number of instruments currently available with which to measure cancer-related fatigue. These include instruments developed for use initially with healthy populations, such as airmen and workers engaged in manual and clerical work. However, cancer-specific fatigue assessment instruments are now available, and are preferable to those instruments developed without reference to this patient group. Fatigue is often found as a single item or scale in self-report measures of symptoms, mood and functional status reflecting the effect of fatigue and the interaction of fatigue with other symptoms or concepts related to quality of life. Factors to be considered in selecting a measure of fatigue for research will be outlined, and recommendations for the future development and validation of useful and scientifically credible measures of fatigue made.

Fatigue↗

PubMed1993

Rheumatologic disease among Air Force recruits: a multimillion-dollar epidemic.

A retrospective analysis of medical discharge diagnoses of Airmen Basic undergoing basic military training in the Air Force for a 1-year period from 1990 to 1991 was performed. The weighted variable cost to replace each recruit discharged was then used to estimate the cost to the Air Force attributable to rheumatologic disease. Musculoskeletal disorders were found to account for 67% of medical discharges, costing the Air Force at least 2.70 million dollars during the period under study. The patellofemoral syndrome, pes planus deformity, and low back pain were the most frequently encountered diagnoses.

Female↗

PubMed2004

Energy requirements of military personnel.

Energy requirements of military personnel (Soldiers, Sailors, Airmen, and Marines) have been measured in garrison and in field training under a variety of climatic conditions. Group mean total energy expenditures for 424 male military personnel from various units engaged in diverse missions ranged from 13.0 to 29.8 MJ (3109-7131 kcal) per day. The overall mean was 19.3+/-2.7 MJ (mean+/-SD) (4610+/-650 kcal) per day measured over an average of 12.2 days (range 2.25-69 days). For the 77 female military personnel studied, mean total energy expenditures for individual experimental groups ranged from 9.8 to 23.4 MJ (2332-5597 kcal) per day, with an overall mean of 11.9+/-2.6 MJ (2850+/-620 kcal) per day, measured over an average of 8.8 days (range 2.25-14 days). Women, presumably due to their lower lean body mass, resting metabolic rate, and absolute work rates, had lower total energy expenditures. Combat training produced higher energy requirements than non-combat training or support activities. Compared to temperate conditions, total energy expenditures did not appear to be influenced by hot weather, but tended to be higher in the cold or high altitude conditions.

Adult↗

PubMed2006

Immunization to protect the US Armed Forces: heritage, current practice, and prospects.

Americans serving with the US Armed Forces need protection from the dangerous infections that they can contract during training, based on occupation, during overseas deployment, or because of underlying health status. For over 230 years, the military health-care system has immunized troops to protect them personally and to help them accomplish their missions. Military researchers have invented, developed, and improved vaccines and immunization delivery methods against more than 20 diseases. This article consolidates content from several previous historical reviews, adds additional sources, and cites primary literature regarding military contributions and accomplishments. Discussion emphasizes smallpox, typhoid fever, tetanus, influenza, meningococcal disease, adenovirus, yellow fever, pneumococcal disease, and anthrax. Delivery issues include documentation, simultaneous immunization, seroscreening, safety surveillance, jet injection, and cold-chain management. Immunization policies for each major US conflict are described. Military immunization programs need to be individualized on the basis of personal contraindications and prior immunity. The proper conduct of military immunization programs respects the need for detailed education of military personnel, maximizes quality in immunization delivery, and supports quality clinical care to prevent and treat adverse events after immunization. Military immunization programs maintain the health of soldiers, marines, sailors, airmen, and coast guardsmen, the resources most critical to military success.

Bacterial Vaccines↗

PubMed1988

Thromboembolic disease.

(1) Thromboembolic disease is a rare condition in physically fit subjects and is, therefore, likely to occur only rarely in aircrew. (2) The clinical diagnosis of both pulmonary embolism and deep venous thrombosis is unreliable. As the occurrence of these conditions has serious implications so far as the future licensing of airmen is concerned, it is of paramount importance to establish the diagnosis beyond doubt. (3) The chance of recurrence after an acute pulmonary embolus is low, particularly in those subjects in whom a definite acute and transient predisposing factor such as recent surgery or trauma can be identified. (4) When there is no definite predisposing factor to an acute pulmonary embolism, careful assessment is needed. The possibility that the embolus was the first sign of some serious sytemic illness, such as malignancy, should be considered and the possibility of rare clotting abnormalities sought. (5) Patients with subacute pulmonary embolism should be regarded as for those with acute pulmonary embolism and no obvious risk factor. A large proportion of these patients will have no predisposing factor and will require long-term oral anticoagulants as part of their routine therapy. Fortunately this condition is very rare. (6) Patients with repeated deep venous thrombosis, usually associated with chronic damage to the venous system of the leg, also may require long-term oral anticoagulants and their condition is likely to be exacerbated by long periods of inactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerospace Medicine↗

PubMedDate not supplied

Melatonin: aeromedical, toxicopharmacological, and analytical aspects.

Melatonin, a pineal hormone present in the blood of humans and other species, has a distinct diurnal variation in its biosynthesis and, therefore, in its concentration. This variation has suggested the possibility of a regulatory function in day/night-dependent physiological processes such as sleep and has led scientists to explore the effects of administered melatonin on the modulation of circadian rhythms. For the self-treatment of sleep disorders and other benefits, melatonin use has been extolled to the extent that 20 million new consumers were added to the U.S. retail market in 1995. Its principal aeromedical application has been in the experimental treatment of jet-lag effects. For aircraft passengers, melatonin administration at destination bedtime appears to improve sleep quality and to decrease the time required to reestablish normal circadian rhythms. For international aircrews that travel through multiple time zones without time to adapt to new environments, taking melatonin before arriving home may further impair already disturbed circadian rhythms. Its use to adjust to shiftwork changes by air traffic controllers, aircraft maintenance workers, and support personnel is even more controversial. Limited studies suggest that giving this hormone to shift workers should be done only under controlled conditions and that taking it at the wrong time may actually impair job performance. Because of its possible interaction with certain medications and the changes in its concentrations observed in some clinical conditions, the practitioner must exercise caution during the medical certification of airmen. The variations in the concentration of melatonin can be effectively determined by radioimmunoassay, high-performance liquid chromatography, and gas chromatography-mass spectroscopy analytical techniques. These techniques are capable of measuring the human daytime (10 pg/mL) and nighttime (30-120 pg/mL) melatonin in plasma/serum. Melatonin measurements in victims of accidental death may allow forensic scientists and accident investigators to use the relationship between its concentration and the time of day when death occurred. The most accurate estimations of the time of death result from analysis of melatonin content of the whole pineal body, whereas less accurate estimates are obtained from serum and urine analyses. Pineal levels of melatonin are unlikely to be altered by exogenous melatonin, but its blood and urine levels would change. High blood levels in a daytime crash victim would suggest exogenous supplementation. The possible interfering effects of postmortem biochemical processes on melatonin concentrations in whole blood and in other tissues are not well understood, and there is a need for the continuing research into melatonin's chronobiological properties to define its proper applications and limitations. The indiscriminate use of melatonin by aviation professionals may pose unacceptable safety risks for air travel.

Aerospace Medicine↗