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Cancer mortality after nasopharyngeal radium irradiation in the Netherlands: a cohort study.

BACKGROUND: Nasopharyngeal radium irradiation (NRI) was used widely from 1940 through 1970 to treat otitis serosa in children and barotrauma in airmen and submariners. We assessed whether NRI-exposed individuals were at higher risk for cancer-related deaths than were nonexposed individuals. METHODS: We conducted a retrospective cohort study of all-cause and cancer-related mortality in 5358 NRI-exposed subjects and in 5265 frequency-matched nonexposed subjects, who as children were treated at nine ear, nose, and throat clinics in The Netherlands from 1945 through 1981. We recorded personal and medical data from original patient medical records and assessed vital status through follow-up at municipal population registries. Risk of mortality was evaluated by standardized mortality ratios (SMRs). All statistical tests were two-sided. RESULTS: The average radiation doses were 275, 10.9, 1.8, and 1.5 cGy for the nasopharynx, pituitary, brain, and thyroid, respectively. The median follow-up was 31.6 years. Three hundred two NRI-exposed subjects had died, with 269.2 deaths expected (SMR = 1.1; 95% confidence interval [CI] = 1.0 to 1.3); among nonexposed subjects, 315 died, with 283.5 deaths expected (SMR = 1.1; 95% CI = 0.99 to 1.2). Cancer-related deaths of 96 exposed subjects (SMR = 1.2; 95% CI = 0.95 to 1.4) and 87 nonexposed subjects (SMR = 1.0; 95% CI = 0.8 to 1.3) were documented. There were no excess deaths from cancers of the head and neck area among exposed subjects. However, there were excess deaths from cancers of lymphoproliferative and hematopoietic origin (SMR = 1.9; 95% CI = 1.1 to 3.0), mainly from non-Hodgkin's lymphoma (SMR = 2.6; 95% CI = 1.0 to 5.3). We found no evidence that breast cancer deaths were less than expected (SMR = 1.7; 95% CI = 0.9 to 2.8) in contrast to an earlier study. CONCLUSIONS: Our findings do not indicate an increased cancer mortality risk in a population exposed to NRI in childhood. More prolonged follow-up of this and other NRI cohorts is recommended.

Barotrauma↗

Recurrent personality factors based on trait ratings.

Intercorrelations among ratings on 35 personality traits, selected as representative of the personality domain, were obtained for eight samples. These samples differed in length of acquaintanceship from 3 days to more than a year; in kind of acquaintanceship from assessment programs in a military training course to a fraternity house situation; in type of subject from airmen with only a high-school education to male and female undergraduate students to first-year graduate students; and in type of rater from very naive persons to clinical psychologists and psychiatrists with years of experience in the evaluation of personality. Centroid or multiple-group factors were extracted and rotated orthogonally to simple structure. For one study, an independent solution was obtained in which analytic rotations were accomplished on an IBM 650 computer using Kaiser's normal varimax criterion. Five fairly strong and recurrent factors emerged from each analysis, labeled as (a) Surgency, (b) Agreeableness, (c) Dependability, (d) Emotional Stability, and (e) Culture.

Adult↗

The psychiatrist's role in aerospace operations.

This paper presents two unique aspects of aerospace psychiatry: the influence of the specialized stressors and occupational requirements of an aviation career and the ambiguous role of the aerospace psychiatrist. Aerospace psychiatrists have multiple, sometimes conflicting, responsibilities to the organization and society (the social control task) and to the individual aviator (the humanistic and medical tasks). In the two case reports below the authors describe airmen who had vasovagal syncope and how the psychiatrist intervened and resolved these conflicting tasks.

Adult↗

Late health effects of childhood nasopharyngeal radium irradiation: nonmelanoma skin cancers, benign tumors, and hormonal disorders.

Nasopharyngeal radium irradiation (NRI) was widely used from 1940 through 1970 to treat otitis serosa in children and barotrauma in airmen and submariners. We assessed whether NRI-exposed individuals were at higher risk for benign tumors, nonmelanoma skin cancer, thyroid disorders, and conditions related to regulatory control of anterior pituitary hormones, such as growth and reproductive characteristics. We conducted a retrospective cohort study in 3,440 NRI-exposed and 3,088 nonexposed subjects, who as children were treated at nine ear, nose and throat clinics in The Netherlands between 1945 and 1981. Based on information from original medical records, we traced vital status through follow-up at municipal population registries. Disease status (including medical confirmation) and indicators of pituitary gland radiation damage were assessed from a self-administered questionnaire in 1997. The average radiation doses were 11, 7, and 1.5 cGy for pituitary, parotid, and thyroid gland, respectively, and 3.2 cGy for the facial skin. Among exposed subjects, 23 benign head and neck tumors were observed, compared with 21 among nonexposed subjects. Elevated risk of basal cell carcinoma of the head and neck area was observed in exposed subjects (odds ratio = 2.6; 95% confidence interval: 1.0-6.7). Exposed and nonexposed groups did not differ substantially with regard to thyroid disorders, height, and reproductive characteristics, although exposed males more frequently reported a history of fertility problems compared with nonexposed males (odds ratio = 1.4; 95% confidence interval: 1.0-2.1). We found no evidence of highly elevated risk of benign head and neck tumors, nonmelanoma skin cancer, thyroid disorders, or indicators of pituitary radiation damage after childhood NRI in The Netherlands.

Adolescent↗

Relevant MMPI norms for young adult Air Force trainees.

The Air Force Medical Evaluation Test (AFMET) research program utilized the MMPI in a psychological screening battery for basic trainees. T-scores based on the Adult Norms seemed excessively elevated. The norms for Minnesota Adolescents were tried for the 17-year-old airmen. MMPIs were given to entire squadrons not in the project, and the means and standard deviations were found to differ significantly from both earlier norms. These young adults differed in age, race, and education from the sample population of the Minnesota Adult Norms. T-conversion tables based on these new means and standard deviations were compiled.

Adolescent↗

Georges Dreyer (1873-1934) and a forgotten episode of respiratory physiology at Oxford.

Georges Dreyer was the first Professor of Pathology at Oxford University and he held this post from 1907 to 1934. Although his main research interests were in bacteriology and immunity, he made important contributions to respiratory physiology, but these have been almost completely forgotten. He developed a new apparatus for administering low oxygen mixtures to test the effects of hypoxia in airmen during World War I, developed a high successful oxygen delivery system, was responsible for the first low-pressure chamber in a UK academic institution, and carried out some physiological measurements in the chamber that were years ahead of their time. His chamber was also used by a group from Cambridge and Turin, Italy for a series of important physiological studies. In spite of these contributions, almost nobody who works in respiratory physiology today, even in Oxford, recognizes the name of Dreyer.

England↗

Variables related to cannabis use.

A sample of 4,564 self-admitted cannabis users was compared with a sample of airmen who had no known record of drug abuse. This study indicates that there is a very strong likelihood for cannabis users to abuse other drugs. There are relationships between cannabis use and geographic area of enlistment, religious preference, aptitude scores, race, educational level, and age at enlistment. Cannabis use is also related to the likelihood of getting an undesirable discharge, to Airman Performance Report, and to promotion rate.

Achievement↗

The United States Armed Forces Amputee Patient Care Program.

United States military amputees are treated at either Walter Reed Army Medical Center (Washington, DC) or Brooke Army Medical Center (Fort Sam Houston, TX). At each center, a multidisciplinary team from more than a dozen specialties works together to address the psychological, social, vocational, and spiritual needs of our soldiers, marines, sailors, and airmen, as well as their physical rehabilitation. Excellent outcomes are being achieved with the current practices of the Armed Forces Amputee Care Program, but a great deal of evidence-based research must be done to determine the optimal time to close the wound, the etiology of heterotopic ossification in blast injury, the factors determining optimal socket design, and the best sequence and timing for introduction of different prosthetic technologies in the rehabilitation process.

Amputees↗

Process of care for battle casualties at Walter Reed Army Medical Center: Part II. Physical therapy service.

Physical therapists, physical therapy assistants, and physical therapy technicians provide care to soldiers, sailors, Marines, and airmen returning from Operation Enduring Freedom and Operation Iraqi Freedom. We describe the inpatient and outpatient services provided, the problems and solutions encountered, and the lessons learned at the beginning of the war.

Amputation, Surgical↗

1993 architectural design awards.

The 10th annual architectural design awards sponsored by Contemporary Long Term Care salute nursing homes and retirement communities that combine a flair for innovative living environments with a sensitivity to the needs of aging residents. These facilities represent the very best in elderly housing that prolongs independence while enhancing efficient operation. The 1993 winners are: King Health Center, U.S. Soldiers' and Airmen's Home, Washington, DC; The Terrace of Los Gatos, Los Gatos, CA; Walker Elder Suites, Edina, MN; The Jefferson, Ballston, VA; The Forum at Rancho San Antonio, Cupertino, CA.

Aged↗

Significance of low hematocrit levels in asymptomatic young adults: results of 15 years follow-up.

HYPOTHESIS: Periodic complete blood counts are not recommended for disease prevention in low-risk, non-pregnant adults. Consequently, there are few follow-up studies of the prevalence of incidentally detected anemia in asymptomatic subjects and its significance for their well-being. The objective of this survey is to determine the frequency of anemia and its predictive value for disease over a 15-yr annual follow-up of a cohort of asymptomatic young males, selected for physical fitness and intelligence. METHODS: One thousand Israeli airmen aged 18-30 yr at entry into this historical-prospective study in 1968 were used as subjects. Hematocrit (Hct) levels were examined annually. On the average each subject had 13.2 tests in the course of the 15 yr follow-up. We arbitrarily defined anemia as a Hct of 40% or less on two or more tests, and compared the prevalence of diagnosed disorders in subjects with and without anemia. RESULTS: During follow-up, anemia was found in 125 (12.5%) of the subjects. On successive annual examinations of the same individual Hct levels varied by 3% or more in 3.5% of those without anemia, and in 10.5% of those with anemia. The frequency of diagnosed disorders, excluding inter-current infections and trauma, was 25.6%, and 10.9% among those with and without anemia, respectively (OR = 2.8, 95% CI 1.8-4.6). Anemia was associated with inflammatory bowel disease (OR = 12.1, 95% CI 2.3 78.6) and malignancy (OR = 3.6, 95% CI 1.1-10.7). It preceded diagnosis only in one case with Waldenstr 246 m's macroglobulinemia, in one case of inflammatory bowel disease and two cases of myocardial infarction. CONCLUSIONS: A finding of anemia doubled the likelihood of chronic disease. However, it had a limited predictive value for subsequent morbidity and did not lead to detection of treatable disorders or to disorders that might otherwise have endangered flight safety. Fluctuations of up to 3% in Hct over time may be viewed as normal in young males.

Adolescent↗

Dystonia, botulinum neurotoxin, and the aviator.

Dystonia is both a symptom and the name for group of illnesses called the dystonias. The physical manifestation consists of sustained, involuntary contractions of the muscles in one or more parts of the body, resulting in twisting or distortion of that part of the body. For focal dystonias including torticollis, blepharospasm and spasmodic dysphonia, botulinum toxin injections have become the treatment of choice because of the ability of this toxin to sufficiently weaken the muscle to reduce the spasm but not so much as to cause paralysis. This paper involves the fate of four airmen all afflicted with a form of dystonia who had been reviewed in the Aeromedical Certification Division of the FAA Civil Aeromedical Institute.

Aerospace Medicine↗

Vision readiness at Seymour Johnson Air Force Base.

Ensuring that our forces are vision ready, i.e., they have the appropriate visual acuity, optical devices, and eye health to perform their mission, is essential on today's battlefield. A study was conducted at Seymour Johnson Air Force Base to determine the prevalence of vision readiness in a deploying fighter squadron. Of the 204 personnel screened, 59 wore glasses or contact lenses. Of these 59, 15 individuals (25%) were optically ready and 44 individuals (75%) were not optically ready to deploy. Optical readiness is defined as having the correct type and number of optical devices. Of the 15 individuals (25%) who were optically ready, 13 (87%) had had a professional eye examination within 12 months. Of the 44 individuals (75%) who were not optically ready, 36 (82%) had been examined within 1 year. Pearson's chi 2 test (chi 2 = 1.59, degrees of freedom = 3, significance = 0.66) indicated that there was no significant association between readiness and the date of the last examination. This study reveals that although personnel are having regular periodic professional eye examinations, optometry personnel, commanders, and deploying airmen must take a more active role in ensuring that our forces are vision ready.

Aerospace Medicine↗

German acceleration research from the very beginning.

German airmen were experiencing G-induced physiological effects as early as WWI, although no research on acceleration physiology was conducted at that time in Germany. This changed in 1931 with the studies of Heinz von Diringshofen, who gained experience with prolonged acceleration in flight. The first German centrifuge was constructed by the von Diringshofen brothers and was in operation at the Air Ministry's Aeromedical Research Institute in Berlin from 1935-1945. After WWII, Otto Gauer and Heinz Haher authored the paper "Man under Gravity-Free Conditions," paving the way to manned space exploration and demonstrating the change of research interest from the effects of multiple G forces to those of zero G.

Acceleration↗

Relapse to smoking after basic military training in the U.S. Air Force.

This study examined predictors of smoking relapse in the year after the mandatory smoking ban during basic military training (BMT) in the U.S. Air Force. Participants were all smokers who completed BMT from August 1995 to August 1996 and relapsed to smoking in the subsequent year (N = 4,303). Results demonstrated that the vast majority of airmen (69.8%) returned to smoking within 1 month after BMT and that most (90%) were still in training status when they smoked their first cigarette after BMT. Relapsed smokers appeared more motivated to quit smoking at 1-year follow-up compared with when they were in BMT. Individuals making serious quit attempts after BMT were younger and had greater levels of physical activity, more confidence in quitting, and more favorable perceptions of the BMT ban than individuals not attempting to quit. Based on these findings, recommendations are discussed for improving abstinence rates after BMT.

Adolescent↗

Louis H. Bauer, M.D., and the first civil U.S. aeromedical standards: his continuing legacy.

Louis Hopewell Bauer, M.D. (1888-1964) promulgated the first civil aviation medicine regulations for U.S. civil airmen on December 31, 1926. Major elements of these regulations are reflected in the current Federal Aviation Administration Civil Airman Medical Standards, these latter including modifications resulting from medical and aeronautical technical advances. Dr. Bauer's plans covering periodic examinations, waivers, and a system implemented through designated "Aviation Medical Examiners" are continued to this day. Dr. Bauer founded the progenitor of the present Aerospace Medical Association in 1929, the Aero Medical Association. Further, he founded the Journal of Aviation Medicine, the predecessor of the present Aviation, Space, and Environmental Medicine journal, the first issue published in March, 1930. Dr. Bauer's influence in medicine broadened to include the presidency of the American Medical Association (1952-3) and a long standing leadership role with the World Medical Association. His 1926 textbook, Aviation Medicine, stands as an historic centerpiece in the evolution of aviation medicine. Bauer's leadership and contributions to civil aviation medicine came at the right time to enhance the development of U.S. civil aviation and civil aviation safety.

Aerospace Medicine↗

Human factors in aviation crashes involving older pilots.

BACKGROUND: Pilot errors are recognized as a contributing factor in as many as 80% of aviation crashes. Experimental studies using flight simulators indicate that due to decreased working memory capacity, older pilots are outperformed by their younger counterparts in communication tasks and flight summary scores. OBJECTIVE: This study examines age-related differences in crash circumstances and pilot errors in a sample of pilots who flew commuter aircraft or air taxis and who were involved in airplane or helicopter crashes. METHODS: A historical cohort of 3306 pilots who in 1987 flew commuter aircraft or air taxis and were 45-54 yr of age was constructed using the Federal Aviation Administration's airmen information system. Crash records of the study subjects for the years 1983-1997 were obtained from the National Transportation Safety Board (NTSB) by matching name and date of birth. NTSB's investigation reports were reviewed to identify pilot errors and other contributing factors. Comparisons of crash circumstances and human factors were made between pilots aged 40-49 yr and pilots aged 50-63 yr. RESULTS: A total of 165 crash records were studied, with 52% of these crashes involving pilots aged 50-63 yr. Crash circumstances, such as time and location of crash, type and phase of flight, and weather conditions, were similar between the two age groups. Pilot error was a contributing factor in 73% of the crashes involving younger pilots and in 69% of the crashes involving older pilots (p = 0.50). Age-related differences in the pattern of pilot errors were statistically insignificant. Overall, 23% of pilot errors were attributable to inattentiveness, 20% to flawed decisions, 18% to mishandled aircraft kinetics, and 18% to mishandled wind/runway conditions. CONCLUSIONS: Neither crash circumstances nor the prevalence and patterns of pilot errors appear to change significantly as age increases from the 40s to the 50s and early 60s.

Accidents, Aviation↗

Vision readiness in Operation Restore Hope.

Ensuring that our forces are vision ready for their mission is essential on today's battlefield. Vision readiness considers optical readiness (appropriate correcting eyewear) and visual readiness (adequate job-required visual acuity). A study of vision readiness among deploying personnel for Operation Restore Hope in Bosnia from December 1995 to September 1997 was conducted at Fort Benning, Georgia. Of the 10,063 personnel screened, 3,554 (35.3%) were not optically ready for deployment and 406 (4.0%) were not visually ready for deployment. Analyses indicated a statistically significant difference between the active duty and reserve components in optical and visual readiness. A more effective vision readiness process should be implemented before deployment to ensure that all personnel are deployment ready. Optometry personnel, commanders, and deploying soldiers, sailors, airmen, and marines must take a more active role in ensuring that our forces have the appropriate visual acuity and optical devices to deploy.

Contact Lenses↗