Association Between Cumulative G-force Exposure and Cervical Spine Degenerative Changes.

Introduction: Fighter pilots work in a unique environment and are subject to high G-force loads under simultaneous head movements. Neck pain is reported to be a common health problem among fighter pilots leading to time lost flying and flight duty limitations. The present study aimed to find out if differences in early military flight career G-force exposure levels could increase the risk for degenerative changes in the cervical spine.

Is device-measured physical activity associated with musculoskeletal disorders among young adult Finnish men?

Background: Musculoskeletal (MSK) disorders represent a significant burden to society and can be unpleasant for the affected individuals. Physical activity (PA) can prevent MSK disorders while conferring other health benefits. The present study aimed to investigate associations between device-measured PA and perceived MSK disorders among young adult men.

Functional assessment of military aircrew applicants in a hypobaric chamber.

Background: Aircrew are exposed to environmental pressure changes. In the Republic of Singapore Air Force (RSAF), applicants assessed to be at intermediate risk of otic barotrauma undergo a hypobaric chamber assessment ["trial of chamber" (TOC)] to functionally evaluate their suitability for military aircrew vocations.

Aims: To identify factors associated with TOC failure among applicants with otorhinolaryngological conditions.

Hyperventilation and Hypoxia Hangover During Normobaric Hypoxia Training in Hawk Simulator.

In military aviation during high-altitude operations, an oxygen or cabin pressure emergency can impair brain function and performance. There are variations in individuals' physiological responses to low partial pressure of oxygen and hypoxia symptoms can vary from one exposure to another. The aim of this study was to evaluate how normobaric hypoxia (NH) affects pilots' minute ventilation and 10 min afterwards on Instrument Landing System (ILS) flight performance in Hawk simulator during a tactical flight sortie.

Prevalence of leukocyturia in a cohort of French asymptomatic aircrews.

Objectives: Sexually transmitted infections (STIs) can cause leukocyturia. We aimed to estimate the prevalence of leukocyturia in asymptomatic aircrews and the proportion of STIs in those presenting leukocyturia.

Methods: The LEUCO survey was a prospective cohort study conducted among aircrews between 14th October 2019 and 13th March 2020 at the Toulon aeromedical centre in France.

Can a patient with pulmonary hypertension travel safely by plane?

Air travel is known as the safest way of transportation. Therefore, patients with health problems prefer to travel by air; however, those with heart or lung issues, who do not have any problems under normal conditions, may experience some problems in high altitude and different environmental conditions. In this review, we have described the points to be considered during air travel in patients with pulmonary hypertension.

Is air travel safe for patients with cardiac implantable electronic devices?

Parallel to the rapid expansion of air travel services and advances in medical technology, more passengers with cardiac implantable electronic devices (CIEDs) fly each year. In general, commercial airline flights are considered safe for patients with CIEDs; nevertheless, some specific precautions should be undertaken in some certain circumstances. Apart from the risk of a minor and overlooked pneumothorax early after implantation of a CIED, which may be aggravated due to sudden pressure changes during flight, electromagnetic interference, cosmic radiation and vibration are the other risks a patient with a CIED may encounter during air travel, nevertheless, these are rare and often do not bring about significant clinical consequences.

Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up.

Introduction: Degenerative changes of the cervical spine often cause disability and flight duty limitations among Finnish Air Force (FINAF) fighter pilots. We aimed to study the effect of +Gz exposure on degenerative changes in the cervical spine by comparing cervical MRIs of FINAF fighter pilots and controls.

Methods: At baseline, the volunteer study population consisted of 56 20-year-old FINAF male fighter pilots (exposure group) and 56 21-year-old Army and Navy cadets (control group).

Central aortic hemodynamics following acute lower and upper-body exercise in a cold environment among patients with coronary artery disease.

Exercise is beneficial to cardiovascular health, evidenced by reduced post-exercise central aortic blood pressure (BP) and wave reflection. We assessed if post-exercise central hemodynamics are modified due to an altered thermal state related to exercise in the cold in patients with coronary artery disease (CAD). CAD patients (n = 11) performed moderate-intensity lower-body exercise (walking at 65-70% of HR) and rested in neutral (+ 22 °C) and cold (- 15 °C) conditions.

Muscular Fitness Improves during the First Year of Academy Studies among Fighter Pilot Cadets.

: An adequate level of muscular fitness is related to occupational performance in military personnel, including pilots flying high performance aircraft. The aim of this study was to describe the baseline level and the change in muscular fitness between the first and the second years of the Air Force Academy among fighter pilot cadets. : The muscular strength and endurance test results of 182 male fighter pilot cadets were analyzed during their first year in the Air Force Academy and one year after.

The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners.

Introduction: Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian-military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military's involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare.

Normobaric hypoxia training in military aviation and subsequent hypoxia symptom recognition.

Altitude hypoxia episodes are increasingly common in military aviation. Hypoxia training is mandatory for fighter pilots, but evidence-based data on the effects of training are scarce. The purpose of this study was to validate the normobaric hypoxia (NH) training effect.

Endothelial function in response to exercise in the cold in patients with coronary artery disease.

Background: Regular long-term physical exercise has favourable effects on endothelial function in patients with coronary artery disease (CAD). However, the effects of an acute exercise bout in the cold on endothelial function are not known.

Methods: At first, the effects of moderate-intensity aerobic lower-body exercise were assessed in CAD patients (n = 16) in a neutral [+22°C] and cold [-15°C] environment.

Cardiorespiratory and muscular fitness in young adult Finnish men between 2003 and 2015.

Introduction: Physical fitness is strongly related to health and may offer valuable information about public health. We investigated trends in physical fitness, leisure-time physical activity (LTPA), and anthropometry of young healthy adult Finnish men in representative population-based samples between 2003 and 2015.

Methods: Three independent cross-sectional samples of 18- to 35-year-old Finnish men were assessed in 2003 (n = 889), 2008 (n = 803), and 2015 (n = 690).

Good safety practice in a randomized controlled trial (CadColdEx) involving increased cardiac workload in patients with coronary artery disease.

Background: Methodological information acknowledging safety of cardiac patients in controlled medical experiments are lacking. The descriptive report presents one good practice for considering safety in a randomized controlled study involving augmented cardiovascular strain among persons with coronary artery disease (CAD).

Methods: The patients were pre-selected by a cardiologist according to strictly defined selection criteria.

Association of Flying Time with Hearing Loss in Military Pilots.

Background: Military pilots are exposed to harmful noise levels, and the two possible effects of this are hearing loss and tinnitus.

Objective: This study was conducted to determine the prevalence of noise-induced hearing loss among Saudi military pilots and to determine its association with total flight hours and aircraft type (i.e.

Non-coronary cardiac surgery and percutaneous cardiology procedures in aircrew.

This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew following non-coronary surgery or percutaneous cardiology interventions (both pilots and non-pilot aviation professionals). Aircrew may have pathology identified earlier than non-aircrew due to occupational cardiovascular screening and while aircrew should be treated using international guidelines, if several interventional approaches exist, surgeons/interventional cardiologists should consider which alternative is most appropriate for the aircrew role being undertaken; liaison with the aircrew medical examiner is strongly recommended prior to intervention to fully understand this. This is especially important in aircrew of high-performance aircraft or in aircrew who undertake aerobatics.

Congenital heart disease in aircrew.

This article focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with suspected or confirmed congenital heart disease (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology. This expert opinion was born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of cardiovascular disease in aircrew (HFM-251) many of whom also work with and advise civil aviation authorities.

Contemporaneous management of valvular heart disease and aortopathy in aircrew.

Valvular heart disease (VHD) is highly relevant in the aircrew population as it may limit appropriate augmentation of cardiac output in high-performance flying and predispose to arrhythmia. Aircrew with VHD require careful long-term follow-up to ensure that they can fly if it is safe and appropriate for them to do so. Anything greater than mild stenotic valve disease and/or moderate or greater regurgitation is usually associated with flight restrictions.

Heart muscle disease management in aircrew.

This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with suspected or confirmed heart muscle disease (both pilots and non-pilot aviation professionals). ECG abnormalities on aircrew periodic medical examination or presentation of a family member with a confirmed cardiomyopathy are the most common reason for investigation of heart muscle disease in aircrew. Holter monitoring and imaging, including cardiac MRI is recommended to confirm or exclude the presence of heart muscle disease and, if confirmed, management should be led by a subspecialist.

Management of cardiac conduction abnormalities and arrhythmia in aircrew.

Cardiovascular diseases are the most common cause of loss of flying licence globally, and cardiac arrhythmia is the main disqualifier in a substantial proportion of aircrew. Aircrew often operate within a demanding physiological environment, that potentially includes exposure to sustained acceleration (usually resulting in a positive gravitational force, from head to feet (+Gz)) in high performance aircraft. Aeromedical assessment is complicated further when trying to discriminate between benign and potentially significant rhythm abnormalities in aircrew, many of whom are young and fit, have a resultant high vagal tone, and among whom underlying cardiac disease has a low prevalence.