O uso de substâncias psicoativas na aviação civil: uma revisão integrativa / The use of psychoactive substances in civil aviation: an integrative review

A Agência Nacional de Aviação Civil (ANAC) estabelece como uso indevido de substâncias psicoativas a utilização, devidamente comprovada, de uma ou mais substâncias psicoativas cujos efeitos se façam presentes durante a jornada de trabalho de qualquer pessoa desempenhando função em atividade de risco à segurança operacional na aviação civil (ARSO). A International Civil Aviation Organization (ICAO) chama de uso problemático de substâncias psicoativas, o uso de uma ou mais dessas substâncias por profissionais de aviação e que possam constituir perigo ou risco direto ao usuário ou ainda, colocar outras vidas em risco, levando a prejuízos à saúde e bem-estar de outros, além de agravar doenças ocupacionais, sociais, mentais e físicas (ICAO, 2006). Esta revisão bibliográfica integrativa tem como objetivo realizar levantamento sobre as repercussões na segurança operacional quanto ao uso de substâncias psicoativas por aeronautas durante as situações de trabalho, discutir o que tem sido proposto sobre o tema e identificar a existência de programas de apoio. O método utilizado nesta revisão apoia-se no modelo Prisma. Foram realizadas buscas nos documentos normativos da ICAO como o Anexo 1, DOC 8984 e DOC 9654. Os documentos da ANAC utilizados são os Regulamentos Brasileiros de Aviação Civil (RBAC 67; 120) e a Instrução Suplementar (IS -003). De um total de 860 artigos, foram selecionados 27 que discutem sobre os exames toxicológicos post-mortem, exames aleatórios e de suspeita justificada, exames pré-admissionais, uso de medicamentos prescritos e não prescritos, uso de drogas lícitas e ilícitas e questões éticas e de sigilo. Os artigos resultantes da busca demonstram que a porcentagem de pilotos da aviação comercial que infringiram as regras toxicológicas é inferior a 1,0%, o que sugere que as estratégias de educação, aliadas aos exames pré-admissionais têm tido impacto positivo. Os artigos apontam que os pilotos gostariam de ter mais informações sobre o uso de medicamentos permitidos e proibidos para uso durante as situações de trabalho. Não foram localizados artigos que tenham analisado os programas de apoio, peer support, nas questões de efetividade prática e legal. O Brasil não conta com programas de apoio aos aeronautas, a exemplo de outros reguladores que o exigem como a EASA, FAA, CASA.

Agência Nacional de Aviação Civil (ANAC) establishes as misuse of psychoactive substances the use, properly evidenced, of one or more psychoactive substances whose effects are present during the duty time of any person performing a safety sensitive function (ARSO). The International Civil Aviation Organization (ICAO) refers to problematic use of psychoactive substances, the use of one or more of these substances by aviation personnel that may constitute a direct hazard or risk to the user or put other lives at risk, resulting in prejudice to the health and well-being of others, as well as causing occupational, social, mental, and physical illness (ICAO, 2006). This integrative literature review aims to study the repercussions on operational safety regarding the use of psychoactive substances by aeronauts during work situations, discuss what has been proposed on the subject and identify the existence of support programs. The method applied is based on the Prisma model. Searches were conducted in ICAO normative documents, Annex 1, DOC 8984, DOC 9654 and ANAC regulations, such as RBAC 67, RBAC 120 and supplementary instruction IS-003. From a total of 860 articles, 27 articles were selected that discuss post-mortem toxicological examinations, random and justified suspect examinations, pre-admittance examinations, use of prescribed and non-prescribed medications, use of licit and illicit drugs and ethical and confidentiality questions. The selected articles show that the percentage of commercial aviation pilots who have violated toxicological rules is less than 1.0%, which suggests that education strategies, combined with pre-admission examinations, have had a positive impact; they also indicate that pilots would like to have more information on the use of allowed and not allowed drugs for use during duty time periods. No articles were found that analyzed peer support programs in terms of effectiveness, practical and legal aspects. Brazil does not have a peer support programs, like other regulators do, such as EASA, FAA, CASA.

Regulação e trabalho em jornadas irregulares: o caso de pilotos brasileiros. Implicações para o trabalho e para a saúde / Regulation and irregular work hours: the case of Brazilian pilots. Implications for work and health

A fadiga na aviação é um tema antigo, porém ganhou maior visibilidade na última década. Em 2019, a Agência Nacional de Aviação Civil publicou o Regulamento Brasileiro de Aviação Civil 117, intitulado Requisitos para gerenciamento de risco de fadiga humana. A presente pesquisa buscou verificar a adequação do regulamento perante a literatura da área e sob o ponto de vista dos pilotos. Objetivos específicos: a. comparar as recomendações da literatura sobre trabalho em turnos, noturnos e em jornadas irregulares, em relação às principais regras constantes do RBAC 117 aplicáveis a tripulações simples; b. identificar similaridades e diferenças entre o RBAC 117 e regulamentações equivalentes dos países que apresentam maior quantidade de horas voadas no mundo e de empresas selecionadas que voam para o Brasil; c. verificar a percepção de pilotos brasileiros acerca de suas escalas de trabalho e possíveis consequências ao trabalho e à saúde; e d. descrever ciclos de atividade e repouso e percepção de fadiga e sonolência em um grupo de pilotos brasileiros, considerando as escalas de trabalho implementadas a partir do RBAC 117. Métodos. Para atingir o objetivo "a", foi realizada uma revisão integrativa de literatura; para o objetivo "b", foi realizada uma pesquisa documental; para cumprimento do objetivo "c" foram realizadas entrevistas semiestruturadas com pilotos de linhas aéreas brasileiras e aplicados questionários de sono, cronotipo e jet lag social; para verificação do objetivo "d" foi realizado um estudo de campo, acompanhando 51 pilotos de linhas aéreas brasileiras. Neste estudo, os participantes usaram actígrafo e preencheram o diário de sono, assim como responderam à escala de fadiga e de sonolência três vezes ao dia, durante, em média, 15 dias consecutivos. Resultados. Os resultados da parte teórica sugerem que o RBAC 117 está parcialmente adequado às recomendações da literatura sobre fadiga, sonolência e trabalho em turnos, e que regulações de outras autoridades podem fornecer exemplos úteis para o gerenciamento da fadiga na aviação civil. As entrevistas semiestruturadas indicaram que as folgas únicas de 24 horas e a duração de 12 horas de repouso são as principais fontes de fadiga percebida dos pilotos. O estudo de campo mostrou que as percepções de fadiga e sonolência dos pilotos são maiores em jornadas que ocorrem durante a madrugada (00h-06h00) e em períodos cedo pela manhã (06h01-07h59), e que a duração do sono e percepção de qualidade do sono são menores e piores antes de jornadas iniciadas nestes períodos do dia. Folgas únicas de 24 horas apresentaram maior risco de percepção de fadiga. Conclusões. Os períodos do dia para trabalhar considerados mais desafiadores pelos pilotos foram o noturno (madrugada) e de início cedo; duas ou mais jornadas consecutivas nesses horários de trabalho favoreceram a ocorrência de fadiga severa e de sonolência excessiva. O gerenciamento a fadiga na aviação civil não depende apenas da regulação, mas as prescrições são vitais e obrigatórias, de forma que o RBAC 117 pode ser aprimorado. Empresas aéreas e tripulantes podem utilizar os achados desta pesquisa úteis na melhoria de suas políticas organizacionais e gerenciamento pessoal.

Fatigue in aviation is an old topic, but it has gained greater visibility in the last decade. In 2019, the Brazilian National Civil Aviation Agency published the Brazilian Civil Aviation Regulation 117, entitled "Requirements for Human Fatigue Risk Management." This research aimed to verify the adequacy of the regulation in relation to the literature in the area and from the pilots' point of view. The specific objectives were: a. to compare the literature recommendations on shift work, night work, and irregular working hours with the main rules contained in RBAC 117 applicable to two-pilot crews; b. to identify similarities and differences between RBAC 117 and equivalent regulations of States that have the highest number of flight hours in the world and airlines that most frequently fly to Brazil; c. to verify the perception of Brazilian airline pilots about their work schedules and possible consequences to work and health; and d. to describe activity-rest cycles and the perceived fatigue and sleepiness during flight duties in a group of Brazilian pilots, considering the work schedules implemented based on RBAC 117. Methods: To achieve objective "a," an integrative literature review was conducted. For objective "b," a documentary research was carried out. For the fulfillment of objective "c," semi-structured interviews were conducted with Brazilian airline pilots, and sleep, chronotype, and social jet lag questionnaires were administered. To verify objective "d," a field study was conducted, monitoring 51 Brazilian airline pilots. In this study, participants wore actigraphy devices and filled out sleep diaries, as well as responded to fatigue and sleepiness scales three times a day, for an average of 15 consecutive days. Results: The results of the theoretical part suggest that RBAC 117 is partially adequate to the literature recommendations on fatigue, sleepiness, and shift work, and that regulations from other authorities can provide useful examples for fatigue management in civil aviation. The semi-structured interviews indicated that single 24-hour days off and the 12-hour rest period are the main sources of perceived fatigue among pilots. The field study showed that pilots' perceptions of fatigue and sleepiness are higher on flight duties that occur during late night (00h-06h00) and early morning periods (06h01-07h59), and that sleep duration and perceived sleep quality are lower and worse before shifts starting during these times of the day. Single 24-hour days off presented a higher risk of perceived fatigue. Conclusions: According to the literature, the most challenging periods of the day for pilots to work were found to be the late night and early morning periods, and that two or more consecutive shifts during these working hours increase the likelihood of severe fatigue and excessive sleepiness. Fatigue management in civil aviation does not solely depend on regulations, but they are vital and mandatory prescriptions, and thus, RBAC 117 can be improved. Airlines and crew members can use the findings of this research to improve their organizational policies and personal management.

Daños a la salud asociados a riesgos laborales en el tránsito aéreo mexicano, 2020-2021 / Adverse health effects associated with occupational risk factors among Mexican air traffic workers, 2020-2021

En el sector aéreo los trabajadores laboran en ambientes atípicos, debido a que están expuestos continuamente a diversos riesgos. En aviación, la mayoría de los sistemas de gestión están enfocados en controlar riesgos operativos, es decir, factores que podrían perjudicar el correcto desempeño de las aeronaves. El objetivo del presente estudio consistió en determinar la asociación entre riesgos laborales y daños a la salud, a los que se expone el personal de Servicios a la Navegación en el Espacio Aéreo Mexicano. Para ello, se utilizaron la Encuesta Individual para la Evaluación de la Salud de los Trabajadores, la Prueba de Síntomas Subjetivos de Fatiga y, la Escala de Depresión, Ansiedad y Estrés. Participaron 199 trabajadores y se realizó un análisis multivariable de los resultados, considerando una significancia estadística de p≤0.05 y un intervalo de confianza al 95%. Se encontró que el personal femenino tiene una mayor prevalencia de fatiga (2.31), trastornos del sueño (1.80) y lumbalgia (1.58). El personal de control de tránsito aéreo tiene mayor prevalencia de estrés (2.71) y ansiedad (1.75). Aquellos expuestos a cambios bruscos de temperatura, presentan mayor ansiedad (99%) y estrés (90%). Para mejorar las condiciones laborales en el sector aeronáutico mexicano, se requiere de una adecuada comprensión de la relación que guardan los riesgos con el perfil de daño de los trabajadores. Esta acción permitirá tomar acciones preventivas y correctivas, asertivas y eficientes(AU)

In the aerospace industry people work in atypical environments, because workers are continuously exposed to various risks. In aviation, management systems are focused mainly on controlling operational risks, i.e., factors that could harm the correct performance of an aircraft. The objective of this study was to determine the association between occupational risk factors and adverse health effects among staff belonging to the Mexican Air Space Navigation Services [Servicios a la Navegación en el Espacio Aéreo Mexicano]. We administered the Individual Survey for the Evaluation of Workers' Health, the Subjective Symptoms of Fatigue Test, and the Depression, Anxiety and Stress Scale. A total of 199 workers participated and a multivariate analysis of the results was performed, considering 95% confidence intervals and a statistical significance level of p≤0.05. We found that female staff hada higher prevalence of fatigue (2.31), sleep disorders (1.80) and low back pain (1.58). Air traffic control personnel have a higher prevalence of stress (2.71) and anxiety (1.75). Those exposed to sudden changes in temperature reported more anxiety (99%) and stress (90%). To improve working conditions in the Mexican aeronautical sector, an adequate understanding of the relationship between risks and the injury profile of the workers is required. This action will facilitate the implementation of preventive and corrective, assertive and efficient measures(AU)

Características de composición corporal, ángulo de fase y agua corporal en paracaidistas chilenos de elite / Characteristics of body composition, phase angle and body water in elite Chilean skydivers

RESUMEN: Durante la práctica del paracaidismo, una deficiente composición corporal no sólo puede afectar el rendimiento deportivo, sino que, además, incrementa la probabilidad de sufrir una lesión o accidente grave. Conocer las características de sus componentes, podría ayudar a prevenirlas. El objetivo del estudio fue describir la composición corporal, ángulos de fase y agua corporal total en paracaidistas chilenos de alta competencia. Participaron del estudio 8 paracaidistas profesionales del Team Chile® (33,4 ± 4,9 años) con más de seis años de experiencia. La evaluación de las masas grasa, muscular, libre de grasa, magra y visceral, así como el ángulo de fase y el agua corporal total obtenida a través de impedancia bioeléctrica. Los deportistas presentaron un peso corporal de 76,7 ± 5,7 kg, estatura 1,72 ± 0,1 m e IMC 26,0 ± 1,9 kg/m2. La composición corporal promedio mostró un 20,6 ± 3,0 % de masa grasa, 44,9 ± 2,0 % de masa muscular y 79,4 ± 3,0 % de masa libre de grasa. El ángulo de fase promedio fue de 7,25 ± 0,33°. El agua corporal total de los participantes fue de 44,6 ± 3,2 1. Se concluye que los resultados obtenidos pueden ser utilizados por los profesionales de las ciencias del deporte como valores de referencia para el control de la composición corporal, fase angular y agua corporal en paracaidistas para optimizar el rendimiento deportivo y evitar lesiones.

SUMMARY: Unsuitable body composition in skydivers not only affect the sport performance but also could increase the probability of risk injury or severe accident; hence, to determine body composition characteristics could be helpful to prevent such events. This study aimed to describe body composition, phase angle, and total body water in highly trained Chilean skydivers. Eight Team Chile® professional skydivers (33.4 ± 4.9 years) with more than 6 years of experience participated in this study. Fat mass, muscle mass, fat-free mass, lean mass, visceral mass, phase angle, and total body water were measured by bioelectrical impedance. Skydivers had a bodyweight of 76.7±5.7 kg, a height of 1.72 ±0.1 m, and a body mass index of 26.0 ±1.9 kg/m2. Regarding body composition, they had a fat mass of 20.6 ±3.0 %, a muscle mass of 44.9 ±2.0 %, and a fat-free mass of 79.4 ±3.0 %. Phase angle and total body water were 7.25 ±0.3° and 344.6±3.2, respectively. The present findings could be useful to science sport professionals as reference values of body composition, phase angle, and total body water of highly trained skydivers to improve sports performance and avoid injuries.

Impacto de las políticas públicas en el desarrollo de la industria del transporte aéreo. el caso de colombia / Impacto das políticas públicas no desenvolvimento do setor de transporte aéreo. o caso da colômbia / Impact of public policies on the development of the air transport industry. the case of colombia

Resumen Siguiendo la tendencia mundial y regional, Colombia liberalizó el sector o industria del transporte aéreo, a principios de década de 1990, y con ello dio inicio a una ininterrumpida (hasta el presente) batería de políticas públicas para dicho sector, paralelamente acompañadas de varias reformas a nivel institucional, todas ellas basadas en la concepción de que el estado colombiano considera el transporte aéreo un servicio público esencial, y que contribuye al desarrollo económico nacional. Por lo tanto, este trabajo, cuyo carácter es de análisis de un estudio de caso, presenta y analiza el impacto de las políticas públicas en el desarrollo y evolución de la industria del transporte aéreo en Colombia. Para ello el análisis se centra, por un lado, en el enfoque y planteamiento de las autoridades colombianas en el diseño e implementación de dichas políticas públicas, y por otro, en la evaluación del desarrollo y crecimiento del sector del transporte aéreo y su directa influencia en otras industrias relacionadas e indicadores socioeconómicos. El principal resultado de las políticas implementadas es: el alto y continuo crecimiento del tráfico aéreo, principalmente a nivel doméstico, lo que consolidó y fortaleció la conectividad y cohesión territorial; aportación a la riqueza nacional; generación de empleo; y apoyo a industrias muy relacionadas entre sí.

Resumo Seguindo a tendência mundial e regional, a Colômbia liberalizou o setor de transporte aéreo, ou indústria, no início da década de 1990, e assim deu início a uma bateria ininterrupta (até o momento) de políticas públicas para esse setor, acompanhada paralelamente por diversas reformas no nível institucional, todas baseadas no conceito de que o Estado colombiano considera o transporte aéreo um serviço público essencial e que contribui para o desenvolvimento econômico nacional. Portanto, este trabalho, cujo caráter é a análise de um estudo de caso, apresenta e analisa o impacto das políticas públicas no desenvolvimento e evolução da indústria do transporte aéreo na Colômbia. Para tanto, a análise se concentra, por um lado, na abordagem e abordagem das autoridades colombianas na formulação e implementação das referidas políticas públicas e, por outro, na avaliação do desenvolvimento e crescimento do setor de transporte aéreo e sua influência direta. em outros setores relacionados e indicadores socioeconômicos. O principal resultado das políticas implementadas é: o elevado e continuado crescimento do tráfego aéreo, principalmente a nível doméstico, que consolidou e reforçou a conectividade e a coesão territorial; contribuição para a riqueza nacional; geração de empregos; e apoio a setores intimamente relacionados.

Abstract Following the global and regional trend, Colombia liberalized the air transport sector at the beginning of the 1990s. This measure unleashed an uninterrupted (until now) set of public policies for the sector, accompanied by several reforms at the institutional level, all in the belief that the Colombian state considers air transport an essential public service that contributes to national economic development. This work uses the case study method to present and analyze the impact of public policies on the development and evolution of the air transport sector in Colombia. The analysis focuses on the approach of the Colombian authorities in the design and implementation of public policies, and the evaluation of the development and growth of the air transport sector and its direct influence on other related industries and socio-economic indicators. The main results of the implemented policies are: high and continued growth of air traffic, mainly at the domestic level, which consolidated and strengthened connectivity and territorial cohesion; contribution to national wealth; generation of employment; and support to closely related industries.

Segurança do paciente no cotidiano de trabalho da equipe multiprofissional do transporte aeromédico inter-hospitalar / Patient safety in the daily work of the multidisciplinary inter-hospital air medical transport team

O presente estudo objetivou analisar a segurança do paciente no cotidiano de trabalho da equipe multiprofissional do transporte aeromédico inter-hospitalar (TAI). Trata-se de um estudo de caso qualitativo, que utilizou o referencial teórico de Michel de Certeau, realizado em uma empresa de transporte aéreo inter-hospitalar na cidade de Belo Horizonte, Minas Gerais. Foram incluídos na pesquisa os profissionais que atuavam com mais de um ano em TAI, sendo 35 profissionais entrevistados: 12 (34,29%) enfermeiros; 14 (40%) médicos; e 9 (25,71%) pilotos. Sendo excluídos os profissionais que possuíam menos de ano de atuação. A coleta de dados foi realizada em por meio de entrevistas individuais guiadas por meio de um roteiro semiestruturado, no período de agosto a setembro de 2019. O estudo foi aprovado pelo Comitê de Ética e Pesquisa da UFMG (COEP/UFMG), sob Parecer nº: 3.368.996. As entrevistas foram agendadas, realizada em ambiente privativo após esclarecimento da pesquisa mediante o termo de consentimento livre esclarecido (TCLE). Após a gravação na íntegra, foram transcritas e submetidas à Análise de Conteúdo Temática e Análise Documental dos prontuários dos pacientes transportados de 2012 a 2017. Os resultados foram organizados em quatro categorias temáticas: os sujeitos da pesquisa e o perfil de atendimentos no TAI; o ambiente de voo e o fazer da equipe multidisciplinar; o controle e a imprevisibilidade no TAI: estratégias e táticas no cotidiano de trabalho; e os elementos que configuram o contexto do TAI. Os resultados mostraram que os atendimentos são, na sua maioria, de pacientes do sexo masculino e portadores de doenças cardiovasculares, neurológicos e trauma. O trabalho é dinâmico, imprevisível em ambiente restrito. No cotidiano, prevalecem às normas das áreas da saúde e da aviação, enfocando os riscos nas duas áreas e o rigor adotado no TAI. Conclui-se que, os profissionais adotam novas maneiras de fazer para tornar o ambiente seguro e as circunstâncias de risco podem ser mitigadas pela equipe.

The presente study aimed to analyze patient safety in the daily work of a multidisciplinar team of inter-hospital air medical transport (TAI). This is a qualitative case study, which used the theoretical framework of Michel de Certeau and it was carried out in an inter-hospital air transport company in Belo Horizonte, Minas Gerais. This study enrolled 35 professionals who had worked for more than one year in TAI: 12 nurses (34.29%); 14 physicians (40%); and 9 pilots (25.71%). Professionals who had less than one year of work were excluded. Data collection occurred between August and September 2019, and was obtained through individual interviews guided by a semi-structured script. This study was approved by the Ethics and Research Committee of UFMG (COEP/UFMG - No.: 3.368.996). Interviews were scheduled and held in a private environment after research explanation and signing of the free informed consent term (TCLE). After being recorded in full, the interviews were transcribed and submitted to Thematic Content Analysis and Document Analysis of the medical records of patients transported from 2012 to 2017. Results were organized into four thematic categories: the research subjects and the profile of assistance in TAI; the flight environment and the role of the multidisciplinary team; control and unpredictability in TAI; strategies and tactics in daily work; and the elements that configure the TAI context. Our results showed that the assistances are mostly for male patients and patients with cardiovascular, neurological and trauma diseases. We also observed that working in inter-hospital medical transport is dynamic and unpredictable in a restricted environment. In a daily basis, health and aviation standards prevail, focusing on the risks in both areas and the rigor adopted at work. We concluded that professionals adopt new ways to make the environment safe and that risky circumstances can be mitigated by the team.

Hematoma subperiosteal orbitário secundário a barotrauma em aviação civil / Orbital subperiosteal hematoma secondary to barotrauma in civil aviation

RESUMO Os diagnósticos diferenciais que compõem as proptoses agudas são, muitas vezes, desafiadores. A anamnese e o exame clínico exigem do oftalmologista atenção especial aos detalhes que permitem diferenciar quadros relativamente benignos e autolimitados de quadros que evoluirão com incapacidades permanentes. Relatamos o caso de uma paciente de 49 anos que, durante viagem de avião, apresentou dor ocular, hematoma periorbitário e proptose do olho esquerdo súbitos. Referia diplopia aguda incapacitante. Exames de tomografia e angiorressonância magnética confirmaram diagnóstico de sinusopatia do seio etmoidal esquerdo e hematoma subperiosteal da órbita esquerda, associado ao barotrauma. Apesar de raro, o diagnóstico de hematoma subperiosteal não traumático deve ser considerado diferencial em relação a proptoses agudas, sendo a anamnese fundamental para essa elucidação diagnóstica.

ABSTRACT Differential diagnoses of acute proptosis are often challenging. History and clinical examination require from ophthalmologists special attention to details, which make it possible to differentiate relatively benign and self-limited conditions from those that will progress to permanent disabilities. We report a 49-year-old female patient who had sudden eye pain, periorbital hematoma and proptosis of the left eye during a commercial flight. She also complained of disabling acute diplopia. Computed tomography and magnetic resonance angiography imaging confirmed the diagnosis of subperiosteal hematoma of the left orbit, associated with left ethmoid sinus disease. Although rare, non-traumatic subperiosteal hematoma should be considered in differential diagnoses of acute proptosis, and history taking is fundamental to elucidate the picture.

Study on Overload Injuries during Periods of Intense Physical Activity Complemented by Isokinetic Dynamometry Evaluation / Estudo das lesões de sobrecarga durante período intenso de atividade física complementado com avaliação por dinamometria isocinética

Abstract Objective The present study aims to measure the incidence of overload injuries in training soldiers, who are subjected to intense physical exercise, and to compare it with a control group. Next, it intends to verify whether there is any relationship between overload injuries and some neuromuscular function parameters. Methods Analytical, prospective observational study. Both the observational and the control group consisted of soldiers from the Portuguese Army. Clinical evaluation was performed by medical interview in the week prior to the beginning of a military parachuting course and in the week immediately after its completion. The neuromuscular performance was assessed by isokinetic dynamometry during the medical interview. Results With 44 of the 57 military personnel in training complaining of pain, the observational group had significantly more injuries than the control group (p< 0.001). Five complaints had traumatic origin and 39 were overload injuries. Of the 39 military personnel with overload injuries, 21 reported limited sports performance. However, isokinetic dynamometry showed no statistically significant differences in neuromuscular performance (p = 0.223 and p = 0.229). Conclusion Military personnel in training are prone to overload injuries, with an incidence rate > 70%. The implementation of strategies for injury monitoring and prevention is critical to promote health and physical capacity.

Resumo Objetivo Os autores pretendem medir a incidência de lesões de sobrecarga em militares em formação, que são submetidos a exercício físico intenso, e compará-la com um grupo controle. Posteriormente, pretende-se verificar se existe alguma relação entre a ocorrência de lesões de sobrecarga e alguns parâmetros da função neuromuscular. Métodos Estudo observacional prospectivo analítico. Grupo de observação e grupo controle constituídos por militares do Exército Português. A avaliação clínica foi feita por entrevista médica na semana que antecede o início do curso de paraquedismo militar e na semana imediatamente após o final do curso. Em simultâneo com a entrevista médica, foi realizada a avaliação da performance neuromuscular através da dinamometria isocinética. Resultados Com 44 dos 57 militares em formação a referir queixas álgicas, o grupo de observação apresentou significativamente mais lesões que o grupo controle (p < 0.001). Cinco queixas foram de origem traumática e 39 foram lesões de sobrecarga. Dos 39 militares com lesões de sobrecarga, 21 referiram limitação do rendimento esportivo. No entanto, na avaliação por dinamometria isocinética, não se verificaram diferenças estatisticamente significativas na evolução da performance neuromuscular (p = 0.223 e p = 0.229). Conclusão Os militares em formação são indivíduos propensos a sofrerem lesões de sobrecarga, tendo-se obtido uma taxa de incidência de lesões de sobrecarga na ordem dos 70%. A implementação de estratégias de monitoração e prevenção das lesões são fundamentais na promoção da saúde e da capacidade física.

Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers / Rouquidão, desconforto do trato vocal e fatores de risco associados em controladores de tráfego aéreo

Abstract Introduction: An air traffic controller is a professional who performs air traffic control functions in air traffic control units and is responsible for controlling the various stages of a flight. Objective: To compare hoarseness and vocal tract discomfort and their risk factors among air traffic controllers in the approach control of São Paulo. Methods: In a cross-sectional survey, a voice self-evaluation adapted from to self-evaluation prepared by the Brazilian Ministry of Labor for teachers was administered to 76 air traffic controllers at approach control of São Paulo, Brazil. Results: The percentage of hoarseness and vocal tract discomfort was 19.7% and 38.2%, respectively. In relation to air pollution, the percentages of hoarseness and vocal tract discomfort were higher among those who consider their working environment to be intolerable than among those in a comfortable or disturbing environment. The percentage of hoarseness was higher among those who seek medical advice due to vocal complaints and among those who experience difficulty using their voice at work than among those who experience mild or no difficulty. The percentage of vocal tract discomfort was higher among those in a very tense and stressful environment than among those who consider their work environment to be mild or moderately tense and stressful. The percentage of vocal tract discomfort was higher among those who describe themselves as very tense and stressed or tense and stressed than among those who describe themselves as calm. Additionally, the percentage of vocal tract discomfort was higher among those who care about their health. Conclusion: Among air traffic controllers, the percentage of vocal tract discomfort was almost twice that of hoarseness. Both symptoms are prevalent among air traffic controllers who considered their workplace intolerable in terms of air pollution. Vocal tract discomfort was related to a tense and stressful environment, and hoarseness was related to difficulty using the voice at work.

Resumo Introdução: O controlador de tráfego aéreo é um profissional que executa funções de controle de tráfego aéreo em unidades de controle de tráfego aéreo e são responsáveis por controlar as várias fases de um voo. Objetivo: Comparar a rouquidão e o desconforto no trato vocal e seus fatores de risco em controladores de tráfego aéreo no centro de controle de aproximação de São Paulo. Método: Em um estudo transversal, uma autoavaliação de voz adaptada da autoavaliação preparada pelo Ministério do Trabalho para professores foi administrada a 76 profissionais do centro de controle de aproximação de São Paulo, Brasil. Resultados: A porcentagem de rouquidão e desconforto no trato vocal foi de 19,7% e 38,2%, respectivamente. Em relação à poluição do ar, as porcentagens de rouquidão e desconforto no trato vocal foram maiores entre aqueles que consideram seu ambiente de trabalho como intolerável do que entre aqueles em um ambiente confortável ou incômodo. A porcentagem de rouquidão foi maior entre aqueles que procuram assistência médica devido a queixas vocais e entre aqueles que têm dificuldade de usar a voz no trabalho do que entre aqueles que experimentam dificuldade leve ou não apresentam dificuldades. A porcentagem de desconforto no trato vocal foi maior entre aqueles em um ambiente muito tenso e estressante do que entre aqueles que consideram seu ambiente de trabalho leve ou moderadamente tenso e estressante. A porcentagem de desconforto no trato vocal foi maior entre aqueles que se descrevem como muito tensos e estressados ou tensos e estressados do que entre aqueles que se descrevem como calmos. Além disso, a porcentagem de desconforto no trato vocal foi maior entre aqueles que se preocupam com sua saúde. Conclusão: Entre os controladores de tráfego aéreo, a porcentagem de desconforto no trato vocal foi quase o dobro da rouquidão. Ambos os sintomas são prevalentes entre os controladores de tráfego aéreo que consideram o seu local de trabalho intolerável em termos de poluição do ar. O desconforto no trato vocal foi associado a um ambiente tenso e estressante e a rouquidão foi associada à dificuldade de usar a voz no trabalho.

Aspects of work and sleep associated with work ability in regular aviation pilots / Aspectos do trabalho e do sono associados à capacidade para o trabalho entre pilotos

ABSTRACT OBJECTIVE: Analyze the association of work organization and sleep aspects with work ability in regular aviation pilots. METHODS: This is a cross-sectional epidemiological study with 1,234 regular aviation pilots who worked domestic and international flights, affiliated with the Brazilian Association of Civil Aviation Pilots. Data collection employed online questionnaire. We compared proportions using Pearson's Chi-squared or Fisher's exact hypothesis tests. Then, we conducted Poisson analysis, with robust variance, to test factors associated with moderate or low work ability. RESULTS: The prevalence of moderate or low work ability was 43.3%. We found that self-perception of insufficient sleep (PR = 1.29; 95%CI 1.06-1.57), increased perception for fatigue (PR = 1.51; 95%CI 1.24-1.84), more than 65 flight hours per month (PR = 1.22; 95%CI 1.01-1.46), less than 10 days of time off per month (PR = 1.27; 95%CI 1.04-1.55), and frequent operational delays (PR = 1.23; 95%CI 1.02-1.48) were factors associated with moderate or low work ability. CONCLUSIONS: Work organization was a determining factor for decreased work ability, especially concerning aspects related to rest and its influence on the sleep of pilots.

RESUMO OBJETIVO: Analisar a associação da organização do trabalho e dos aspectos do sono com a capacidade para o trabalho entre pilotos da aviação regular. MÉTODOS: Foi realizada uma pesquisa epidemiológica transversal, com 1.234 pilotos da aviação regular, que realizavam voos de rotas nacionais e internacionais, afiliados à Associação Brasileira de Pilotos da Aviação Civil. A coleta de dados foi feita através de questionário on-line. Para comparação entre as proporções foram realizados os testes de hipóteses qui-quadrado de Pearson ou Exato de Fisher. Posteriormente, foi efetuada a análise de Poisson, com variância robusta, para testar os fatores associados à capacidade moderada ou baixa para o trabalho. RESULTADOS: A prevalência de capacidade para o trabalho moderada ou baixa foi de 43,3%. Verificou-se que autopercepção de sono insuficiente (RP = 1,29; IC95% 1,06-1,57), maior percepção para fadiga (RP = 1,51; IC95% 1,24-1,84), jornada de voo maior que 65 horas por mês (RP = 1,22; IC95% 1,01-1,46), menos de 10 dias de folga por mês (RP = 1,27; IC95% 1,04-1,55) e atrasos operacionais frequentes (RP = 1,23; IC95% 1,02-1,48) foram fatores associados à capacidade moderada ou baixa para o trabalho. CONCLUSÕES: A organização do trabalho foi um fator determinante para a diminuição da capacidade para o trabalho, em especial quanto aos aspectos relacionados ao descanso e suas repercussões no sono de pilotos.

Miedo a volar: Componentes y formas de afrontamiento de un grupo de patagones que viven en aislamiento relativo / Fear of flying: Components and forms of coping with a group of Patagonians living in relative isolation

Resumen El presente estudio trata del temor a volar, las expectativas de peligro y las estrategias de afrontamiento que las personas dicen utilizar al momento de volar en avión. Un total de 287 participantes, habitantes de una zona aislada geográficamente, que utilizan habitualmente el avión, fueron medidos en las variables ya señaladas. El muestreo fue no probabilístico accidental y el diseño utilizado fue no experimental transversal correlacional. Los principales resultados indican que las personas dicen temer principalmente a situaciones que provocan en ellos la pérdida del control emocional aunque sus estrategias de afrontamiento más comunes suelen estar orientadas a la resolución de problemas. Estas estrategias, orientadas a recuperar simbólicamente el control psicológico, no apuntan al afrontamiento de las emociones. También se describen algunas diferencias en el uso de estas estrategias según género. Se discuten estos resultados en términos de su sincronía con los estudios previos y sus potenciales implicancias para los actuales programas terapéuticos de intervención de dicho problema.

Abstract This study is about the fear of flight, the danger expectations and the coping strategies that people say to use when flying on an airplane. A total of 287 participants, people from a graphically isolated zone that usually use planes, were measured according to the already mentioned variables. The sampling was not accidental probabilistic and the designed used was not experimental transversal correlational. The principal results indicate that people say to be afraid principally of situations that cause in them the loss of the emotional control, although, their most common coping strategies use to be oriented to affront anxiety. This strategy, aimed to regain the psychological control symbolically, does not point to the emotions coping. Also, some differences in the use of these strategies according to gender are described. These results are discussed regarding its timing with previous studies and their potential implications for current therapeutic intervention programs for this problem.

Electroencephalographic Abnormalities in the Screening for Pilot Applicants in Korea

BACKGROUND AND PURPOSE: Electroencephalography (EEG) is often used as a screening tool for selecting pilots despite controversy regarding its contribution to aviation safety. We investigated EEG abnormalities in Korean commercial pilot applicants in order to identify the usefulness of EEG screening in this population. METHODS: We retrospectively analyzed the EEG results of 740 unselected pilot applicants who underwent waking EEG at Inha University Hospital from January 2013 to May 2017. EEG recording was performed for 30 minutes, which included 3 minutes of hyperventilation and intermittent photic stimulation. RESULTS: The pilot applicants were predominantly male (95.3%) and had a mean age of 27.8 years (range: 16–40 years). Nine of them (1.2%) exhibited EEG abnormalities; the most common abnormality (six applicants) was a small amount of generalized irregular slow activities, while the other three applicants (0.4%) exhibited epileptiform discharges, with two showing generalized spike-and-wave complexes and one showing a few spike-and-wave complexes in the left frontotemporal area. The two applicants with generalized spike-and-wave complexes were found to have experienced clinical seizures by a neurologist during detailed history-taking. CONCLUSIONS: This study found that 2 of 740 pilot applicants (0.3%) were diagnosed with epilepsy by routine EEG screening in an unselected population. Considering the low predictive value of EEG without the relevant clinical history in an unselected healthy young population, our findings raise questions regarding the cost-effectiveness of the current EEG screening protocol applied to pilot applicants. We suggest that a more-targeted and standardized EEG screening approach be applied to pilot applicants with epilepsy risk factors or a seizure history as determined by thorough medical history-taking.

Fish-Mouth Closure of the Pancreatic Stump and Parachuting of the Pancreatic End with Double U Trans-Pancreatic Sutures for Pancreatico-Jejunostomy

PURPOSE: Leakage of pancreatico-jejunal anastomosis (PJ) remains the primary cause of morbidity and mortality after Whipple's operation. To reduce the occurrence thereof, the present author recently began to apply a modification of the Blumgart method of anastomosis after Whipple's operation (hereinafter referred to as Lee's method), with very good results. MATERIALS AND METHODS: The modified method and technique utilizes fish-mouth closure of a beveled pancreatic stump and parachuting of the pancreatic end with double U trans-pancreatic sutures (symmetric horizontal mattress-type sutures between the full thickness of the pancreas and the jejunal limb) after duct-to-mucosa pancreatico-jejunostomy. RESULTS: Eleven cases of pylorus preserving Whipple's operation have been performed without a clinically significant postoperative pancreatic fistula. CONCLUSION: This new method (Lee's method) may dramatically reduce the occurrence of postoperative pancreatic fistula after Whipple's operation.

Effects of an alternating work shift on air traffic controllers and the relationship with excessive daytime sleepiness and stress / Efeitos do turno de trabalho alternado em controladores de tráfego aéreo e relação com sonolência diurna excessiva e estresse

ABSTRACT Objective: To evaluate symptoms of stress and excessive daytime sleepiness (EDS) in air traffic control (ATC) officers in Brazil. Methods: Fifty-two ATC officers participated, based at three air traffic control units, identified as A, B and C. Stress symptoms were assessed using the Lipp Inventory of Stress Symptoms for Adults, and EDS by the Epworth Sleepiness Scale. Results: The sample mean age was 37 years, 76.9% of whom were male. Excessive daytime sleepiness was identified in 25% of the ATC officers, with 84.6% of these based at air traffic control unit A, which has greater air traffic flow, operating a 24-hour alternating work shift schedule. A total of 16% of the ATC officers had stress symptoms, and of these, 62% showed a predominance of physical symptoms. Conclusion: The high percentage of ATC officers with EDS identified in group A may be related to chronodisruption due to night work and alternating shifts.

RESUMO Objetivo: Avaliar sintomas de estresse e sonolência diurna excessiva (SDE) em controladores de tráfego aéreo (CTA) do Brasil. Métodos: Participaram 52 controladores pertencentes a 3 órgãos de controle de tráfego aéreo, denominados de A, B e C. Os sintomas de estresse, foram avaliados pelo Inventário de Sintomas de Estresse para Adultos, a SDE pela Escala de Sonolência Epworth. Resultados: 76,9% da amostra são do sexo masculino, com média de idade de 37 anos. SDE foi identificada em 25% dos controladores, desses 84,6%, pertencem aos órgãos de controle de tráfego aéreo A, caracterizado por maior movimento de aeronaves, funcionamento 24 horas e escala de serviço em turnos alternantes. Um total de 16% dos controladores apresentam sintomas de estresse, desses, 62% mostraram o predomínio de sintomas físicos. Conclusão: A porcentagem elevada de CTA com SDE identificada no grupo A pode estar relacionada a cronodisrupção devido ao trabalho noturno e alternado.

Working hours associated with unintentional sleep at work among airline pilots / Jornadas de trabalho associadas a cochilos não intencionais entre pilotos da aviação regular

ABSTRACT OBJECTIVE Tto identify factors associated with unintentional sleep at work of airline pilots. METHODS This is a cross-sectional epidemiological study conducted with 1,235 Brazilian airline pilots, who work national or international flights. Data collection has been performed online. We carried out a bivariate and multiple logistic regression analysis, having as dependent variable unintentional sleep at work. The independent variables were related to biodemographic data, characteristics of the work, lifestyle, and aspects of sleep. RESULTS The prevalence of unintentional sleep while flying the airplane was 57.8%. The factors associated with unintentional sleep at work were: flying for more than 65 hours a month, frequent technical delays, greater need for recovery after work, work ability below optimal, insufficient sleep, and excessive sleepiness. CONCLUSIONS The occurrence of unintentional sleep at work of airline pilots is associated with factors related to the organization of the work and health.

RESUMO OBJETIVO Identificar fatores associados aos cochilos não intencionais durante as jornadas de trabalho de pilotos da aviação regular. MÉTODOS Estudo epidemiológico transversal conduzido com 1.235 pilotos brasileiros de avião do transporte aéreo regular, que realizavam voos nacionais ou internacionais, sendo a coleta de dados realizada on-line. Foi realizada análise de regressão logística bivariada e múltipla, tendo como variável dependente o cochilo não intencional durante o horário de trabalho. As variáveis independentes foram relacionadas a dados biodemográficos, características do trabalho, estilo de vida e aspectos do sono. RESULTADOS A prevalência do cochilo não intencional enquanto pilotava o avião foi de 57,8%. Os fatores associados ao cochilo não intencional foram: voar por mais de 65 horas por mês, atrasos técnicos frequentes, maior necessidade de recuperação após o trabalho, capacidade para o trabalho inferior à ótima, sono insuficiente e sonolência excessiva. CONCLUSÕES A ocorrência do cochilo não intencional durante a jornada de trabalho de pilotos da aviação regular está associada a fatores relacionados à organização do trabalho e à saúde.

Habilidades auditivas de figura-fundo e fechamento em controladores de tráfego aéreo / Auditory skills of figure-ground and closure in air traffic controllers

RESUMO Objetivo Investigar o perfil das habilidades auditivas de fechamento e figura-fundo e fatores relacionados à atenção, comunicação e saúde de controladores de tráfego aéreo (CTA) de aproximação de aeronaves e comparar com os de outros profissionais civis e militares. Método Participaram 60 adultos com limiares audiométricos normais reunidos em dois grupos, pareados por idade e gênero: o grupo estudo formado por 30 profissionais do Controle de Aproximação de aeronaves e o controle, por 30 outros servidores civis e militares. Todos foram submetidos a perguntas relacionadas à atenção, comunicação e saúde e ao Teste de Fala com Ruído e de Identificação de Sentenças Sintéticas em escuta monótica (SSI) para avaliar fechamento e figura-fundo, respectivamente. Foram usados testes estatísticos não paramétricos e análise de regressão logística. Resultados O CTA autorreferiu maior cansaço/esgotamento e estresse e obteve melhor desempenho do que o grupo controle em figura-fundo e semelhante em fechamento. Foi observado que ocorreu uma probabilidade de ser CTA para o estresse em 5,59 vezes e para identificação de sentenças em escuta monótica à orelha direita de 1,24. Conclusão Fechamento e autorrelato de dificuldades de saúde, comunicação e atenção na maioria das questões foram similares em ambos os grupos. Figura-fundo foi significativamente melhor em CTA. Autorreferência de estresse e desempenho à orelha direita no SSI foram preditores significantes do indivíduo ser do CTA.

ABSTRACT Purpose To investigate the auditory skills of closure and figure-ground and factors associated with health, communication, and attention in air traffic controllers, and compare these variables with those of other civil and military servants. Methods Study participants were sixty adults with normal audiometric thresholds divided into two groups matched for age and gender: study group (SG), comprising 30 air traffic controllers and control group (CG), composed of 30 other military and civil servants. All participants were asked a number of questions regarding their health, communication, and attention, and underwent the Speech-in-Noise Test (SIN) to assess their closure skills and the Synthetic Sentence Identification Test - Ipsilateral Competitive Message (SSI-ICM) in monotic listening to evaluate their figure-ground abilities. Data were compared using nonparametric statistical tests and logistic regression analysis. Results More individuals in the SG reported fatigue and/or burnout and work-related stress and showed better performance than that of individuals in the CG for the figure-ground ability. Both groups performed similarly and satisfactorily in the other hearing tests. The odds ratio for participants belonging in the SG was 5.59 and 1.24 times regarding work-related stress and SSI-ICM (right ear), respectively. Conclusion Results for the variables auditory closure, self-reported health, attention, and communication were similar in both groups. The SG presented significantly better performance in auditory figure-ground compared with that of the CG. Self-reported stress and right-ear SSI-ICM were significant predictors of individuals belonging to the SG.

The Need for an Implant Identification Card at Airport Security Check

BACKGROUND: Joint replacement surgery is having an increasing demand as national healthcare systems confront an ever ageing population. Surgical complications associated with lower limb arthroplasty are well known but less investigation has been performed examining its effect on air travel, more specifically, unwanted and significant inconvenience caused to travelers going through airport security. METHODS: In lower limb arthroplasty clinics, 50 patients who met our selection criteria were given questionnaires. Ten airport security officers from 4 international airports (London Stansted, London Gatwick, London Heathrow, and Amsterdam Schiphol International Airport) were also given a separate questionnaire. The opinion of the Civil Aviation Authority was also sought. RESULTS: All 50 patients (mean age, 70.4 years; range, 55 to 84 years) who were presenting in lower limb arthroplasty clinics and who met our selection criteria volunteered to enter the study. Twenty-eight of these patients were female (mean age, 69.1 years; range, 55 to 84 years) and 22 were male (mean age, 71.2 years; range, 58 to 81 years). Of the patients, 14% stated that their joint replacements did not set off the airport security alarm. Responses were received from 10 airport security officers as well. Six airport security officers were male and 4 were female. All of the airport officers were aware of some form of implant identification card with 90% stating that these were useful to them at airport security. Eight-four percent of the patients stated that an implant identification card outlining what joint replacement they possessed and when this had been done would be very useful. Sixteen percent of the patients did not think a card would be beneficial since all of them had set off the airport alarm system only once or less in their lifetime. CONCLUSIONS: It is the opinion of airport security officers and patients that joint replacement implant identification cards streamline airport security checks and decrease the need for more invasive searches at airport security.

Hearing Health in Agricultural Aviation Pilots from Cindacta II Wearing Earplugs and a Helmet

Abstract Introduction Agricultural aviation pilots, exposed daily to intense vibration and noise, are likely to develop noise-induced hearing loss (NIHL). Objectives The aim of this study was to investigate the presence of audiograms consistent with NIHL in agricultural aviation pilots who use earplugs and helmets. Methods We conducted a cross-sectional cohort and observational study. The data were taken from the medical records and audiograms of 94 pilots. Results NIHL was identified in 9.5% of individuals with hearing loss by audiograms at 3,000, 4,000, or 6,000 Hz. Normal audiograms were observed in 46.8% of pilots surveyed. Bilateral hearing loss was more frequent than unilateral hearing loss, occurring in 64.8% of cases. Conclusion Although there was a low incidence of audiograms compatible with NIHL in the records of the pilots examined, the disorder still occurs despite the doubled use of individual hearing protection equipment (helmets and earplugs) for agricultural aviation pilots. Nevertheless, even with the use of earplugs and helmets as noise protectors, the data showed that agricultural pilots suffer inner ear damage caused by occupational noise. Prevention and periodic audiologic evaluations must be conducted in noiseexposed occupational groups.

A first step toward understanding patient safety / 대한마취과학회지

Patient safety has become an important policy agenda in healthcare systems since publication of the 1999 report entitled "To Err Is Human." The paradigm has changed from blaming the individual for the error to identifying the weakness in the system that led to the adverse events. Anesthesia is one of the first healthcare specialties to adopt techniques and lessons from the aviation industry. The widespread use of simulation programs and the application of human factors engineering to clinical practice are the influences of the aviation industry. Despite holding relatively advanced medical technology and comparable safety records, the Korean health industry has little understanding of the systems approach to patient safety. Because implementation of the existing system and program requires time, dedication, and financial support, the Korean healthcare industry is in urgent need of developing patient safety policies and putting them into practice to improve patient safety before it is too late.

Debriefing in pediatrics / 소아과

Debriefing is a conversational session that revolves around the sharing and examining of information after a specific event has taken place. Debriefing may follow a simulated or actual experience and provides a forum for the learners to reflect on the experience and learn from their mistakes. Originating from the military and aviation industry, it is used on a daily basis to reflect and improve the performance in other high-risk industries. Expert debriefers may facilitate the reflection by asking open-ended questions to probe into the framework of the learners and apply lessons learned to future situations. Debriefing has been proven to improve clinical outcomes such as the return of spontaneous circulation after cardiac arrest and the teaching of teamwork and communication in pediatrics. Incorporating debriefing into clinical practice would facilitate the cultural change necessary to talk more openly about team performance and learn from near misses, errors, and successes that will improve not only clinical outcome but also patient safety.