COVID-19 Pandemic Effects on the Well-Being of Professional Pilots.

OBJECTIVE: The aim was to evaluate the well-being of professional pilots using a survey that included the World Health Organization (WHO)-5 Well-Being Index.METHODS: An electronic survey was sent to pilots between June 17-August 2, 2021. Pilots self-categorized as: airline transport pilot (ATP), commercial pilot, or both. Chi-squared and Fisher's exact tests were used to evaluate differences between variables. Logistic regression was used to estimate the odds of impaired well-being.RESULTS: A total of 639 individuals returned the survey. The majority of respondents were ATPs and a majority identified as male. The average well-being score was 68.0 out of 100 possible, with 22% of respondents meeting the threshold definition of impaired well-being. The odds of having impaired well-being were not dependent on gender. In unadjusted analysis, the odds of impaired well-being were higher for those flying as commercial pilots as compared to airline transport pilots/both. Age was also strongly associated with impaired well-being, with younger pilots having greater odds of impaired well-being as compared to older pilots. Only a little over half of the surveyed pilots agreed or strongly agreed that pilot risk of occupational exposure to COVID-19 was appropriately controlled.CONCLUSION: This survey suggests an important connection between pilot age and impaired well-being scores during the COVID-19 pandemic. Future studies targeting the well-being of younger pilots will be of interest. Additionally, measures to reduce occupational risk of COVID-19 exposure may be helpful in view of the substantial fraction of pilots expressing concern regarding that risk.Stratton E, Haddon R, Murad MH, Petterson T, Nelson M, Cowl CT. COVID-19 pandemic effects on the well-being of professional pilots. Aerosp Med Hum Perform. 2022; 93(10):734-738.

[Analysis of the stressors and mental status of civil aviation pilots under the background of the major infectious disease].

Objective: To study the stressors and mental status of civil aviation pilots under the background of major infectious disease. Methods: From January to March 2021, a cluster sampling method was used to select 143 airline pilots in service as the research objects. The self-made emotion and stress source questionnaire, Chinese version of stress perception scale (CPSS) , self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) were used to investigate the airline pilot population. 136 valid questionnaires were collected, with an effective recovery rate of 95.1%. The measurement data conform to the normal distribution and are expressed by (x±s) . T-test and analysis of variance are used for comparison between groups, and Pearson correlation is used for correlation analysis. The data that do not conform to the normal distribution are expressed by the median and quartile [M (Q(1), Q(3)) ], and the non parametric test is used for the comparison between groups. Multiple linear stepwise regression was used to analyze the influencing factors of pressure perception. In addition, Amos 23.0 software was used to construct structural equation models of stress perception and negative emotions. Results: Under the background of the epidemic, the main sources of stress for civil aviation pilots are: the risk of possible reduction in income, the risk of contracting COVID-19, the pressure at work, and the risk of possible slow progress of upgrading. Among them, the first co pilot was more worried about the possible reduction of income than the instructor (P=0.009) ; The first co pilot and the captain of the airline were more worried about the possible slowdown of the upgrade progress than the instructor (P<0.001, P=0.014) . The mean pressure perception of pilots was higher than that of Chinese norm (t=3.11, P=0.002) . The standard scores of anxiety and depression were slightly higher than the standard scores of the Chinese norm under the non epidemic situation (t=7.00, 4.07, all P<0.001) . The results of multiple linear stepwise regression analysis showed that stress perception was negatively correlated with good family relations (t=-8.50, P=0.000) , and positively correlated with worries about slow progress of upgrading, COVID-19 infection, lack of interpersonal communication and income reduction (t=3.31、3.86、2.88、2.06, P<0.05) . Pressure perception was positively correlated with negative emotion (all P<0.001) . The results of structural equation model show that stress perception affects pilots' negative emotions directly or indirectly, and its standardized total effects on anxiety, depression, hypochondriac, fear, compulsion and irritability are 0.719, 0.811, 0.403, 0.355, 0.295 and 0.244 respectively. Conclusion: Public health emergencies have an impact on the mental status of pilots. Should pay attention to the stressors and psychological conditions of pilots in time, and consider formulating measures to relieve the stress of pilots.

A 5-Year Analysis of Aviation Medical Examinations in South Korea.

INTRODUCTION: Little has been studied to promote aviation health in South Korea. The aim of this study was to analyze the results of aviation medical examinations conducted in South Korea over the past 5 yr and, in doing so, provide evidence for establishing a health promotion, disease prevention plan.METHODS: Subjects of the study consisted of applicants who underwent aviation medical examinations from January 1, 2016, to December 31, 2020.RESULTS: Over the past 5 yr, the total number of aviation medical examinations in South Korea has shown an annual increase of more than 10%. In the presence of the COVID-19 pandemic in 2020, the number of aviation medical examinations, both renewal and initial, for all types of licenses, except renewal aviation medical examinations for the ATCL, decreased. Disqualification rates were generally higher in initial examinations than in renewal examinations. The examination results for license renewal showed the ATPL disqualification rate to be the highest at 3.5 per 1000 pilots per year in their 50s, with cardiology cases being the most common reason for disqualification, followed by ophthalmology cases and psychiatry cases. Diagnostic categories for those disqualified after initial aviation medical examinations were similar, though ophthalmological causes were most common, followed by cases of psychiatry and neurology.CONCLUSION: Main causes of disqualification in airmen and air traffic controllers were identified as the presence of cardiovascular, ophthalmic, and psychiatric diseases. The results of this study provide evidence for improving health promotion activity plans to manage risk factors of such diseases for aviation workers.Kim JS, Han BS, Kwon YH, Lim J. A 5-yr analysis of aviation medical examinations in South Korea. Aerosp Med Hum Perform. 2022; 93(6):499-506.

Proactive Coping and Mental Health Among Airline Pilots During China's Regular Prevention and Control of COVID-19: The Role of Perceived Stress and Social Support.

Mental health has always been a prominent public health concern, and it has become more important in the wake of the COVID-19 pandemic. The mental health of airline pilots plays a significant role in their occupational health and overall performance. It is also vital for ensuring the safe operation of aircrafts. Therefore, it is crucial to identify the factors that may improve the mental health of pilots. This study investigates the relationship between proactive coping, perceived stress, social support, and mental health among airline pilots during China's regular prevention and control of COVID-19. Using a sample consisting of 285 Chinese commercial airline pilots, we tested a moderated mediation model to explore whether, how, and when proactive coping affects the mental health of pilots. The results show that proactive coping has a direct and positive effect on pilots' mental health, as well as an indirect effect on mental health through its influence on perceived stress. Social support was found to weaken the relationship between perceived stress and mental health. It also weakened the indirect relationship between proactive coping and mental health through perceived stress. These findings advance our understanding of the underlying mechanisms that affect the mental health of pilots. It also provides empirical evidence for effective mental health interventions for airline pilots during regular prevention and control of COVID-19.

Fatigue, Schedules, Sleep, and Sleepiness in U.S. Commercial Pilots During COVID-19.

INTRODUCTION: COVID-19 has had a significant impact on the aviation industry. While reduced flying capacity may intuitively translate to reduced fatigue risk by way of fewer flights and duty hours, the actual impact of the pandemic on pilot fatigue is unknown.METHODS: We surveyed U.S. commercial airline pilots in late 2020 (N = 669) and early 2021 (N = 156) to assess the impact of COVID-19 on schedules and fatigue during the pandemic.RESULTS: Overall, pilots reported reduced flight and duty hours compared to prepandemic. Average sleep on workdays was slightly shorter in late 2020 (6.87 ± 1.14 h) and recovered to prepandemic levels in early 2021 (6.95 ± 1.11 h). Similarly, the frequency of sleepiness on days off and in-flight increased in late 2020, with 54% of pilots reporting an increase in in-flight sleepiness, then returned to prepandemic levels in early 2021. The use of in-flight sleepiness countermeasures remained the same across assessed time points. Pilots highlighted several factors which impacted their sleep and job performance, including limited access to nutritional food during duty days and layovers, reduced access to exercise facilities during layovers, increased stress due to job insecurity and health concerns, increased distractions and workload, and changes to scheduling.DISCUSSION: Despite a reduction in flights and duty days, COVID-19 led to increased sleepiness on days off and in flight, potentially due to the negative impact of lack of access to essential needs and heightened stress on sleep. Operators need to monitor the change in these COVID-19 related risks as the industry returns to full service.Hilditch CJ, Flynn-Evans EE. Fatigue, schedules, sleep, and sleepiness in U.S. commercial pilots during COVID-19. Aerosp Med Hum Perform. 2022; 93(5):433-441.

Is Emissions Trading Scheme (ETS) an Effective Market-Incentivized Environmental Regulation Policy? Evidence from China's Eight ETS Pilots.

Climate change and environmental issues caused by carbon emissions have attracted the attention of governments around the world. Drawing on the experience of the EU, China is actively developing a national carbon emissions trading market, trying to encourage emission entities to incorporate carbon emissions reduction into production and consumption decisions through carbon pricing. Is this scheme an effective market-incentivized environmental regulatory policy? Since China successively launched ETS pilots in 2013, the effectiveness of reducing carbon emissions has become one of the current focus issues. This study uses the difference-in-differences (DID) method to evaluate the impact of ETS implementation on emissions reduction and employs the Super-SBM model in data envelopment analysis (DEA) to evaluate the emission-reduction efficiency of eight ETS pilots in China. We find that the carbon trading policy has achieved emission-reduction effects in the implementation stage, and the greenness of economic growth has a significant positive impact on regional GDP. The establishment of China's unified carbon market should be coordinated with regional development. Some supporting measures for regional ecological compensation and the mitigation of regional development are yet to be adopted.

Two Fifth-Generation Fighter Pilots Discovered with Latent Autoimmune Diabetes.

BACKGROUND: Fighter pilots undergo extensive medical screening but may still miss rare diseases like latent autoimmune diabetes in adults (LADA). LADA patients have circulating autoantibodies directed against pancreatic beta cell antigens and present with frank diabetes late in life which may elude conventional military flight screening.CASE REPORT: Two fifth-generation fighter pilots, a 38-yr-old man (patient 1) and a 27-yr-old man (patient 2), with no significant past medical histories developed symptoms of fatigue, weight loss, episodic polyuria, and arthralgia. Patient 1's symptoms were initially thought to have been caused by COVID-19, but he subsequently tested negative for viral infection. Lab work instead showed elevated TSH, HgbA1C 11.4%, positive GAD-65, anti-TPO, and anti-islet cell antibodies. Patient 2 developed symptoms following a military deployment and a 72-h diarrheal illness. Due to flight status, patient 2 did not seek expert medical attention for several months, but lab work found HgbA1C of 10.4%, positive GAD-66, and ZnT8 antibodies. Both patients were started on insulin therapy. Patient 1 was also started on levothyroxine for hypothyroidism and retired from flying duties. Patient 2 eventually transitioned to metformin without insulin and returned to flying duties with an aeromedical waiver.DISCUSSION: Our patients maintained peak physical fitness throughout their selection and aviation careers, which likely delayed their clinical presentation. Current USAF flight rules prohibit insulin use with flying fighter aircraft. Early antibody screening during pilot selection may be a cost-effective means of diagnosis as traditional screening techniques are unlikely to detect LADA.Zhang JX, Berry J, Kim NM, Gray JJ, Fotheringham S, Sauerwein TJ. Two fifth-generation fighter pilots discovered with latent autoimmune diabetes. Aerosp Med Hum Perform. 2022; 93(2):106-110.

Predictive Biomathematical Modeling Compared to Objective Sleep During COVID-19 Humanitarian Flights.

BACKGROUND: Biomathematical modeling software like the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model and Fatigue Avoidance Scheduling Tool (FAST) help carriers predict fatigue risk for planned rosters. The ability of a biomathematical model to accurately estimate fatigue risk during unprecedented operations, such as COVID-19 humanitarian ultra-long-range flights, is unknown. Azul Cargo Express organized and conducted five separate humanitarian missions to China between May and July 2020. Prior to conducting the missions, a sleep-prediction algorithm (AutoSleep) within SAFTE-FAST was used to predict in-flight sleep duration and pilot effectiveness. Here we compare AutoSleep predictions against pilots' sleep diary and a sleep-tracking actigraphy device (Zulu watch, Institutes for Behavior Resources) from Azul's COVID-19 humanitarian missions.METHODS: Pilots wore Zulu watches throughout the mission period and reported sleep duration for their in-flight rest periods using a sleep diary. Agreement between AutoSleep, diary, and Zulu watch measures was compared using intraclass correlation coefficients (ICC). Goodness-of-fit between predicted effectiveness distribution between scenarios was evaluated using the R² statistic.RESULTS: A total of 20 (N = 20) pilots flying across 5 humanitarian missions provided sleep diary and actigraphy data. ICC and R² values were >0.90, indicating excellent agreement between sleep measures and predicted effectiveness distribution, respectively.DISCUSSION: Biomathematical predictions of in-flight sleep during unprecedented humanitarian missions were in agreement with actual sleep patterns during flights. These findings indicate that biomathematical models may retain accuracy even under extreme circumstances. Pilots may overestimate the amount of sleep that they receive during extreme flight-duty periods, which could constitute a fatigue risk.Devine JK, Garcia CR, Simoes AS, Guelere MR, de Godoy B, Silva DS, Pacheco PC, Choynowski J, Hursh SR. Predictive biomathematical modeling compared to objective sleep during COVID-19 humanitarian flights. Aerosp Med Hum Perform. 2022; 93(1):4-12.

Aeromedical Implications of Long-Term COVID-19 Sequelae.

BACKGROUND: While many COVID-19 studies focus on acute effects of the infection, few examine the intermediate and long-term sequelae of the illness. Studies have shown that a good portion of patients have chronic effects in several body systems for several months or longer. Such effects can potentially adversely impact pilot performance in flight. We sought to determine the long-term effects of COVID-19 infection, how such effects can affect pilot performance, and how to best evaluate pilots for aeromedical flight clearance.METHODS: We used the PubMed literature search engine to review peer-reviewed articles that focused on the intermediate and long-term effects of COVID-19 infection. Chronic signs and symptoms were subdivided based on the particular body organ system affected. Merging information obtained from case reviews, article reviews, and aeromedical standards, we created a risk stratification guide to assist with the aeromedical disposition of affected pilots.RESULTS: Long-term effects of COVID-19 infection can last for several months or longer. The most common effects are fatigue, weakness, pulmonary diffusion defects, depression, and anxiety.DISCUSSION: This review article focuses on the most common intermediate- and long-term COVID-19 conditions of aeromedical significance and the corresponding course of actions recommended for the aeromedical examiner. Aeromedical evaluation should take into consideration factors related to the pilot, aircraft type, and specific aviation environment. Such evaluation may include diagnostic testing, medical specialist consultation, preflight simulation in an altitude chamber, human centrifuge testing, and/or a flight simulator checkride.Ko SY, Nguyen NK, Lee CL, Lee LA, Nguyen KUT, Lee EC. Aeromedical implications of long-term COVID-19 sequelae. Aerosp Med Hum Perform. 2021; 92(11):898-907.

Psychological distress in Spanish airline pilots during the aviation crisis caused by the COVID-19 pandemic and psychometric analysis of the 12-item general health questionnaire.

The aim of this study was to evaluate the psychological distress of Spanish airline pilots, a group of professionals undergoing an unprecedented work situation as a result of the Covid-19 pandemic. To do so, we administered the General Health Questionnaire-12 (GHQ-12). A total of 342 questionnaires were obtained, with the largest respondent age group being 41-50 years. The psychometric properties of the instrument were also evaluated, with an exploratory factor analysis revealing a unidimensional structure that explained 59.23% of the variance. The total score on the standard GHQ-12 was 4.54 ± 3.31 very close to the cut-off point established to determine psychological distress. The score increased among those unemployed and was also higher among pilots on furlough compared to those whose work situation was relatively normal. Furthermore, the reliability measured by the total Cronbach's alpha was above 0.8 of each across all employment status considered. These results show the desirability of conducting periodic psychological distress assessments of pilots so that effective measures can be implemented to ensure their psychological and socio-emotional well-being. Practitioner summary: This article evaluates psychological distress in a group of professionals that has received scant attention in the field. Moreover, it does so against the background of an atypical situation, evaluating the psychological distress suffered by pilots in different employment categories during the current severe crisis in the aviation sector.Abbreviations: CFI: comparative fit index; COPAC: Official College of Commercial Aviation Pilots; ECA: European Cockpit Association; EFA: exploratory factor analysis; GHQ-12: general health questionnaire-12; IATA: International Air Transport Association; KMO: Kaiser-Meyer-Olkin test; PA: optimal implementation of parallel analysis; ULS: unweighted least squares.

Aerospace Implications of Key Neurological Conditions.

INTRODUCTION: The neurological impact (or lack thereof) of certain medical histories and imaging findings is important to understand in the context of air and spaceflight. There are a number of neurological conditions that, if present in pilots and astronauts, carry variable (and sometimes adverse) functional implications for safety and overall mission success. In this systematic overview, the authors will refer to the relevant clinical and radiological features of brain tumors and vascular anomalies, cerebral edema and intracranial hypertension, concussion and the traumatic brain injury (TBI) spectrum, hematomas, cerebrospinal fluid circulation anomalies including hydrocephalus and sequestrations, spinal degenerative changes, and cerebral ischemia and demyelination. It is notable that these last two conditions have recently been reported to be a complication in some people with coronavirus disease 2019 (COVID-19). A paradigm for practical neurological workup of symptomatic pilots and astronauts will be discussed, as will the controversial notion of pre-emptive radiological screening (vs. not screening) in asymptomatic or clinically occult situations. The concepts of medical surveillance in the setting of known or diagnosed pathologies, and expert panel review and simulator and flight checks in complex neurological cases, are also elaborated on in this paper. We believe this overview will contribute toward the enhancement of a broad understanding of neurological conditions, their clinical workup, and their precautionary management in the setting of aviation and aerospace.Khurana VG, Jithoo R, Barnett M. Aerospace implications of key neurological conditions. Aerosp Med Hum Perform. 2021; 92(2):113119.

The effectiveness of a 17-week lifestyle intervention on health behaviors among airline pilots during COVID-19.

PURPOSE: The aim of this study was to evaluate the efficacy of a 17-week, 3-component lifestyle intervention for enhancing health behaviors during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A parallel-group (intervention and control) study was conducted amongst 79 airline pilots over a 17-week period during the COVID-19 pandemic. The intervention group (n = 38) received a personalized sleep, dietary, and physical activity (PA) program. The control group (n = 41) received no intervention. Outcome measures for sleep, fruit and vegetable intake, PA, and subjective health were measured though an online survey before and after the 17-week period. The changes in outcome measures were used to determine the efficacy of the intervention. RESULTS: Significant main effects for time × group were found for International Physical Activity Questionnaire-walk (p = 0.02) and for all other outcome measures (p < 0.01). The intervention group significantly improved in sleep duration (p < 0.01; d = 1.35), Pittsburgh Sleep Quality Index score (p < 0.01; d = 1.14), moderate-to-vigorous PA (p < 0.01; d = 1.44), fruit and vegetable intake (p < 0.01; d = 2.09), Short Form 12v2 physical score (p < 0.01; d = 1.52), and Short Form 12v2 mental score (p < 0.01; d = 2.09). The control group showed significant negative change for sleep duration, Pittsburgh Sleep Quality Index score, and Short Form 12v2 mental score (p < 0.01). CONCLUSION: Results provide preliminary evidence that a 3-component healthy sleep, eating, and PA intervention elicit improvements in health behaviors and perceived subjective health in pilots and may improve quality of life during an unprecedented global pandemic.

Coronavirus Disease 2019 Suspicion: A Case Report Regarding a Male Emergency Medical Service Pilot With Newly Diagnosed Sarcoidosis.

A 38-year-old emergency medical service Bell 214 male pilot with a dry cough, fever, anorexia, fatigue, and sweating for the past 3 days; an oral temperature of 38°C; blood pressure of 105/65 mm Hg; heart rate of 94 beats/min; respiratory rate of 21 breaths/min; and pulse oximetry of 93% on room air was suspicious for coronavirus disease 2019. Surprisingly, reverse transcription polymerase chain reaction was negative, but bilateral hilar adenopathy was reported in his chest radiography as a new challenge. The pathologic report of the adenopathy biopsy was noncaseating sarcoid-type granulomas. Serologic tests showed a serum angiotensin-converting enzyme level of 58 nmol/mL/min. The bronchoalveolar lavage fluid CD4/CD8 ratio was 3.68. The bronchoalveolar lavage findings provided an accurate sarcoidosis diagnosis, and a high-resolution computed tomographic scan revealed stage 1 pulmonary involvement. Because of the pulmonary involvement, clinical manifestations, use of inhaled fluticasone, and need for longer and accurate follow-up and to protect against coronavirus disease 2019, he has been temporarily suspended until the final assignment.