Global Cardiovascular Risk and Associated Factors in 2792 French Military and Civilian Aircrew.

INTRODUCTION: Cardiovascular (CV) diseases are a major public health issue, the prevention of which plays a key role in promoting flight safety. However, few studies have looked at the determinants of the overall risk of CV morbidity-mortality within the various aeronautical occupations.METHODS: A monocentric, observational, cross-sectional study was based on the retrospective data collected during 6 mo at the Toulon Aeromedical Center. From October 2017 to April 2018, 2792 professional aircrew ages 18-74 were included. The overall CV risk was estimated using the European Society of Cardiology SCORE and the Framingham model, as well as a summation model.RESULTS: More than two-thirds of this mainly male population (86.2%) had no more than one CV risk factor [69.9% (68.2-71.6)]. In 82.5% of cases, this was dyslipidemia according to current European criteria [55.8% (52.4-59.1)] or smoking [26.7% (23.8-29.8)]. An overall risk level of "moderate" to "very high" concerned only one subject in five according to the SCORE model [20.1% (18.6-21.6)], one in six according to Framingham [16.3% (14.9-17.7)] and almost one in three according to the summation model [30.1% (28.4-31.9)].DISCUSSION: Multivariate analyses found no significant associations between socio-professional criteria and overall risk levels. The results have underlined the effect of dyslipidemia and smoking on early risk among applicants. Beyond the illustration of favorable cardiovascular status among aircrews related to the standards of selection and close monitoring process, areas for improvement were identified, inviting the development of prevention strategies around the "moderate" overall CV risk.Huiban N, Gehant M, Brocq F-X, Collange F, Mayet A, Monteil M. Global cardiovascular risk and associated factors in 2792 French military and civilian aircrew. Aerosp Med Hum Perform. 2024; 95(5):233-244.

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. All participants performed a dipstick urinalysis. Those positive for leukocyturia were offered STI screening by nucleic acid amplification test (NAAT) for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis. RESULTS: Among the 2236 included asymptomatic participants (1912 men and 324 women), 127 (36 men and 91 women) were positive for leukocyturia. The prevalence of leukocyturia was 1.9% (1.3-2.6) in men and 28.1% (23.3-33.3) in women (p < 0.001). In men positive for leukocyturia, the NAAT positivity rate for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis was 28.6% (3.7-71.0) in the age group 18-24, 20.0% (0.5-71.6) in the age group 25-34, and zero in the older age group (p 0.65). In women positive for leukocyturia it was 16.7% (4.7-37.4) in the age group 18-24, 18.2% (2.3-51.8) in the age group 25-34, and zero in the older age group (p 0.16). CONCLUSIONS: In asymptomatic individuals, leukocyturia is rare in men and more common in women. In asymptomatic adults under 35 years of age with leukocyturia, multiplex NAAT shows a high proportion of STIs and might be useful in improving STI detection.

Diving Accident Evacuations by Helicopter and Immersion Pulmonary Edema.

BACKGROUND: Scuba diving activities expose divers to serious accidents, which can require early hospitalization. Helicopters are used for early evacuation. On the French Mediterranean coast, rescue is made offshore mainly by a French Navy Dauphin or at a landing zone by an emergency unit EC 135 helicopter.METHODS: We retrospectively analyzed diving accidents evacuated by helicopter on the French Mediterranean coast from 1 September 2014 to 31 August 2016. We gathered data at the Center for Hyperbaric Medicine and Diving Expertise (SMHEP) of the Sainte-Anne Military Hospital (Toulon, France), the 35 F squadron at Hyres (France) Naval Air Station, and the SAMU 83 emergency unit (Toulon, France).RESULTS: A total of 23 diving accidents were evacuated offshore by Dauphin helicopter and 23 at a landing zone on the coast by EC 135 helicopter without hoist. Immersion pulmonary edema (IPE) accounted for one-third of the total diving accidents evacuated by helicopter with identified causes. It was responsible for at least half of the deaths at the dive place. A quarter of the rescued IPE victims died because of early cardiac arrest.DISCUSSION: Helicopter evacuation is indicated when vital prognosis (IPE and pulmonary overpressure in particular) or neurological functional prognosis (decompression sickness) is of concern. IPE is the primary etiology in patients with serious dive injuries that are life-threatening and who will benefit from helicopter evacuation. A non-invasive ventilation device with inspiratory support and positive expiratory pressure must be used, in particular for IPE.Corgie L, Huiban N, Pontier J-M, Brocq F-X, Boulard J-F, Monteil M. Diving accident evacuations by helicopter and immersion pulmonary edema. Aerosp Med Hum Perform. 2020; 91(10):806811.

Generalized Epileptic Seizure Induced by the Stroboscopic Effect of Helicopter Blades.

BACKGROUND: The stroboscopic effect made by helicopter blades passing through rays of sunlight is known as a factor that can induce an epileptic seizure.CASE REPORT: We report a case of inaugural tonic-clonic generalized seizure while refueling an NH 90 helicopter by an aeronautical technician standing under the rotating main rotor on a sunny day at a South of France naval air station. The stroboscopic effect of the helicopter blades was identified as one of the factors involved in the induction of this seizure.DISCUSSION: This aeronautical factor identified here during ground hot refueling must be considered for patients predisposed to epileptic seizures who are being evacuated by helicopter, but also for the medical screening of flight members. This is even more important within the military aeronautical environment, justifying electroencephalogram testing implementation on initial aeronautical medical evaluation in France.Corgie L, Huiban N, Quesnel L, Brocq F-X, Boulard J-F, Monteil M. Generalized epileptic seizure induced by the stroboscopic effect of helicopter blades. Aerosp Med Hum Perform. 2019; 90(10):891-895.

Frequency of barodontalgia among military or civilian pilots and aircrew members.

BACKGROUND: Barodontalgia is dental pain triggered by a change in barometric pressure and can be severe enough to cause in-flight incapacitation. There is a large variation of in-flight barodontalgia incidence in the literature and most of the current epidemiological data on barodontalgia has been compiled from military aircrew. The aim of this study was to evaluate the frequency of barodontalgia in French military and civilian aircrew. METHODS: A cross-sectional study was conducted in 2010. The pilots and crewmembers attending 10 medical units of the French Air Force and Navy, and 5 dedicated to civilian pilots and aircrew were given a standardized and anonymous questionnaire to complete regarding demographic and professional characteristics as well as their barodontalgia. RESULTS: Out of the 1475 questionnaires distributed, 1184 responded (response rate of 80.3%), and 6.6% of these participants (N = 74) reported at least one event of barodontalgia during their career (95% CI: 5.1-8.1%); 43 (6.8%) from the air force and 31 (6.5%) from a civilian service. Median pain intensity during barodontalgia was evaluated at 5.5 out of 10. Pain appeared most commonly during descent (47.3%) and was more frequent below 8000 m. In 10 cases (13.5%), the pilots reported that barodontalgia could have compromised flight security. DISCUSSION: Despite the improvement of aeronautical equipment and the quality of dental care, barodontalgias were still present in 2010 in the French military and in civilian aircrews. We recommend prevention programs be established in order to minimize the frequency of barodontalgias and their potential repercussions on flight safety.