Evaluation of sex inequity in lung-cancer-specific survival.

BACKGROUND: Whether sex is an independent prognostic factor in lung cancer survival is the subject of ongoing debate. Both large national registries and single hospital studies have shown conflicting findings. In this study, we explore the impact of sex on lung-cancer-specific survival in an unselected population that is well-characterized with respect to stage and other covariates. MATERIAL AND METHODS: All patients diagnosed with lung cancer at a single hospital serving a whole and defined region in Southern Norway during the 10 years 2007-2016 were included. Follow-up data were available for at least 56 months for all patients. Analyses were adjusted for stage, treatment, performance status, smoking, age, histology, epidermal growth factor receptor/anaplastic lymphoma kinase/immunotherapy treatment and period. Differences in lung-cancer-specific survival by sex were explored using restricted mean survival times (RMST). RESULTS: Of the 1,261 patients diagnosed with lung cancer, 596 (47%) were females and 665 (53%) males, with mean ages of 68.5 and 69.5 years, respectively. The observed 5-year lung-cancer-specific survival rate was 27.4% (95% CI 23.7, 31.2) in females and 21.4% (95% CI 18.2, 24.8) in males. However, after adjustment for covariates, no significant differences by sex were observed. The 5-year RMST was 0.9 months shorter (95% CI -2.1, 0.31, p = 0.26) in males compared to females. INTERPRETATION: In this cohort, sex was not associated with a difference in lung-cancer-specific survival after adjusting for clinical and biological factors. Imbalance in stage at diagnosis was the main contributor to the observed difference in lung-cancer-specific survival by sex.

Concordance between clinical and pathology TNM-staging in lung cancer.

OBJECTIVES: A prerequisite for utilizing the tumour, lymph-nodes, and metastases (TNM) for the staging of lung cancer patients is a high quality of the reported data on which the staging is based. The aim of this study was to investigate the concordance between the clinical, cTNM and the pathology, pTNM staging for lung cancer, version 8 as reported to the Cancer Registry of Norway (CRN). MATERIALS AND METHODS: A total of 1284 patients who underwent surgery 2018-2019 with sufficient data regarding both clinical and pathology T and N descriptors were included. RESULTS: The differences in tumour diameter reported in the clinical and the pathology notifications were ≤5 mm and ≤10 mm in 65.9 % and in 84.4 % of the cases, respectively. For the c- and pT categories, there was concordance in 53.4 % while 28.4 % were upstaged and 18.2 % were downstaged. For N categories there was concordance in 83.3 % while 13.7 % were upstaged and 3.0 % were downstaged. Unforeseen pN2 was found in 6.2 % of the cases. For TNM staging groups there was concordance in 48.1 % of the cases, while 33.4 % were upstaged and 18.5 % were downstaged. The calculated sensitivity and specificity for reported cTNM staging as diagnostic test for being eligible for adjuvant treatment (stage II-IIIA) were 0.65 and 0.91, respectively. CONCLUSIONS: These data on staging for lung cancer, as reported to the CRN, shows a disappointingly low precision and concordance in c- and pTNM staging. This urges a strategy for a marked improvement.

Under-Reporting of Self-Reported Medical Conditions in Aviation: A Cross-Sectional Survey.

BACKGROUND: The applicants' self-declaration of medical history is crucial for safety. Some evidence indicates that under-reporting of medical conditions exists. However, the magnitude in a population of aviation personnel has not been reported earlier.METHODS: A total of 9941 applicants for medical certificate/attestation for aviation-related safety functions during the last 5 yr up to December 2019 were registered at the Civil Aviation Authority Norway. E-mail addresses were known for 9027 of these applicants, who were invited to participate in a web-based survey.RESULTS: Among the 1616 respondents, 726 (45%) were commercial pilots, 457 (28%) private pilots, 272 (17%) air traffic controllers, and the remaining were cabin crew or crew in aerodrome/helicopter flight information service (AFIS or HFIS, respectively). A total of 108 were initial applicants. The age group 50+ constituted the largest proportion of respondents (53%). Aeromedical certification in general was believed to improve flight safety "to a high" or "very high extent" by 64% of the respondents. A total of 188 individuals (12%) admitted having under-reported information related to one or more categories, including mental (3%) or physical health (4%), medications (2%), and drug use, including alcohol use (5%). Among these, 21 participants believed their own under-reporting "to some" or "to a high extent" affected flight safety. In total 50% of noninitial applicants reported that they knew colleagues who had under-reported information. Analyses revealed that being a commercial pilot showed a higher risk for under-reporting compared with other classes and the perception of aeromedical examiners in a supportive or authoritative role reduced the risk.CONCLUSIONS: Under-reporting of medical conditions could be significant in aviation. Further studies should be conducted to investigate the true extent of under-reporting and its impact on flight safety and what mitigating measures might be recommended.Strand T-E, Lystrup N, Martinussen M. Under-reporting of self-reported medical conditions in aviation: a cross-sectional survey. Aerosp Med Hum Perform. 2022; 93(4):376-383.

Factors associated with delayed treatment initiation in an unselected cohort of patients with small-cell lung cancer.

BACKGROUND: Small-cell lung cancer (SCLC) is an aggressive, rapidly progressive malignancy. Thus, expedient diagnosis and treatment initiation is important. This study identifies and quantifies factors associated with delayed diagnosis and treatment initiation in patients with SCLC and compares time to treatment in SCLC with a cohort of patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: The study included all patients diagnosed with SCLC at a hospital in southern Norway in a ten-year period (2007-2016), and all NSCLC patients during the period 2013-2016. Total time to treatment (TTT), was defined as the number of days from date of referral due to suspicion of lung cancer to first day of treatment. Factors associated with prolonged TTT were estimated using multivariate median regression analysis. RESULTS: The median TTT and interquartile range (IQR) for the 183 patients with SCLC was 16 (10-23) days. Factors associated with delayed TTT included outpatient versus inpatient evaluation (+8.4 days), number of diagnostic procedures (+4.3 days per procedure), stage I-III versus stage IV (+3.6 days) and age (+2.1 days per 10 years). In 2013-16, TTT in SCLC was 3.5 days shorter than in the period before and less than half that of NSCLC in the same period, 15 (9-22) versus 33 (22-50) days (p = 0.001). CONCLUSION: Shorter TTT is seen in higher stage, while longer TTT is a result of increasing complexity of the diagnostic process and treatment decisions of patients with curative intent treatment. Knowledge on delaying factors can shorten TTT and improve clinical practice.

Age-related treatment patterns for stage I NSCLC in three European countries.

INTRODUCTION: Surgery is the preferred treatment for patients with early-stage non-small cell lung cancer (NSCLC) while stereotactic body radiation therapy (SBRT) may be applied in patients with major comorbidity or high age. We evaluated the association between age and treatment utilization for early-stage NSCLC in patients diagnosed in 2015-2016 in three European countries. PATIENTS AND METHODS: Information was retrieved from population-based registries in England, Norway and the Netherlands. Treatment patterns and two-year overall survival rates for 105,124 patients with clinical stage I were analysed by age-group. RESULTS: Surgical resection rates were higher in Norway (55%) and England (53%) than in the Netherlands (47%), and decreased with increasing age. SBRT use was highest in the Netherlands (41%), followed by Norway (29%) and England (12%). In the Netherlands, SBRT was the prevailing treatment in patients aged 70 years or older. In octogenarians, the proportion not receiving curative intent treatment was 53% in England, versus 35% in Norway and 22% in the Netherlands. Two-year survival rates were better for surgery than for SBRT and slightly better in Norway. CONCLUSION: In patients aged 70 years or older, the proportion not receiving any curative treatment remains substantial, and differs significantly between countries. Measures to address these disparities are needed.

Metformin use and lung cancer survival: a population-based study in Norway.

BACKGROUND: We assessed associations between metformin use and survival in a nationwide Norwegian cohort of lung cancer (LC) patients. METHODS: The study linked 22,324 LC patients from the Cancer Registry of Norway diagnosed 2005-2014 with the Norwegian Prescription Database. We estimated associations of pre- and post-diagnostic metformin use with overall survival (OS) and LC-specific survival (LCSS) using multivariable time-fixed and time-dependent Cox regression. RESULTS: Pre-diagnostic metformin use was not associated with improved survival in all patients. Nevertheless, pre-diagnostic metformin use was associated with better LCSS in squamous cell carcinoma (SCC) patients (hazard ratio (HR) = 0.79; 95% confidence interval (CI) 0.62-0.99) and in patients with regional stage SCC (HR = 0.67; 95%CI 0.47-0.95). Post-diagnostic metformin use was associated with improved LCSS in all patients (HR = 0.83; 95%CI 0.73-0.95), in patients with SCC (HR = 0.75; 95%CI 0.57-0.98), regional stage LC (HR = 0.74; 95%CI 0.59-0.94), and regional stage SCC (HR = 0.57; 95%CI 0.38-0.86). OS showed similar results. Analyses of cumulative use showed a dose-response relationship in all patients, patients with adenocarcinoma and SCC, and with regional and metastatic LC. CONCLUSIONS: Metformin use was associated with improved survival, especially LCSS in patients with regional stage SCC. Further prospective studies are required to clarify the role of metformin in LC treatment.

Increase in curative treatment and survival of lung cancer in Norway 2001-2016.

We have studied the alterations in the use of curative treatment and the outcome for lung cancer patients in Norway 2001-2016. The Cancer Registry of Norway has a practically complete registration of all cancer diagnoses, treatments given and deaths. For the years 2001-2016, 43,137 patients were diagnosed with lung cancer. Stereotactic radiotherapy was established nationwide from 2008 and its use has increased, and in 2016, 8.8% were given this treatment. In addition 20.6% were operated and 8.5% were treated with conventional radiotherapy. Thus 37.9% of those diagnosed were treated with intention to cure, compared to 22.9% in 2001 (p < 0.0001). Further, the median survival for the whole group diagnosed with lung cancer increased from 6.0 (95% CI 5.6-6.7) months in 2001 to 11.8 (95% CI 10.9-12.7) in 2016. The 5 year survival increased from 9.4 (95% CI 8.1-10.8)% to 19.9 (95% CI 19.2-20.6)% in the same period. In 2016 the age adjusted incidence rate was 59.5 per 100,000 (Norwegian standard) and had increased significantly in both sexes. There had also been an increase in mean age at diagnosis and the proportion diagnosed in an early stage. The increase in curative treatment has been paralleled with a doubling in both the median and 5-year survival. The present results are used for surveillance and as a benchmark, and we are looking forward to reaching a proportion of 40% of patients given curative treatment.

Achieving Thoracic Oncology data collection in Europe: a precursor study in 35 Countries.

BACKGROUND: A minority of European countries have participated in international comparisons with high level data on lung cancer. However, the nature and extent of data collection across the continent is simply unknown, and without accurate data collection it is not possible to compare practice and set benchmarks to which lung cancer services can aspire. METHODS: Using an established network of lung cancer specialists in 37 European countries, a survey was distributed in December 2014. The results relate to current practice in each country at the time, early 2015. The results were compiled and then verified with co-authors over the following months. RESULTS: Thirty-five completed surveys were received which describe a range of current practice for lung cancer data collection. Thirty countries have data collection at the national level, but this is not so in Albania, Bosnia-Herzegovina, Italy, Spain and Switzerland. Data collection varied from paper records with no survival analysis, to well-established electronic databases with links to census data and survival analyses. CONCLUSION: Using a network of committed clinicians, we have gathered validated comparative data reporting an observed difference in data collection mechanisms across Europe. We have identified the need to develop a well-designed dataset, whilst acknowledging what is feasible within each country, and aspiring to collect high quality data for clinical research.

Substantial nation-wide improvement in lung cancer relative survival in Norway from 2000 to 2016.

INTRODUCTION: There have been significant changes in both diagnostic procedures and therapy for lung cancer since the beginning of the millennium. National incidence and survival data from 2000 through 2016 are studied. METHODS: National data on cancer incidence and vital status are virtually complete. Changes in incidence and survival are described by absolute numbers, percentages, and calculation of relative survival (period analysis). RESULTS: A total of 44,825 individuals were diagnosed with lung cancer in Norway in the study period. The number of incident cases increased with 49% whereas the prevalence increased with 136% from 2000 to 2016. Age-standardised rates rose markedly for women and levelled off for men. In 2016, adenocarcinoma accounted for about 50% of all lung cancers, slightly more for women than for men. The entity "NSCLC not otherwise specified" declined from 24% to 13%, and the fraction of patients with metastatic disease decreased from 54% to 46% during the period, for both sexes combined. The overall median survival time doubled for women and men, reaching 14.3 months and 11.4 months, respectively. For patients with metastatic disease, median survival time showed a small increase but remained less than 6 months. The overall 5-year relative survival increased from 16% to 26% in women and from 16% to 22% in men. The corresponding improvements for the subgroup of non-surgically treated cases with localised disease, were up from 25% to more than 40% in females, and from 10% to almost 40% in males. CONCLUSION: There have been notable changes in incidence patterns and a remarkable improvement in survival for lung cancer over the last 17 years, most markedly for patients without distant metastases at the time of diagnosis. Hopefully, survival will improve even more when immunotherapy is implemented.

Implementation of lung cancer CT screening in the Nordic countries.

INTRODUCTION: We review the current knowledge of CT screening for lung cancer and present an expert-based, joint protocol for the proper implementation of screening in the Nordic countries. MATERIALS AND METHODS: Experts representing all the Nordic countries performed literature review and concensus for a joint protocol for lung cancer screening. RESULTS AND DISCUSSION: Areas of concern and caution are presented and discussed. We suggest to perform CT screening pilot studies in the Nordic countries in order to gain experience and develop specific and safe protocols for the implementation of such a program.

The novel combination of theophylline and bambuterol as a potential treatment of hypoxemia in humans.

Hypoxemia can be life-threatening, both acutely and chronically. Because hypoxemia causes vascular dysregulation that further restricts oxygen availability to tissue, it can be pharmacologically addressed. We hypothesized that theophylline can be safely combined with the ß2-adrenergic vasodilator bambuterol to improve oxygen availability in hypoxemic patients. Ergogenicity and hemodynamic effects of bambuterol and theophylline were measured in rats under hypobaric and normobaric hypoxia (12% O2). Feasibility in humans was assessed using randomized, double-blind testing of the influence of combined slow-release theophylline (300 mg) and bambuterol (20 mg) on adverse events (AEs), plasma K+, pulse, blood pressure, and drug interaction. Both drugs and their combination significantly improved hypoxic endurance in rats. In humans, common AEs were low K+ (<3.5 mmol/L; bambuterol: 12, theophylline: 4, combination: 13 episodes) and tremors (10, 0, 14 episodes). No exacerbation or serious AE occurred when drugs were combined. A drop in plasma K+ coincided with peak bambuterol plasma concentrations. Bambuterol increased heart rate by approximately 13 bpm. Drug interaction was present but small. We report promise, feasibility, and relative safety of combined theophylline and bambuterol as a treatment of hypoxemia in humans. Cardiac safety and blood K+ will be important safety endpoints when testing these drugs in hypoxemic subjects.

Aeromedical Evaluation for an F-16 Candidate with Incomplete Paraplegia.

BACKGROUND: A candidate with paraplegia contacted the Institute of Aviation Medicine, Oslo, requesting a medical examination and medical certification for flying back seat on an F-16 Fighting Falcon. Thorough aeromedical examinations, including specialist evaluations, were initiated for the final decision to be made. CASE REPORT: Almost 13 yr earlier the candidate had acquired spinal cord damage at neurological level L1 after falling 4 m (13 ft) from out of a window. The CT scans showed luxation of the 12th thoracic vertebra with fracture and dislocation of the 1st lumbar vertebra. He went for surgery, where fixation of the 12th thoracic vertebra to the 1st lumbar vertebra was performed. He developed syringomyelia 1 yr postoperatively and was re-operated on twice in the following years. He was now in a wheelchair, but engaged himself in several sport activities such as sledge-hockey and sit-skiing, participating in several Paralympics. DISCUSSION: With respect to the general principles of aviation medicine, several considerations had to be taken into account before a medical certification could be given. The risks associated with an F-16 flight in relationship to the candidate's general health and the fixation of his spinal cord had to be evaluated. Also, his ability to perform required tasks during the flight and in case of an emergency was an important issue discussed. Finally, the candidate's medical and physical condition should not present a considerable risk to flight safety. After extensive specialist consultations and in-depth discussions, the candidate was given medical certification to fly back seat in a F-16. Chahal-Kummen M, Strand T-E, Owe JO, Gulliksen E, Wagstaff AS. Aeromedical evaluation for an F-16 candidate with incomplete paraplegia. Aerosp Med Hum Perform. 2016; 87(11):968-971.

Near-Infrared Spectra in Buccal Tissue as a Marker for Detection of Hypoxia.

INTRODUCTION: Hypoxia caused by high altitude exposure can impair cerebral and mental functions. Blood flow and oxygenation of the buccal tissue can be reliable markers to detect hypoxia. In this study, near infrared spectroscopy was used in combination with a novel optical probe to evaluate the applicability of the novel probe in measuring hypoxia markers in buccal tissue under a hypoxic condition. METHODS: Six healthy participants were tested at altitudes from 2000 to 16,000 ft inside a hypobaric chamber. The buccal reference measurements of blood flow and oxygen saturation were synchronized with the spectral measurements of the novel near infrared probe and the relationship between the reference measurements and spectral data were evaluated by multivariate partial least square method. In addition, finger oxygen saturation was measured during the experiment and the recordings were compared with buccal oxygen saturation. RESULTS: The spectral analysis illustrated that the spectral data from the near infrared probe correlated strongly with the absorption features of both buccal flow and oxygenation measured by the reflectance sensors (average R(2) = 0.89). The results showed probably overestimated values for buccal oxygen saturation recorded by the reference pulse oximeter in comparison with finger oxygen saturation, with the mean difference increasing from 1.8% at 2000 ft to 11.4% at 16,000 ft. CONCLUSION: The novel near infrared probe showed promising results for simultaneous measurement of blood flow and oxygen saturation in the buccal tissue. The suggested method can be used as a new technique for early indication of hypoxia in future clinical applications.

Lung cancer treatment is influenced by income, education, age and place of residence in a country with universal health coverage.

Selection of lung cancer treatment should be based on tumour characteristics, physiological reserves and preferences of the patient. Our aims were to identify and quantify other factors associated with treatment received. Lung cancer patient data from 2002 to 2011 were obtained from the national population-based Cancer Registry of Norway, Statistics Norway and the Norwegian Patient Register. Multivariable logistic regression examined whether year of diagnosis, age, sex, education, income, health trust, smoking status, extent of disease, histology and comorbidities were associated with choice of treatment; surgery or radical or palliative radiotherapy, within 1 year of diagnosis. Among the 24,324 lung cancer patients identified, the resection rate remained constant while the proportion of radical radiotherapy administered increased from 8.6 to 14.1%. Older patients, those with lower household incomes and certain health trusts were less likely to receive any treatment. Lower education and the male gender were identified as negative predictors for receiving surgery. Smoking history was positively associated with both radical and palliative radiotherapy, while comorbidity and symptoms were independently associated with receiving surgery and palliative radiotherapy. Although Norway is a highly egalitarian country with a free, universal healthcare system, this study indicates that surgery and radical and palliative radiotherapy were under-used among the elderly, those with a lower socioeconomic status and those living in certain health trusts.

Lung cancer survival in Norway, 1997-2011: from nihilism to optimism.

We examine changes in survival and patient-, tumour- and treatment-related factors among resected and nonresected lung cancer patients, and identify subgroups with the largest and smallest survival improvements.National population-based data from the Cancer Registry of Norway, Statistics Norway and the Norwegian Patient Register were linked for lung cancer patients diagnosed during 1997-2011. The 1- and 5-year relative survival were estimated, and Cox proportional hazard regression, adjusted for selected patient characteristics, was used to assess prognostic factors for survival in lung cancer patients overall and stratified by resection status.We identified 34 157 patients with lung cancer. The proportion of histological diagnoses accompanied by molecular genetics testing increased from 0% to 26%, while those accompanied by immunohistochemistry increased from 8% to 26%. The 1-year relative survival among nonresected and resected patients increased from 21.7% to 34.2% and 75.4% to 91.5%, respectively. The improved survival remained significant after adjustment for age, sex, stage and histology. The largest improvements in survival occurred among resected and adenocarcinoma patients, while patients ≥80 years experienced the smallest increase.Lung cancer survival has increased considerably in Norway. The explanation is probably multifactorial, including improved attitude towards diagnostic work-up and treatment, and more accurate diagnostic testing that allows for improved selection for resection and improved treatment options.

The percentage of lepidic growth is an independent prognostic factor in invasive adenocarcinoma of the lung.

BACKGROUND: The literature is inconclusive as to whether the percentage of the lepidic component of an invasive adenocarcinoma (AC) of the lung influences prognosis. We studied a population-based series of selected, resected invasive pulmonary ACs to determine if incremental increases in the lepidic component were an independent, prognostic variable. METHODS: Patients undergoing resection for lung cancer reported to the Cancer Registry of Norway and diagnosed in the period 1993-2002 with a bronchioloalveolar carcinoma (BAC) (old terminology) (adenocarcinoma in situ, AIS in the new terminology) in the lung were selected. A pulmonary pathologist reviewed all sections and estimated the percentage of the lepidic component. Follow-up of survival was to the end of 2013. RESULTS: One hundred thirty-one patients were identified, 102 had AC with lepidic growth. Of these, 44 had AC with a component of lepidic growth less than 50% and seven had AC with 95% lepidic component or more. One of the latter cases was considered to be AIS. In regression analyses, superior survival was associated with a greater lepidic component (p = 0.041). Mucinous tumors had a worse prognosis than non-mucinous (p = 0.012) in regression analyses, as did increasing age and stage. The five-year observed survival was 69.0% for non-mucinous cases and 66.7% for the group with a lepidic component of 80% or greater. CONCLUSION: The percentage of the lepidic component appears to be an independent, significant prognostic factor in a selection of pulmonary AC.

Utilizing national patient-register data to control for comorbidity in prognostic studies.

OBJECTIVE: To construct an updated comorbidity index (Patient Register Index [PRI]) using national data collections from Norway and compare its predictive ability of 1-year mortality with the Charlson Comorbidity Index (CCI). MATERIALS AND METHODS: Data regarding over 1.11 million patients registered in the Norwegian Patient Register in 2010 and 2011 were used to construct the PRI. The PRI was evaluated by comparing its model fit and discrimination with the CCI. RESULTS: Compared with the CCI, the PRI weights decreased for six, increased for four, and were unchanged for seven diseases. When the PRI was added to the model including age and sex, the age effects were reduced by up to 38% for patients older than 50 years. All measures of model fit improved for the PRI model. CONCLUSION: Adjustment for comorbidity is especially important for patients 50 years of age or older, and its effect on 1-year mortality is almost comparable to the age effect. The PRI is based on more recent data than the CCI, and is more representative of the general population due to its construction.

The European initiative for quality management in lung cancer care.

Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.

Mortality from cancer and other causes in commercial airline crews: a joint analysis of cohorts from 10 countries.

BACKGROUND: Commercial airline crew is one of the occupational groups with the highest exposures to ionising radiation. Crew members are also exposed to other physical risk factors and subject to potential disruption of circadian rhythms. METHODS: This study analyses mortality in a pooled cohort of 93 771 crew members from 10 countries. The cohort was followed for a mean of 21.7 years (2.0 million person-years), during which 5508 deaths occurred. RESULTS: The overall mortality was strongly reduced in male cockpit (SMR 0.56) and female cabin crews (SMR 0.73). The mortality from radiation-related cancers was also reduced in male cockpit crew (SMR 0.73), but not in female or male cabin crews (SMR 1.01 and 1.00, respectively). The mortality from female breast cancer (SMR 1.06), leukaemia and brain cancer was similar to that of the general population. The mortality from malignant melanoma was elevated, and significantly so in male cockpit crew (SMR 1.57). The mortality from cardiovascular diseases was strongly reduced (SMR 0.46). On the other hand, the mortality from aircraft accidents was exceedingly high (SMR 33.9), as was that from AIDS in male cabin crew (SMR 14.0). CONCLUSIONS: This large study with highly complete follow-up shows a reduced overall mortality in male cockpit and female cabin crews, an increased mortality of aircraft accidents and an increased mortality in malignant skin melanoma in cockpit crew. Further analysis after longer follow-up is recommended.

Sine wave mesopic contrast sensitivity -- defining the normal range in a young population.

PURPOSE: Limited information is available regarding the normal range of mesopic sine wave contrast sensitivity (CS). The aim of this study was therefore to define a reference range and in addition to identify factors related to mesopic CS in a young population. METHODS: Individuals with normal visual acuity (VA) were included from a population of air crew members visiting the Institute of Aviation Medicine for routine medical examinations. CS was measured using the Optec 6500/FACT and evaluated by (i) the CS curve with five frequencies and (ii) the index of contrast sensitivity (ICS). ICS was defined as the sum of the weighted differences from the median CS value for each frequency. Multivariate analyses were performed to identify factors related to CS. RESULTS: In a total of 197 subjects included, the mean mesopic CS score was significantly lower compared to the corresponding photopic measurements for all five frequencies tested. Median CS score for frequencies 1.5, 3, 6, 12 and 18 cycles per degree was 50, 114, 180, 60 and 33 for photopic and 71, 80, 90, 22 and 12 for mesopic (- glare) conditions, respectively. Better binocular VA was positively associated, while the use of corrective lenses was negatively associated with CS performance. CONCLUSION: We have provided reference values for mesopic CS and identified factors important for CS. The difference between mesopic and photopic measurements highlights the need for separate population norms. The new ICS score may be a useful collective descriptor of the traditional CS curve with five frequencies.