The Untapped Potential of Narrative as a Tool in Aviation Mental Health and Certification.

INTRODUCTION: Work-related stress is common in pilots, with broad implications, including the potential development of mental health symptoms and sometimes even psychiatric disease. This commentary argues for the use of narrative as a tool to promote preventive health behaviors in pilots and combat misinformation about aeromedical certification related to mental health.Hoffman WR, McNeil M, Tvaryanas A. The untapped potential of narrative as a tool in aviation mental health and certification. Aerosp Med Hum Perform. 2024; 95(3):165-166.

Self-Reported Health Care Avoidance Behavior in U.S. Military Pilots Related to Fear for Loss of Flying Status.

INTRODUCTION: U.S. military pilots are required to meet certain medical standards in order to maintain an active flying status. Military pilots face potential temporary or permanent loss of flying privileges in the setting of a new condition or symptom that does not meet required standards, which could result in negative social and occupational repercussions for the pilot. For this reason, it has been proposed that U.S. military pilots participate in health care avoidance behavior, but little evidence exists to characterize such a trend in this population. MATERIALS AND METHODS: We conducted a non-probabilistic Internet survey of the general population of U.S. pilots from November 1, 2019 through August 1, 2021. The current study is a sub-analysis of military pilots. RESULTS: A total of 4,320 pilots answered the informed consent question, and 264 selected one military pilot type and were included in this sub-analysis. There were 72% of military pilots who reported a history of health care avoidance behavior (n = 190), and no statistical difference was found between age groups, gender, and military pilot types. There were 55.5% of pilots who reported a history of seeking informal medical care (n = 147), 33.7% of pilots who have flown despite a new symptom they felt required medical evaluation, 42.5% of pilots who reported withholding information on aeromedical screening (n = 111), and 11.4% of pilots who reported a history of undisclosed prescription medication use (n = 30). CONCLUSIONS: U.S. military pilots may participate in health care avoidance behavior because of fear for loss of flying status.

Breaking the Pilot Healthcare Barrier.

INTRODUCTION: It has been proposed that pilots face a perceived barrier to seeking medical care due to what a change in health status might mean to their status as a pilot. While this is often common knowledge to pilots and some physicians, this phenomenon has limited research or characterization in the medical literature. In this commentary, we propose a definition for the barrier pilots face in seeking healthcare in hopes of focusing future research efforts.Hoffman W, Bjerke E, Tvaryanas A. Breaking the pilot healthcare barrier. Aerosp Med Hum Perform. 2022; 93(8):649-650.

Healthcare Avoidance in Aircraft Pilots Due to Concern for Aeromedical Certificate Loss: A Survey of 3765 Pilots.

OBJECTIVE: To study healthcare avoidance behavior in pilots related to fear of aeromedical certificate loss. METHODS: Voluntary participation in an anonymous survey distributed to U.S. pilots. RESULTS: A total of 3765 pilots were included in the analysis. There were 56.1% of pilots (n = 2111) who reported a history of healthcare avoidance behavior due fear for losing their aeromedical certificate. There were 45.7% who sought informal medical care (n = 1721) and 26.8% who misrepresented/withheld information on a written healthcare questionnaire for fear of aeromedical certificate loss (n = 994). CONCLUSIONS: Aircraft pilots may participate in healthcare avoidance behavior related to fear of losing their aeromedical certificate. Further work is necessary to address pilot healthcare avoidance.

Statins and Musculoskeletal Conditions in U.S. Air Force Active Duty Aviators.

BACKGROUND: The purpose of this study was to examine the association of statin use and musculoskeletal conditions within the population of U.S. Air Force active duty aviators. METHODS: The study was a retrospective cohort analysis of aviators between 2004-2014 as identified from personnel data. Based on pharmacy data, participants were divided into two groups: statin users (received a statin for at least 90 d) and nonusers (never received a statin throughout the study period). Using participants' baseline characteristics, a propensity score was generated and used to match statin users to nonusers in a 1:6 ratio. Conditional logistic regression was used to determine the odds ratio for a musculoskeletal condition. RESULTS: A total of 19,330 participants met study criteria (131 statin users and 19,199 nonusers). Of these, 112 statin users were matched to 672 nonusers. Among matched pairs, statin users were not at significantly increased risk (odds ratio: 1.239; 95% confidence interval: 0.768, 1.999) for musculoskeletal conditions. Likewise, there was no observed significant association between specific musculoskeletal disease diagnosis groups and statin use. CONCLUSIONS: In this aviator population, there was not an increased overall likelihood of musculoskeletal conditions for statin users relative to propensity score-matched nonusers. A well-designed prospective cohort analysis or clinical trial is needed to ascertain possible adverse effects of statins on performance in the aviation environment.Tvaryanas AP, Wagner JH, Maupin GM. Statins and musculoskeletal conditions in U.S. Air Force active duty aviators. Aerosp Med Hum Perform. 2018; 89(5):421-427.

The Commander's Wellness Program: Assessing the Association Between Health Measures and Physical Fitness Assessment Scores, Fitness Assessment Exemptions, and Duration of Limited Duty.

INTRODUCTION: Air Force Medical Service health promotions staff have identified a set of evidenced-based interventions targeting tobacco use, sleep habits, obesity/healthy weight, and physical activity that could be integrated, packaged, and deployed as a Commander's Wellness Program. The premise of the program is that improvements in the aforementioned aspects of the health of unit members will directly benefit commanders in terms of members' fitness assessment scores and the duration of periods of limited duty. The purpose of this study is to validate the Commander's Wellness Program assumption that body mass index (BMI), physical activity habits, tobacco use, sleep, and nutritional habits are associated with physical fitness assessment scores, fitness assessment exemptions, and aggregate days of limited duty in the population of active duty U.S. Air Force personnel. METHODS: This study used a cross-sectional analysis of active duty U.S. Air Force personnel with an Air Force Web-based Health Assessment and fitness assessment data during fiscal year 2013. Predictor variables included age, BMI, gender, physical activity level (moderate physical activity, vigorous activity, and muscle activity), tobacco use, sleep, and dietary habits (consumption of a variety of foods, daily servings of fruits and vegetables, consumption of high-fiber foods, and consumption of high-fat foods). Nonparametric methods were used for the exploratory analysis and parametric methods were used for model building and statistical inference. RESULTS: The study population comprised 221,239 participants. Increasing BMI and tobacco use were negatively associated with the outcome of composite fitness score. Increasing BMI and tobacco use and decreasing sleep were associated with an increased likelihood for the outcome of fitness assessment exemption status. Increasing BMI and tobacco use and decreasing composite fitness score and sleep were associated with an increased likelihood for the outcome of limited duty status, whereas increasing BMI and decreasing sleep were associated with the outcome of increased aggregate days of limited duty. The observed associations were in the expected direction and the effect sizes were modest. Physical activity habits and nutritional habits were not observed to be associated with any of the outcome measures. CONCLUSIONS: The Commander's Wellness Program should be scoped to those interventions targeting BMI, composite fitness score, sleep, and tobacco use. Although neither self-reported physical activity nor nutritional habits were associated with the outcomes, it is still worthwhile to include related interventions in the Commander's Wellness Program because of the finding in other studies of a consistent association between the overall number of health risks and productivity outcomes.

Assessment of Deployment-Related Exposures on Risk of Incident Mental Health Diagnoses Among Air Force Medical Service Personnel: Nested Case-Control Study.

Background: Recent military conflicts in Iraq (Operation Iraqi Freedom), Afghanistan (Operation Enduring Freedom), and elsewhere have been associated with psychological impacts among military personnel. However, relatively little is known about the relationship between those conflicts and psychological health of military health care professionals. Previous work has shown certain demographic factors associated with diagnosed mental health conditions after deployment. However, unique exposures in the deployed environment may be present that are also associated. Understanding the relationship between the demographic factors, exposures, and post-deployment mental health (PDMH) conditions has not been investigated. The purpose of this study was to determine the association between occupational and/or environmental exposures and incident PDMH conditions in a defined population of United States Air Force health care personnel returning from the deployed environment (i.e., deployment-related exposures). Methods: A nested case-control study compared cohort members with (N = 4,114) and without (N = 14,073) a PDMH condition in terms of deployment-related occupational and/or environmental exposures. PDMH conditions were identified using the electronic health record and exposures were determined using post-deployment health assessments. Demographic-adjusted multivariable logistic regression models were used to compute odds ratios (ORs). Results: The final regression model comprised five exposure and 12 demographic variables. Reported exposures were not strongly associated with incident PDMH conditions (OR ranged from 1.22 to 1.38) and were lower than some demographic factors. Demographic characteristics with relatively large effect sizes (ORs less than 0.5 or greater than 1.5) included the protective factors of Air Force Guardsman (OR: 0.45), reservists (OR: 0.34), and surgeons (OR: 0.32), as well as the risk factor of nurses (OR: 1.51). All model parameters had a p-value less than 0.0001 and the area under the receiver operating characteristic curve was 0.668. Conclusions: Given the low area under the receiver operating characteristic, the final statistical model had only marginal performance in its ability to correctly identify cases. Thus, other factors should be studied to identify additional predictors for PDMH conditions.

Risk Factors for Hearing Decrement Among U.S. Air Force Aviation-Related Personnel.

INTRODUCTION: The purpose of this study was to analyze historical hearing sensitivity data to determine factors associated with an occupationally significant change in hearing sensitivity in U.S. Air Force aviation-related personnel. METHODS: This study was a longitudinal, retrospective cohort analysis of audiogram records for Air Force aviation-related personnel on active duty during calendar year 2013 without a diagnosis of non-noise-related hearing loss. The outcomes of interest were raw change in hearing sensitivity from initial baseline to 2013 audiogram and initial occurrence of a significant threshold shift (STS) and non-H1 audiogram profile. Potential predictor variables included age and elapsed time in cohort for each audiogram, gender, and Air Force Specialty Code. Random forest analyses conducted on a learning sample were used to identify relevant predictor variables. Mixed effects models were fitted to a separate validation sample to make statistical inferences. RESULTS: The final dataset included 167,253 nonbaseline audiograms on 10,567 participants. Only the interaction between time since baseline audiogram and age was significantly associated with raw change in hearing sensitivity by STS metric. None of the potential predictors were associated with the likelihood for an STS. Time since baseline audiogram, age, and their interaction were significantly associated with the likelihood for a non-HI hearing profile. DISCUSSION: In this study population, age and elapsed time since baseline audiogram were modestly associated with decreased hearing sensitivity and increased likelihood for a non-H1 hearing profile. Aircraft type, as determined from Air Force Specialty Code, was not associated with changes in hearing sensitivity by STS metric.Greenwell BM, Tvaryanas AP, Maupin GM. Risk factors for hearing decrement among U.S. Air Force aviation-related personnel. Aerosp Med Hum Perform. 2018; 89(2):80-86.

Health- and Performance-Related Outcomes in Air Force Medical Service Personnel with a Post-Deployment Mental Health Condition.

Background: This study examined associations between incident post-deployment mental health (PDMH) conditions and health- and performance-related outcomes in the population of Air Force Medical Service personnel on active duty between 2003 and 2013 who had at least one deployment. Methods: Using a posttest-only with nonequivalent groups design, the study cohort was divided into two groups based on the occurrence of an incident PDMH condition, and the groups were then compared in terms of the following health- and performance-related outcomes: health care and pharmaceutical utilization, duty and mobility restrictions, and physical fitness assessment exemptions and composite fitness score. Archival data were extracted from existing databases and associations were assessed using both parametric and nonparametric approaches. Results: The cohort comprised 12,216 participants, from which subcohorts were drawn to assess specific outcome measures. Participants with an incident PDMH used health care at 1.8 times the rate and were 6.2 times more likely to be classified as a high utilizer of health care as compared with those without a PDMH condition (controls). They were 2.1-103.0 times more likely to be prescribed one of 22 therapeutic classes of medication and were 2.4 times more likely to have polypharmacy than controls. They were 2.5 times more likely to have a duty or mobility restriction, and the ratio of days spent with a restriction to days without a restriction was 1.8 times that of controls. Lastly, they were 2.4 times more likely to have a physical fitness assessment exemption, but there was no significant difference in the likelihood of a composite fitness score of <90 points. Conclusions: The presence of an incident PDMH condition was associated with increased health care and pharmaceutical utilization and decreased occupational performance as assessed in terms of restricted duty status and participation in physical fitness assessments.

Modeling Predictors of Duties Not Including Flying Status.

INTRODUCTION: The purpose of this study was to reuse available datasets to conduct an analysis of potential predictors of U.S. Air Force aircrew nonavailability in terms of being in "duties not to include flying" (DNIF) status. METHODS: This study was a retrospective cohort analysis of U.S. Air Force aircrew on active duty during the period from 2003-2012. Predictor variables included age, Air Force Specialty Code (AFSC), clinic location, diagnosis, gender, pay grade, and service component. The response variable was DNIF duration. Nonparametric methods were used for the exploratory analysis and parametric methods were used for model building and statistical inference. RESULTS: Out of a set of 783 potential predictor variables, 339 variables were identified from the nonparametric exploratory analysis for inclusion in the parametric analysis. Of these, 54 variables had significant associations with DNIF duration in the final model fitted to the validation data set. The predicted results of this model for DNIF duration had a correlation of 0.45 with the actual number of DNIF days. Predictor variables included age, 6 AFSCs, 7 clinic locations, and 40 primary diagnosis categories. DISCUSSION: Specific demographic (i.e., age), occupational (i.e., AFSC), and health (i.e., clinic location and primary diagnosis category) DNIF drivers were identified. Subsequent research should focus on the application of primary, secondary, and tertiary prevention measures to ameliorate the potential impact of these DNIF drivers where possible.Tvaryanas AP, Griffith C Jr. Modeling predictors of duties not including flying status. Aerosp Med Hum Perform. 2018; 89(1):52-57.

Statins and Musculoskeletal Conditions in U.S. Air Force Active Duty Service Members.

BACKGROUND: This study examined the association of statin use and musculoskeletal conditions in statin users and nonusers within the population of U.S. Air Force active duty Service members in the military health care system. METHODS: The study was a retrospective cohort analysis of Service members between 2004 and 2014 as identified from personnel data having physical fitness and cardiac risk data available and who were free of musculoskeletal diagnoses for 6 months before the study period. Based on pharmacy data, participants were divided into two groups: statin users (received a statin for at least 90 days) and nonusers (never received a statin throughout the study period). Using participants' baseline characteristics, a propensity score was generated and used to match statin users to nonusers in a 1:3 ratio. Conditional logistic regression was used to determine the odds ratio (OR) for a musculoskeletal injury. FINDINGS: A total of 123,138 participants met study criteria (592 statin users and 122,546 nonusers). Of these, 516 statin users were propensity score matched to 1,548 nonusers. Among matched pairs, statin users had a higher OR (OR: 1.369; 95% confidence interval [CI]: 1.166-1.606) for musculoskeletal conditions. This association was driven by a higher frequency of back problems in statin users relative to nonusers. The number needed to be exposed for one additional person to be harmed was 20.104 (95% CI: 10.326-232.711). DISCUSSION: Statin use was associated with an increased likelihood of musculoskeletal conditions in the population of U.S. Air Force active duty Service members. Further investigations should evaluate the contribution of duty-related physical requirements as well as the duration of musculoskeletal condition-associated duty limitations.

Statin Therapy in Low-Risk Air Force Aviators with Isolated Hypercholesterolemia.

INTRODUCTION: This study evaluated the use of statin therapy in U.S. Air Force (USAF) aviators with isolated hypercholesterolemia in terms of compliance with clinical practice guidelines (CPGs) and effectiveness in reducing low-density lipoprotein cholesterol (LDL-C) and coronary heart disease (CHD) risk. METHODS: This was a mixed design, 8-yr retrospective study that included 8185 participants with isolated hypercholesterolemia, of which 1458 (17.81%) were prescribed statin monotherapy. RESULTS: Overall agreement between CPG recommendations and patient-clinician decision makers was 0.920 (95% confidence interval: 0.955, 0.959) and 0.891 (95% confidence interval: 0.843, 0.851) per 2002 and 2013 CPGs, respectively. Overall agreement was primarily driven by the negative proportion of specific agreement; positive agreement was moderate for the 2002 CPG and poor for the 2013 CPG. LDL-C levels marginally decreased for all participants except non-CPG-recommended statin users per the 2002 CPG. CHD risk was minimally reduced for all participants per the 2002 CPG with the exception of CPG-recommended statin users, for whom risk increased; CHD risk decreased for CPG-recommended statin users, but increased for non-CPG-recommended statin users per the 2013 CPG. No one statin medication was found to be more clinically effective in reducing LDL-C or CHD risk, regardless of dose intensity. CONCLUSIONS: Aerospace medicine practitioners are following CPG recommendations for statin therapy. Statins provided minimal benefit, however, and CPG recommendations proved irrelevant in reducing LDL-C and CHD risk in this population of Air Force aviators. This result is attributable, in part, to the young age of the study cohort and the short follow-up period.Tvaryanas AP, Mahaney HJ, Schroeder VM, Maupin GM. Statin therapy in low-risk air force aviators with isolated hypercholesterolemia. Aerosp Med Hum Perform. 2017; 88(8):752-759.

Risk Factors for Incident Postdeployment Mental Health Conditions Among U.S. Air Force Medical Service Personnel.

The prevalence of postdeployment mental health (PDMH) conditions in military health care personnel appears to be on par with that of other military personnel. However, there is no comprehensive analysis of incident PDMH conditions within the overall population of U.S. Air Force Medical Service personnel. This study explored the epidemiology of incident PDMH conditions among Air Force Medical Service personnel returning from deployment. A cohort survival analysis was conducted of 24,409 subjects without preexisting mental health conditions and at least one deployment during 2003-2013. Electronic health record data were used to ascertain the diagnosis of a PDMH condition. The primary outcome measure was an incident PDMH condition defined as a mental health diagnosis on at least two separate clinical encounters. The incidence of PDMH conditions was 59.74 per 1,000 person-years. Adjustment, anxiety, mood, sleep, and post-traumatic stress disorders accounted for 78% diagnoses. Protective factors included officer, surgeon, specific enlisted career fields, Air National Guard or Air Force Reserve, and multiple deployments. Risk factors included nurse, other specific enlisted career fields, female, and unmarried with dependents. Most subjects (73%) were diagnosed within the standard 30-month surveillance time period; median time to diagnosis was 13 months.

A 10-Year Cross-Sectional Analysis of Air Force Flight and Operational Medicine Clinic Health Care Services.

OBJECTIVES: This study described the patient population and the health care services delivered in the Air Force Flight and Operational Medicine Clinics (FOMCs) over the past 10 years. METHODS: A cross-sectional analysis was performed on the retrospective cohort of patients who received care at a FOMC from 2003 to 2012. RESULTS: A total of 714,157 individuals, generating 4,829,626 encounters, were included in the cohort. They were predominately male service members under the age of 41. One-fifth of individuals were retirees and family members, with one-third being in the pediatric age range. The cohort accessed health care services for three primary reasons: health examinations (28%), occupational dispositions (18%), and primary care (54%). When primary care was sought, the predominate health conditions were upper respiratory infections, back problems, and nontraumatic joint disorders. When services and procedures were a component of the care, they were predominately associated with health examinations involving ophthalmologic, auditory, and cardiac screening tests. Individuals accessing the FOMCs had relatively low need for access to health care services, requiring a median of two annual encounters. CONCLUSIONS: This study provided insight into the health care delivered in FOMCs and establishes a foundation for future planning and management of FOMC health care delivery.

Assessment of Deployment-Related Exposures on Risk of Incident Mental Health Diagnoses Among Air Force Critical Care Providers: Nested Case-Control Study.

OBJECTIVES: The purpose of this study was to determine the association between deployment-related occupational/environmental exposures and incident postdeployment mental health (PDMH) conditions in a defined population of military health care professionals working in the deployed critical care environment. METHODS: A nested case-control study compared cohort members with a PDMH condition (cases, N = 146) with those without a PDMH condition (controls, N = 800) in terms of deployment-related exposures as ascertained using Postdeployment Health Assessment DD 2796 questionnaire data. Multivariable logistic regression models were used to compute odds ratios. RESULTS: Nonphysician career fields (i.e., nurses and medical technicians), exposure to dead bodies or people killed/wounded, history of a vehicular accident/crash, exposure to sand/dust, exposure to lasers, and use of mission-oriented protective posture (MOPP) overgarments were associated with increased likelihood for a PDMH condition. The infrequent exposures (i.e., vehicular accident/crash, lasers, and MOPP overgarments) were the exposures most strongly associated with subsequent PDHM conditions. CONCLUSIONS: For military health care providers returning from the deployed environment, several exposures are useful for predicting those at increased risk for a PDMH condition. However, there are likely many other important risk factors beyond those captured on the DD 2796 questionnaire.

A Randomized Controlled Trial of Core Strengthening Exercises in Helicopter Crewmembers with Low Back Pain.

BACKGROUND: The purpose of this study was to determine if five core strengthening exercises would decrease pain severity and related disability in U.S. Air Force helicopter aircrew members with low back pain. METHODS: The study was a randomized control group repeated measures design. The experimental manipulation consisted of a set of five core strengthening exercises performed 4 d/wk for 12 wk. Self-reported pain severity and disability were ascertained at baseline and 12 wk using the Numerical Pain Rating Scale (NPRS) and Modified Oswestry Low Back Pain Disability Index (MODI), respectively. The NPRS was used to ascertain both daily pain (NPRS(daily)) and in-flight pain (NPRS(flight)). Self-reported improvement or deterioration in low back pain was measured using the Global Rating of Change Scale (GRCS). RESULTS: There were 12 subjects enrolled and 5 were randomized to the intervention group. The mean NPRS(flight) score decreased 1.8 points vs. increasing 0.1 points during the trial for the intervention and control groups, respectively. The mean MODI score decreased 4.8 points vs. increasing 1.7 points during the trial for the intervention and control groups, respectively. The mean GRCS score at the end of the trial was 4.0 vs. 0 for the intervention and control groups, respectively. There was no difference between groups in terms of mean NPRS(daily) scores. CONCLUSIONS: Core strengthening exercises were effective in reducing in-flight pain and led to a reduction in pain symptoms and disability over the 12-wk study period as compared to those subjects who maintained their regular exercise regimen.

Risk of incident mental health conditions among critical care air transport team members.

BACKGROUND: This study investigated whether Critical Care Air Transport Team (CCATT) members are at increased risk for incident post-deployment mental health conditions. METHODS: We conducted a retrospective cohort study of 604 U.S. Air Force medical personnel without preexisting mental health conditions who had at least one deployment as a CCATT member during 2003-2012 as compared to a control group of 604 medical personnel, frequency matched based on job role, with at least one deployment during the same period, but without CCATT experience. Electronic health record data were used to ascertain the diagnosis of a mental health condition. RESULTS: The incidence of post-deployment mental health conditions was 2.1 per 1000 mo for the CCATT group versus 2.2 per 1000 mo for the control group. The six most frequent diagnoses were the same in both groups: adjustment reaction not including posttraumatic stress disorder (PTSD), anxiety, major depressive disorder, specific disorders of sleep of nonorganic origin, PTSD, and depressive disorder not elsewhere classified. Women were at marginally increased risk and nurses and technicians were at twice the risk of physicians. The distribution of the time interval from end of the most recent deployment to diagnosis of incident mental health condition was positively skewed with a median greater than 6 mo. CONCLUSIONS: CCATT members were at no increased risk for incident post-deployment mental health conditions as compared to non-CCATT medical service members. Nearly two-thirds of incident post-deployment mental health conditions were diagnosed outside the standard 6-mo medical surveillance period, a finding warranting further study.

Accommodating adolescent sleep-wake patterns: the effects of shifting the timing of sleep on training effectiveness.

STUDY OBJECTIVE: This study evaluated the effect of accommodating adolescent sleep-wake patterns by altering the timing of the major sleep period of US Army recruits. DESIGN: The quasi-experimental study compared recruits assigned to one of two training companies: one with a customary sleep regimen (20:30 to 04:30) while the other employed a phase-delayed sleep regimen (23:00 to 07:00), the latter aligning better with biologically driven sleep-wake patterns of adolescents. SETTING: The study was conducted during Basic Combat Training (BCT) at Fort Leonard Wood, Missouri. TRAINEES: The study included 392 trainees: 209 received the intervention, while 183 composed the Comparison group. MEASUREMENTS AND RESULTS: Demographic and psychophysiological measures were collected on all trainees. Weekly assessments of subjective fatigue and mood, periodic physical fitness, marksmanship scores, and attrition rates from BCT were studied. Actigraphy was collected on approximately 24% of trainees. Based on actigraphy, trainees on the phase-delayed sleep schedule obtained 31 m more sleep/night than trainees on the customary sleep schedule. The Intervention group reported less total mood disturbance relative to baseline. Improvements in marksmanship correlated positively with average nightly sleep during the preceding week when basic marksmanship skills were taught. No differences were seen in physical fitness or attrition rates. In contrast to the Intervention group, the Comparison group was 2.3 times more likely to experience occupationally significant fatigue and 5.5 times more likely to report poor sleep quality. CONCLUSIONS: Accommodating adolescent sleep patterns significantly improves mental health and performance in the training environment.

Fatigue in pilots of remotely piloted aircraft before and after shift work adjustment.

BACKGROUND: Remotely piloted aircraft (RPA) with long endurance allow near-continuous operations, necessitating the implementation of shift work for crewmembers to provide the necessary manning of ground control stations. Shift work has a well-known association with fatigue, degraded work performance, and an increased risk for errors and accidents. This study presents the results of a follow-up survey of a particular population of shift-working RPA crewmembers 1 yr after modification of their shift work schedule. METHODS: A cross-sectional survey of 66 RPA crewmembers was conducted using a collection of validated fatigue scales. This data was compared to survey data collected a year prior from the same population and from a reference group of non-shift-working aircrew. Shift system features and individual and situational differences associated with fatigue were explored. Additionally, several alternative types of shift schedules were assessed through modeling and simulation. RESULTS: The study found no significant reduction in reported fatigue despite prior modifications to the shift work schedule to increase opportunities for recovery. Months shift working, sleep quality, and disturbances in family and social activities were associated with overall fatigue scores. Approximately half of those surveyed met criteria for occupationally significant fatigue. Months shift working, use of on-duty napping, and fatigue scores were predictive of those with occupationally significant fatigue. Modeling of feasible variants of the current shift work schedule failed to reveal a significantly improved alternative schedule. CONCLUSIONS: Collectively, the results demonstrate a persistent problem with chronic fatigue in this study population, likely reflective of continued inadequate opportunities for recovery and restorative sleep.