Grounding of Pilots: Medical Reasons and Recommendations for Prevention

BACKGROUND: This article presents the results of an EASA-commissioned study aimed at analyzing the medical causes of grounding of a broad European pilot population and recommending measures to reduce the risk of in-flight incapacitation in commercial air transport pilots.METHOD: European National Aviation Authorities (NAAs) were requested to provide data concerning the total number of pilots that were examined, their age and license category, number of unfit pilots, and the medical causes of each case of grounding. Diagnoses were classified according to the format and definitions laid down in Commission Regulation (EU) No. 1178/2011 Part Med.RESULTS: Analyzed were 82,435 cases assessed by 6 NAAs. Of these cases, 2.1% were assessed as unfit to fly. Frequent causes for grounding a pilot were cardiovascular (19%), psychiatric (11%), neurological (10%), and psychological (9%). Cardiovascular conditions were the most frequent cause for grounding in the older age groups, with 21% in the age 51–60 cohort, 28% in the age 61–65 cohort, and 48% in those beyond 65 yr. Psychiatric and psychological diagnoses were most frequent in the age 20–40 cohort.DISCUSSION: Cardiovascular conditions were the most frequent cause for grounding. Cardiovascular diseases (CVD) are associated with modifiable risk factors. Tackling these risk factors gives aeromedical examiners the opportunity to improve the health of pilots and reduce CVD-related flight safety risks by reducing the number of pilots at risk of in-flight incapacitation. The mandatory periodical medical examination of pilots provides an excellent framework for risk prevention and follow-up of preventive measures.Simons R, Maire R, Van Drongelen A, Valk P. Grounding of pilots: medical reasons and recommendations for prevention. Aerosp Med Hum Perform. 2021; 92(12):950–955.

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Enhancing the Awareness of Modifiable Risk Factors for Cancer Prevention in the Alabama Black Belt Region: A Follow-up Study

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2021.0178 ◽

2021 ◽

Vol 32 (4) ◽

pp. 1995-2011

Author(s):

Joel Tumwebaze ◽

Vivian L. Carter ◽

Norma L. Dawkins

Keyword(s):

Risk Factors ◽

Cancer Prevention ◽

Black Belt ◽

Modifiable Risk Factors ◽

Follow Up Study ◽

Black Belt Region

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Modifiable Risk Factors for Alzheimer Disease and Subjective Memory Impairment across Age Groups

PLoS ONE ◽

10.1371/journal.pone.0098630 ◽

2014 ◽

Vol 9 (6) ◽

pp. e98630 ◽

Cited By ~ 35

Author(s):

Stephen T. Chen ◽

Prabha Siddarth ◽

Linda M. Ercoli ◽

David A. Merrill ◽

Fernando Torres-Gil ◽

...

Keyword(s):

Risk Factors ◽

Alzheimer Disease ◽

Memory Impairment ◽

Age Groups ◽

Modifiable Risk Factors ◽

Subjective Memory ◽

Subjective Memory Impairment

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Modifiable risk factors predicting major depressive disorder at four year follow-up: a decision tree approach

BMC Psychiatry ◽

10.1186/1471-244x-9-75 ◽

2009 ◽

Vol 9 (1) ◽

Cited By ~ 23

Author(s):

Philip J Batterham ◽

Helen Christensen ◽

Andrew J Mackinnon

Keyword(s):

Risk Factors ◽

Major Depressive Disorder ◽

Decision Tree ◽

Depressive Disorder ◽

Modifiable Risk Factors ◽

Major Depressive ◽

Tree Approach

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Risk Factors for Thrombosis Vary According to Age in Patients with Essential Thrombocythemia: a Retrospective Analysis of 1090 Patients from the “Gruppo Laziale SMPC Ph Negative “,

Blood ◽

10.1182/blood.v118.21.3854.3854 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3854-3854

Author(s):

Marco Montanaro ◽

Roberto Latagliata ◽

Michele Cedrone ◽

Nicoletta Villivà ◽

Raffaele Porrini ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Thrombotic Event ◽

Age Groups ◽

Thrombotic Risk ◽

Mutational Status ◽

Group A ◽

Group B

Abstract Abstract 3854 Increasing age is a well-recognised risk factor for thrombotic events in patients with Essential Thrombocythemia (ET): however, few data exist on the role of other clinical and biological features in different age groups. To address this issue, we analysed retrospectively 1090 ET patients (M/F 403/687, median age 63 years, IR 17 – 96) diagnosed at 11 Hematological Institutions in the Lazio region from 1980 to 2010 and with a median period of follow-up of 84 months (IR 1 – 371). Based on the commonly adopted age threshold, 480 patients (44 %) were < 60 years (Group A) and 610 (56 %) were ≥ 60 years (Group B). Clinical and biological features as well as cardiovascular risk factors analyzed for the impact on the thrombotic risk in the two age groups are reported in the Table.Group A < 60 yearsGroup B ≥ 60 yearsPutative risk factorsRisk ratio (95% CI)P valueRisk ratio (95% CI)P valueM/F167/3132.68 (1.03–6.94)0.0029236/3741.12 (0.17–2.59)0.73WBC median (range) x 109/l8.9 (4.29–22.35)0.387 (0.149–1,004)0.06458.9 (1.2–57.7)0.79 (0.41–1.47)0.445PLTS median (range) x 109/l837 (451–3582)0.37 (0.258–1.70)0.66802 (450–3104)0.52 (0.28–0.99)0.0052Hb median, g/dL (range)14.1 (6.0–18.4)0.86 (0.33–2.24)0.76914.0 (7.0–17.8)0.87 (0.45–1.67)0.674*JAK-2 mutational status: wild type/mutated (%)53.2/46.81.57 (0.50–4.87)0.4434.1/65.90.498 (0.17–1.48)0.209Previous thrombotic events: n° (%)· All events72 (15)2.18 (0.59–7.96)0.12149 (24.4)3.01 (1.38–6.57)0.0004· within 24 months from diagnosis48 (10)1.43 (0.19–10.4)0.7464 (10.5)0.506 (0.18–1.39)0.189· within 60 months from diagnosis60 (12.5)NA0.5191 (14.9)0.323 (0.11–0.95)0.023Cardiovascular risk factors: Y/N %○ Arterial hypertension41.7/58.31.68(0.64–4.36)0.2880.7/19.30.96 (0.36–2.57)0.935○ Diabetes10.2/89.81.11 (0.23–5.15)0.8925.0/75.01.09 (0.38–3.11)0.86○ Smoking attitude45.6/54.42.78 (1.01–7.65)0.06758.3/41.71.04 (0.35–3.09)0.94○ Hyperlipidemia31.0/69.03.11(0.917–10.592)0.03951.6/48.42.31 (0.70–7.55)0.203 In Group A, 39 patients (8.1%) had at least one thrombotic event during follow-up; there were 20 (51.3%) arterial thrombosis and 19 (48.7%) venous thrombosis. In Group B, 63 patients (10.3%) had at least one thrombotic event during follow-up; there were 38 (69.4%) arterial thromboses and 25 (39.6%) venous thromboses. In group A univariate analysis for thrombosis-free survival performed by Kaplan-Meier method, disclosed a significant impact of male gender (p=0.0029, CI 1.03–6.94, HR 2.68), > 2 cardiovascular risk factors (p=0.0002, CI 1.87 – 190, HR 18.94) and isolated hyperlipidemia (p=0.039, CI 0.917 – 10.59, HR 3.11), while previous thrombotic events had no significant impact (p=0.27). By contrast, the presence of a previous thrombotic event was the only feature with a significant impact on thrombotic risk in Group B (p=0.0004, CI 1.38 – 6.55, HR 3.01). WBC and PLTS values at different cut-off levels as well as JAK-2 mutational status did not have any impact on thrombosis in either age groups. However, in group B, we observed a trend (p=0.052, CI 0.28–0.99, HR 0.52) towards a protective effect of higher PLTS values (> 800 × 109/l). In conclusion, our data seem to reinforce the need of a different thrombotic risk assessment in distinct age groups: in particular, younger patients could benefit from early recognition and treatment of well-known cardiovascular risk factors. Disclosures: No relevant conflicts of interest to declare.

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Behaver and risk factors for health of operators employed in oil production and preparation enterprises

Medical Herald of the South of Russia ◽

10.21886/2219-8075-2020-11-4-107-112 ◽

2020 ◽

Vol 11 (4) ◽

pp. 107-112

Author(s):

N. I. Latyshevskaya ◽

V. V. Mirochnik ◽

L. A. Davydenko

Keyword(s):

Risk Factors ◽

Motor Activity ◽

Older Workers ◽

Preventive Measures ◽

Age Groups ◽

Oil Refining ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Medical Activity ◽

Two Age Groups

Objective: to evaluate the behavioral risk factors of the workers of the primary oil refining workshop with the aim of using them as a tool for substantiating management decisions and forming vectors of preventive measures.Materials and methods: the method of active survey investigated the prevalence of behavioral risk factors among operators in two age groups (20 – 35 and 36 – 60 years old).Results: the main vectors of behavioral risks for operators of different age groups were established: lack of motor activity, smoking, low medical activity, low perception of behavioral risks. Violations of lifestyle are predominantly combined (violations by 2 – 4 indicators). For older operators are more characterized by low motor and medical activity, disturbances in diet, an overestimation of the degree of influence of environmental and occupational factors on health when the significance of individual behavior is underestimated.Conclusions: Social policy at the enterprise should take into account the main vectors of behavioral risks, lower motivation and the implementation of a healthy style of behavior typical of older workers.

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Effect of a lifestyle-focused electronic patient support application on risk factor management in post-myocardial infarction patients – a randomized controlled trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2978 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Ogmundsdottir Michelsen ◽

I Sjolin ◽

M Back ◽

M Gonzalez ◽

A Olsson ◽

...

Keyword(s):

Risk Factors ◽

Exercise Capacity ◽

Mobile Device ◽

Controlled Trial ◽

Modifiable Risk Factors ◽

Funding Source ◽

Lifestyle Advice ◽

Device Application ◽

Randomized Controlled

Abstract Background Cardiac rehabilitation (CR) is central in reducing morbidity and mortality after myocardial infarction (MI). However, the fulfillment of guideline recommended CR targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. Purpose The aim of this study was to assess the efficacy of a mobile device application to support adherence to lifestyle advice and self-control of risk factors as a complement to traditional CR after MI. Method This unblinded multi-centre randomized controlled trial included 150 patients with MI (81% men, 60.4±8.8 years). All patients in the intervention (INT) and control (CON) groups participated in a 1-year CR program. Additionally, INT patients (n=101) received access to the mobile device application for 25 weeks post-MI where information about lifestyle (i.e., diet, physical activity, smoking), modifiable risk factors (i.e., weight, blood pressure (BP)), and symptoms could be registered. The software provided direct positive feedback and lifestyle advice. Data was reviewed twice weekly by the CR nurse. The primary outcome was change in sub-maximal exercise capacity (W) between an exercise test 2-weeks post MI and at follow-up 4 month later. Secondary outcomes included changes in lifestyle and modifiable risk factors including body mass index, waist circumference, blood-lipids, fasting glucose and HbA1c, between baseline and 2-week, 2-month and 1-year follow-up visits. Regression analysis was used, adjusting for relevant baseline variables. Results Participation in CR was high, with 96% of INT patients and 98% of the CON patients attending the 1-year follow-up visit. Forty-six percent of the INT patients and 57% of the CON patients attended centre-based exercise training (p=0.1). In the INT group 86% logged data in the application at least once. Adherence, defined as logging data at least twice per week, was 92% in week 1 and 57% in week 25. There was a numerical trend toward better exercise capacity improvement in the INT group (INT +14.4±19.0 vs. CON +10.3±16.1 W, p=0.2) although differences were non-significant. INT patients achieved larger BP reduction at 2-weeks (systolic) and 2-months (systolic and diastolic) (Figure). At 2-months 70% vs. 46% of smokers in the INT vs CON groups had quit smoking, and at 1-year the respective percentages were 57% vs. 36%. The number of smokers in the study was however low (n=33) and the differences non-significant. For other secondary endpoints no differences were observed. Conclusion Complementing CR with a mobile device application improved BP during the first months after MI, and non-significant trends towards better exercise capacity and higher smoking cessation rates were observed. Even though the differences were non-significant in our small study sample, they indicate that using eHealth in the form of a mobile device application could clinically benefit post-MI patients participating in CR. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Governmental funding of clinical research within the National Health Services in Sweden.

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Complications of Percutaneous Renal Biopsy

Seminars in Interventional Radiology ◽

10.1055/s-0039-1688422 ◽

2019 ◽

Vol 36 (02) ◽

pp. 097-103

Author(s):

Kenaz Bakdash ◽

Kristofer M. Schramm ◽

Aparna Annam ◽

Matthew Brown ◽

Kimi Kondo ◽

...

Keyword(s):

Risk Factors ◽

Renal Biopsy ◽

Bleeding Complications ◽

Modifiable Risk Factors ◽

Delayed Presentation ◽

Histologic Diagnosis ◽

Poor Renal Function ◽

Percutaneous Renal Biopsy ◽

Risk Patients

AbstractPercutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.

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Prevalence and Risk Factors of Hypothalamic-Pituitary Dysfunction in Infant and Toddler Childhood Brain Tumor Survivors

Acta Endocrinologica ◽

10.1530/eje-21-0137 ◽

2021 ◽

Author(s):

C A Lebbink ◽

T.p Ringers ◽

A.y.n. Schouten-van Meeteren ◽

L van Iersel ◽

S.c Clement ◽

...

Keyword(s):

Risk Factors ◽

Brain Tumor ◽

Age Groups ◽

Tumor Location ◽

Childhood Brain Tumor ◽

Older Children ◽

Treatment Protocols ◽

Pituitary Dysfunction ◽

Frequent Use

Objective Childhood brain tumor survivors (CBTS) are at risk to develop hypothalamic-pituitary (HP) dysfunction (HPD). The risk for HPD may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. Specific studies on HPD in infant brain tumor survivors (infant-BTS, 0-1 years at diagnosis) or toddler brain tumor survivors (toddler-BTS, ≥1-3 years) have not been performed. Patients and Methods A retrospective nationwide cohort study in CBTS was performed. Prevalence and risk factors for HPD were compared between infant-, toddler- and older-BTS. Subgroup analysis was performed for all non-irradiated CBTS (n=460). Results In total 718 CBTS were included, with a median follow-up time of 7.9 years. Overall, despite less frequent use of radiotherapy (RT) in infants, no differences in prevalence of HPD were found between the three groups. RT (OR 16.44; 95%CI 8.93 to 30.27), suprasellar tumor location (OR 44.76; 95%CI 19.00 to 105.49) and younger age (OR 1.11; 95%CI 1.05 to 1.18) were associated with HP dysfunction. Infant-BTS and toddler-BTS showed more weight gain (p<0.0001) and smaller height SDS (p=0.001) during follow-up. In non-irradiated CBTS, infant-BTS and toddler-BTS were significantly more frequently diagnosed with TSH-, ACTH- and ADH deficiency, compared to older-BTS. Conclusion Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than older children. These results emphasize the importance of special infant- and toddler brain tumor treatment protocols and the need for endocrine surveillance in children treated for a brain tumor at young age.

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Prevalence, outcome and management of patients with SLE and secondary antiphospholipid antibody syndrome after aPL seroconversion

Rheumatology ◽

10.1093/rheumatology/keaa463 ◽

2020 ◽

Author(s):

Margherita Zen ◽

Marta Loredo Martinez ◽

Francesco Benvenuti ◽

Mariele Gatto ◽

Francesca Saccon ◽

...

Keyword(s):

Risk Factors ◽

Oral Anticoagulation ◽

Odds Ratio ◽

Lupus Anticoagulant ◽

Thrombotic Event ◽

Modifiable Risk Factors ◽

Antiphospholipid Antibody ◽

Antiphospholipid Antibody Syndrome ◽

Thrombotic Risk

Abstract Objective The withdrawal of oral anticoagulation (OAC) in patients with SLE and secondary aPL syndrome (SAPS) who become seronegative has not been clearly investigated to date. Our aim was to evaluate the prevalence of aPL seroconversion and the prognosis of SLE patients with SAPS who withdrew OAC after aPL negativization. Methods We retrospectively analysed data of all SLE patients (ACR criteria) with SAPS (Sydney criteria) prospectively followed-up in our clinic. aPL seroconversion was defined as negativization of lupus anticoagulant, aCL, and anti-β2glycoprotein-1 antibodies on two or more consecutive measurements, at least 12 weeks apart. OAC discontinuation was defined as the definitive withdrawal of all anticoagulants. Results Fifty-five out of 513 (10.7%) SLE patients had vascular SAPS. Sixteen patients (29.1%) became aPL seronegative during follow-up. Immunosuppressive therapy predicted aPL negativization (odds ratio 5.211, 95%CI 1.341, 20.243), whereas APS diagnosis prior to that of SLE (odds ratio 0.078, 95%CI 0.008, 0.799) and triple-positive profile (odds ratio 0.264, 95%CI 0.115, 0.609) were negative predictors of aPL negativization. OAC was discontinued in 13/55 patients (23.6%), after a median follow-up of 45 months (range 1–276) from aPL seroconversion. SLE-related modifiable risk factors for thrombosis were observed in 10/13 patients (77%) at the time of the thrombotic event. No thrombotic recurrences were observed during a mean follow-up time of 44 (19) months from OAC discontinuation. Conclusions Our results suggest that OAC can be safely discontinued in SLE patients who became persistently seronegative for aPL, at least when aPL-related thrombotic events occurred in presence of other thrombotic risk factors.

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