Survey on eye comfort in aircraft: II. Use of ophthalmic solutions

Flight attendants frequently use ophthalmic solutions (eye-drops) to relieve their eye discomfort while working in the aircraft. The purpose of this paper is to present some insight concerning the use of ophthalmic solutions by flight attendants. This paper follows Part I, a survey that evaluated some of the environmental conditions in the aircraft that influenced eye comfort. A questionnaire was developed in conjunction with the Air Safety Department of the Association of Flight Attendants. The common eye problem characterized by conjunctival redness and eye irritation occurred with 95% of the 774 respondents. Furthermore, 60% of these respondents indicated that they have used eyedrops while in flight. The majority of the respondents were using an ocular decongestant; however, this author suggests that the use of artificial tears would be more effective in relieving eye discomfort in the aircraft.     

空中乘务员角膜接触镜使用情况与眼部不适症关系研究

目的：探讨空中乘务员角膜接触镜使用情况与眼部不适症的关系。方法抽取某航空公司空中乘务员912人,采用统一的问卷调查角膜接触镜使用情况及眼部健康情况,并对引起眼部不适症的危险因素进行分析。结果空中乘务员角膜接触镜佩戴率为28.29％,佩戴者与非佩戴者在11种眼部不适症上的差异均有统计学意义（ P＜0.05）;多因素logistic 回归分析结果表明,验配地点、戴镜化妆、戴镜洗脸洗澡、每日戴镜时间过长、角膜接触镜到期继续使用、戴镜过夜、定期搓洗角膜接触镜、及时更换护理液、佩戴和摘取前洗手等9个因素与眼部不适症相关性显著（ P＜0.05）,相对危险度分别为1.277、1.259、1.264、1.186、1.235、1.458、0.641、0.716、0.627。结论空中乘务员角膜接触镜佩戴率较高,不良的佩戴行为易引起眼部不适,应加强科学配戴方法宣教,促进其安全、正确使用。     

Disorienting effects of aircraft catapult launchings. II. Visual and postural contributions.

Gx accelerations approximating those encountered in aircraft catapult launchings were generated on the human centrifuge Dynamic Flight Simulator at the Naval Air Development Center. Each of four catapult-experienced Naval aviators continuously oriented himself to the gravitational vertical both before and after exposure to the accelerations under two conditions: a) while he sat in total darkness, and b) while he viewed a small target projected at eye level in his mid-sagittal plane. The accelerations produce changes of pitch orientation that were affected by the presence or absence of the target, and the changes of orientation persisted well after the accelerations were terminated. Visual and postural illusions and their contributions to the disorientation are discussed, and the disorientation is related to certain water-collision accidents that have been reported to occur following aircraft catapult launchings at night.     

Contact lenses and corrective flying spectacles in military aircrew--implications for flight safety

BACKGROUND: Refractive devices used by aviators need to suit the aerospace environment or their failure can have serious implications. A relatively minor visual disability can result in loss of life and aircraft. We surveyed commonly occurring problems with the different types of refractive correction worn by Royal Air Force (RAF) aircrew over the previous 12 mo. We also asked if they had experienced any flight safety incidents (FSI) relating to their refractive correction. METHODS: A retrospective anonymous questionnaire survey was given to 700 active aircrew occupationally graded as requiring corrective flying spectacles (CFS) or contact lenses (CL) for flying. RESULTS: 63% (443) of the questionnaires were completed. CL were worn by 53% of aircrew; 71% of them used daily disposable CL. CFS were worn by the remaining 47% of aircrew, 14% of whom used multifocal lenses. Of CFS wearers, 83% reported problems including misting, moving, discomfort, and conflict with helmet-mounted devices (HMD). CL-related ocular symptoms were reported in 67% of wearers including cloudy vision, dry eye, photophobia, red eyes, excessive mucus formation, CL movement, itching, and grittiness. No CL-related FSI were reported over the previous 12 mo compared with 5% CFS-related FSI (p < 0.001). The graded performance of CL for vision, comfort, handling, convenience, and overall satisfaction was significantly higher than for CFS. CONCLUSION: CFS are associated with problems in terms of comfort and safety. CL are well tolerated by aircrew, and deliver improved visual performance.     

Pregnancy outcomes among female flight attendants

Flight attendants have been reported to be at increased risk for menstrual abnormalities and for spontaneous fetal loss. This study examined Washington State birth certificates for associations between adverse pregnancy outcomes and maternal employment as a flight attendant. Current pregnancy outcomes (low birthweight, prematurity, low Apgar scores, and abnormal sex ratio) were not significantly related to occupation. Flight attendants reported their preceding pregnancy resulted in a spontaneous fetal loss nearly twice as often as other women (relative risk = 1.9, 95% confidence interval = 1.3-2.7). However, when comparison was restricted to other employed women, the risk was lower (RR = 1.3, 95% CI = 0.9-1.9). A clinically significant pregnancy risk among flight attendants cannot be excluded on the basis of this study, but the apparent excess risk of spontaneous fetal loss in this and particularly in a previous study could be explained at least in part by methodologic limitations.     

Review of studies on flight attendant health and comfort in airliner cabins

BACKGROUND: A number of studies have examined the effect of the airliner cabin environment and other factors on the health and comfort of flight attendants (FAs), but no comprehensive review of such studies is available. METHODS: This paper reviews studies conducted after 1980 that addressed FA short-term health and comfort effects. Relevant literature was identified using the National Institute of Health's PUBMED database. RESULTS: Twenty-one studies were identified and classified into two types: in-flight surveys and surveys of general flight experiences. Most studies used questionnaires to obtain perceptions of the cabin environment, comfort, and health-related symptoms, but some included objective measurements. Only a few studies used a random sample or control groups. Effects of confounding variables generally have not been analyzed. DISCUSSION: Most studies shared some weaknesses such as poor response rate, significant response bias, exclusive reliance on questionnaires, or limited analysis. Taken together, the studies indicate that various complaints and symptoms reported by FAs appear to be associated with their job duties and with the cabin environment. Most notable are "dryness" symptoms attributable to low humidity and "fatigue" symptoms associated with factors such as disruption of circadian rhythm. Practically all symptoms are exacerbated by longer flight durations. Studies citing problems of "poor aircraft cabin air quality" tend to be weak in design and have addressed only general flight experiences of FAs. Although certain FA complaints are consistent with possible exposure to air pollutants, the relationship has not been proven and such complaints also are consistent with causes other than poor air quality.     

Work-related musculoskeletal symptoms reported by female flight attendants on long-haul flights

INTRODUCTION: Flight attendants working on long-haul international commercial airline operations exposed to ergonomic stressors are likely to experience work-related musculoskeletal symptoms (WMS). To date, however, no studies investigating the extent of WMS experienced by this specific population have been published. The purpose of this study was to identify the prevalence and severity (frequency, duration, and intensity) of WMS experienced by female flight attendants working on long-haul international flights for one major airline. METHODS: A cross-sectional, mailed survey was conducted with female flight attendants randomly selected from a union membership list. Inclusion criteria were female flight attendants who had worked at least one long-haul international flight in the prior 3 mo and had worked at least 75 flight hours in the prior month. A total of 185 eligible flight attendants returned completed questionnaires (63% response rate). WMS in nine body regions were measured by the Nordic Musculoskeletal Questionnaire and the National Institute for Occupational Safety and Health Symptom Survey. RESULTS: The prevalence of WMS by body region ranged from 50% to 86%. Almost all (97%) of the flight attendants in this study experienced some level of WMS during the past year. The WMS tended to involve more than one body region, and the lower back was the most commonly affected body region. DISCUSSION: Female flight attendants working on long-haul international flights at one major airline showed a high prevalence of WMS, suggesting the need for replication studies with other airlines and the need for investigation into the risk factors associated with this substantial problem.     

Injury risk factors in parachuting and acceptability of the parachute ankle brace

INTRODUCTION: This investigation examined risk factors for injuries during military parachute training and solicited attitudes and opinions regarding a parachute ankle brace (PAB) that has been shown to protect against ankle injuries. METHODS: Male Army airborne students (N = 1677) completed a questionnaire after they had successfully executed 4 of the 5 jumps necessary for qualification as a military paratrooper. The questionnaire asked about injuries during parachute descents, demographics, lifestyle characteristics, physical characteristics, physical fitness, airborne recycling (i.e., repeating airborne training because of failure to qualify on a previous attempt), PAB wear, problems with aircraft exits, and injuries in the year before airborne school. A final section of the questionnaire solicited open-ended comments about the PAB. RESULTS: Increased risk of a parachute-related injury occurred among students who had longer time in service, were older, taller, heavier, performed fewer push-ups, ran slower, were airborne recycles, did not wear the PAB, had an aircraft exit problem, and/or reported an injury in the year prior to jump school. Among students who wore the brace, most negative comments about the PAB had to do with design, comfort, and difficulties during parachute landing falls. CONCLUSIONS: This study supported some previously identified injury risk factors (older age, greater body weight, and not using a PAB) and identified a number of new risk factors. To address PAB design and comfort issues, a strap is being added over the dorsum of the foot to better hold the PAB in place.     

Premilitary sexual assault and attrition in the U.S. Navy

A prospective study examined whether adult premilitary sexual victimization predicted women's military attrition. In a survey of female Navy recruits (N = 2,431), 56% reported some form of adult unwanted sexual contact before entering the military, with 25% reporting completed rape. Approximately one-third of respondents left the Navy before completing their 4-year term of service. When rape, attempted rape, and lower-level unwanted sexual contact were considered simultaneously, only rape predicted attrition. Women who reported premilitary rape, compared with those who did not, were 1.69 times more likely to leave the military. The pattern of results held across the 4-year period examined and after controlling for demographic predictors.     

Development of an advanced life support patient transfer training program

Bayne-Jones Army Community Hospital is relatively isolated from major military or civilian medical centers. Patients there who require a higher level of care are transferred to tertiary facilities. It is standard for nurses or physicians to accompany patients requiring Advanced Cardiac Life Support care during transfer to another facility. A 2-day course was developed to provide nurses and physicians with advanced training in caring for patients during transport. The purpose was to develop a pool of nurses and other health care providers who would be trained and experienced as medical attendants on ground ambulance, rotary-wing aircraft, and fixed-wing aircraft. Nurses were awarded 16.6 contact hours of continuing education, and the course has been submitted for continuing medical education units. On after-action reports, students indicated favorable results but needed more scenario and intubation training. The course is being offered quarterly, has been updated, and continues to be evaluated.     

Reproductive disorders and pregnancy outcomes among female flight attendants

BACKGROUND: Occupational exposures in female aircrew may cause adverse pregnancy outcomes and menstrual disturbances. We studied reproductive health among female flight attendants. METHODS: We conducted a cross-sectional health survey among an occupational cohort of current and former flight attendants using a postal questionnaire including items on pregnancy outcome, menstrual characteristics, and infertility. We investigated these factors by occupational status (in service or not). RESULTS: The questionnaire was sent to 3036 women with a response rate of 64% (74% for current and 48% for former flight attendants). Spontaneous abortion rates were similar for pregnancies of women in service and not (12.6 vs. 11.4%; p = 0.58). Induced abortion rates were lower for in-service pregnancies (7.9%) compared with pregnancies of women not in service (21.1%) (p < 0.001). Menstrual irregularities in the year preceding the survey for women under 40 yr were more frequent among current than former flight attendants (20.6% vs. 10.4%, p = 0.02). Fertility problems were reported by 20.6% of respondents. An association between infertility and irregular menstrual cycles was found: odds ratio 1.6; 95% confidence limits 1.1, 2.4. CONCLUSIONS: Active flight attendants had a lower rate of induced abortions than former flight attendants, but the spontaneous abortion rate was similar between the two groups. Active flight attendants reported more menstrual irregularities, which are a risk factor for infertility. Lack of comparison with working women in other occupations precludes a conclusion that flight attendants are at greater occupational risk of reproductive disorders. Future studies of reproductive health in flight attendants should address personal and work-related risk factors in more detail and include comparison occupational groups.     

Eye tracking,point of gaze,and performance degradation during disorientation

BACKGROUND: The cognitive cockpit concept has been proposed as a potential disorientation countermeasure. It involves monitoring the pilot's physiological, behavioral and subjective responses during disorientation. This data is combined to provide a real time model of pilot state, which is used as a basis for optimizing pilot performance. This study attempts to investigate whether there are consistent behavioral or physiological "markers" that can be monitored during a specific disorientation scenario. METHODS: An Integrated Physiological Trainer with interactive aircraft controls and an eye-tracking device was employed. Fourteen subjects proficient in maintaining straight-and-level flight and who have acquired the skills in changing attitude participated in the study. They were exposed to a flight profile consisting of straight-and-level flying and change in attitude without exposure to a head roll (control condition) and a profile with exposure to a head roll (experimental conditions) during constant yaw rotation. Flight performance parameters and subjects' eye movements and point of gaze behavior were monitored continuously. RESULTS: Immediately on the return to upright head position, all subjects reported a strong apparent pitch displacement that lasted < or = 20 s and a lesser sensation of lateral movement. Significant differences (p < 0.01) were noted on a number of scanning behaviors between the control and the experimental conditions. The appearance of nystagmus was apparent as indicated by the number of involuntary saccades during disorientation. Flight performance decrement in the experimental conditions was reflected by a significant deviation in maintaining airspeed (p < 0.01). CONCLUSION: It appears that the pitch illusion consistently affects visual scanning behavior and is responsible for the decrement in flight performance observed in the simulator.     

Civilian air ambulance services in Oregon

To describe and evaluate the status of air ambulance service in Oregon, questionnaires were mailed to Oregon's 18 air ambulance operators; 16 operators responded with data on aircraft type and configuration, medical supplies and equipment aboard the aircraft, and training of inflight attendants. Records of 128 of the 152 patients transported by these services during September, 1985, were reviewed to estimate the extent to which patients had been appropriately selected. Findings were: trauma patients being transported to large specialized medical centers comprised the single largest patient category; failure to obtain an aeromedical assessment of every patient preflight resulted in some inappropriate transports, with airlift definitely contraindicated in at least 2% of the cases; most agencies met advanced life support standards for equipment; inflight documentation was inadequate; numerous aircraft lacked pressurization and adequate doorway size; many attendants received insufficient aeromedical training; and existing state regulations went unenforced. Measures to guide services and to remedy existing deficiencies are recommended.     

The number of steps taken by flight attendants during international long-haul flights

BACKGROUND: Previous studies have revealed that female cabin attendants on long flights are most likely to have health problems. Since health problems can be related to workload and work stress and since the number of steps taken by an employee during a work shift can be an objective measure of the work load of cabin attendants, it is necessary to evaluate the predictors of the number of steps. METHODS: We used pedometers worn by 118 female flight attendants to study the number of steps during flights and its predictors during long international flights. RESULTS: The mean number of steps during 636.53 (SD = 129.11 )-minute flights was 10,742.85 (SD = 3,547.17). The crude number of steps per minute was 16.88, and the adjusted number of steps per minute was 14.04. Flight length and the number of sleeping hours worked (i.e., between midnight and 6:00 am) were significant predictors of the number of steps. CONCLUSION: Although it is implied that flight duration and night flight increase the work load of flight attendants, we need to consider psychological aspects to evaluate the overall effects of their jobs on work stress and health.     

G-induced loss of consciousness: retrospective survey results from 2259 military aircrew

INTRODUCTION: Prevalence of G-induced loss of consciousness (G-LOC) in the United Kingdom Royal Air Force (RAF) was found to be 19.3% in 1987. With the introduction of the Typhoon, a fourth generation aircraft, the prevalence of G-LOC has been re-assessed to determine the effectiveness of current G tolerance training. METHOD: A survey was sent to 4018 RAF aircrew, irrespective of their current role. Information was requested on G-LOC, role and aircraft type, experience, and attitudes toward G-LOC prevention. RESULTS: Responses were received from 2259 (56.2%) individuals, 882 (39%) of whom were current fast jet aircrew. At least one episode of G-LOC was reported by 20.1% of all respondents. In front line aircraft, prevalence of G-LOC among the 882 fast jet aircrew who responded was 6%. In the whole group, G-LOC was reported most commonly in aircrew under training (70.9%), and was most prevalent in training aircraft (77.4% of G-LOC events). At the time of the G-LOC, 64% of aircrew had less than 100 h total flying time. G-LOC was reported most frequently between +5 to +5.9 Gz, and "push-pull" maneuvers were associated with 31.3% of G-LOC events. Pulling G was not considered a problem by 50.6% of respondents, although over 80% recognized the value of flying currency, use of an anti-G suit, and physical fitness, and 55.6% felt that centrifuge training would be valuable. DISCUSSION: The prevalence of G-LOC in the RAF has changed little since 1987, and there remains considerable scope for aircrew education, particularly with the introduction of the Typhoon.     

Cognitive coping and anxiety symptoms among people who seek help for fear of flying

INTRODUCTION: Fear of flying among potential passengers is rather common. In order to treat fear of flying most efficiently, it is important to find out which aspects are related to flight anxiety. The objective of the present study was to examine the extent to which various cognitive coping strategies in response to a flight were used by airline passengers and their relationship with anxiety symptoms. METHOD: A total of 261 persons who were all seeking treatment for fear of flying filled in the Cognitive Emotion Regulation Questionnaire, the anxiety subscales of the Symptom Check List (SCL-90), the Flight Anxiety Situations questionnaire, and the Flight Anxiety Modality questionnaire. RESULTS: Respondents reported using refocus on planning, rumination, putting into perspective to the highest extent and catastrophizing and other-blame to the lowest extent. Furthermore, respondents who reported using self-blame, acceptance, rumination, and/or catastrophizing to a higher extent also reported significantly higher levels of anxiety. DISCUSSION: As the present study suggests that several cognitive coping strategies are related to anxiety, intervention programs should pay attention to these aspects. The present study gives important clues about which cognitive coping strategies should be challenged in treatment of flight anxiety.     

基于主观感觉的人体关节活动舒适性评价

目的对人体主要关节活动舒适性进行评价。方法参照国军标中的规定，确定出所要评价的关节及关节活动，由20位健康的男被试者参加，根据主观感觉利用自由模量幅度估计法，对其站姿和坐姿时相应关节活动的舒适性进行评价，确定出相对不舒适度指数，以描述关节活动总体舒适度的变化情况。结果主观感觉的不舒适程度受关节、关节活动类型以及活动角度等方面的影响。结果显示，在试验测试的8个关节中，主观感觉最舒适的关节活动在肩部，而最不舒适的关节活动在髋部。结论研究中提出的方法和结果可以为航空设计部门的工效评估以及姿态舒适性方面的军标制订提供参考和指导。     

Hand discomfort following heliox chamber dives

During a series of dry chamber dives using compressed heliox, five attendants and one wet diver experienced eight episodes of hand discomfort, the character of which was atypical of limb pain during decompression sickness. Although immersed for most of the dive, during the compression and decompression phases, the wet diver's hands were out of the water and hence exposed to the helium-containing chamber atmosphere. In all cases, symptoms resolved within a maximum of 48 h. There was no response to hyperbaric oxygen therapy in the three cases that presented before spontaneous resolution. While the attendants wore dry suits to minimize skin absorption of helium, their hands, were exposed to the heliox atmosphere. After the first six cases of hand symptoms, a dry glove assembly was added to prevent helium absorption through the exposed hand. Two cases of hand discomfort occurred following the addition of the dry glove assembly to the dry suit. In both cases, the symptoms were less severe and resolved over a significantly shorter time period. Adoption of the dry gloves resulted in the incidence of hand discomfort among attendants falling from 25% (5/20) to 2.4% (2/84) (p = 0.005). Possible mechanisms of causation of this hand discomfort, thought to be the result of local tissue absorption of helium, are discussed.     

Environmental tobacco smoke (ETS) in airliners--a health hazard evaluation.

Some passengers and airline attendants have expressed concern about exposure to environmental tobacco smoke (ETS) in commercial airlines. Irritation of the eyes and respiratory tract, odor, and personal sensitivities are often the bases of complaints. Previous studies demonstrate low concentrations of materials, including ETS. Attendants fly some 800 h per year, passengers much less. Based on previous studies and duration of exposures, the absorbed dose of ETS is less than a cigarette equivalent per year. Nicotine absorption of 0.2 to 0.3 mg in 8-10 h flights has been reported as unlikely to have physiologic effects. The retained 'dose' in relation to the hypotheses of risks to health based on the conflicting results of studies on 'passive smoking' are discussed. There are additional confounding factors in aircraft. We consider segregation into smoking and nonsmoking zones to be reasonably effective in meeting the preferences of passengers.     

Civil unrest and ocular trauma.

The incidence and causes of ocular trauma among Israeli troops serving in the West Bank and Gaza between 1987 and 1989 was investigated. Of the 985 soldiers who were reported injured, 11.3% (111) were reported to have suffered from injuries to the eye. Although most of the soldiers were supplied with some kind of protective gear, only 27% reported that they received eye protection; none used this protection at the time of injury. Fifty-seven percent of the injuries were caused by stones and 38% by flying glass; 14.6% of soldiers suffered bilateral eye injuries. Only 12.1% of those injured wore corrective lenses. Although only 5% were originally reported to have suffered moderate to severe injuries, 38% complained of residual vision impairment. Better eye protection and enforcement of orders to use such gear would reduce the number and severity of ocular injuries.