Fatigue and Associated Factors among Airline Pilots

Abstract : Purpose: This study aimed to identify the prevalence of fatigue and its associated factors leading to the fatigue among Korean commercial airline pilots. Methods: An anonymous, web-based questionnaire collecting data on sleep related characteristics was completed by airline pilots. The final 1,029 samples of completed questionnaires were analyzed. The association of the risk factors with fatigue was determined using logistic regression analysis. Results: The prevalence of fatigue was 60% (Fatigue Severity Scale index≥3.2), disturbed sleep 28% (Pittsburgh Sleep Quality Index≥9), daytime sleepiness 17% (Epworth Sleepiness Scale≥10), and sleep apnea (Berlin Questionnaire≥2) 11%. The fully adjusted logistic regression showed that quality of life (odds ratio [OR]=0.16, confidence interval [CI]=0.11–0.24), daytime sleepiness (OR=1.26, CI=1.18–1.34), sleep quality (OR=1.44, CI=1.29–1.61), mental workload (OR=1.10, CI=1.05–1.14), vigorous physical activity (OR=0.82, CI=0.72–0.92), late starts (OR=1.25, CI=1.06– 1.46) and average weekly flying hours (OR=1.02, CI=1.00–1.03) were associated with higher levels of fatigue. Conclusion: Lower quality of life, disturbed sleep, more subjective sleepiness, shorter sleep duration, higher mental workload, less vigorous physical activity, frequent late starts, and longer flying hour were shown to be risk factors for fatigue in airline pilots. These findings should be taken into account in the development of sleep and fatigue countermeasures for airline pilots.

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Epidemiological Aspects of Hepatitis E Virus Infections between South Korea and Japan

Abstract : Purpose: Hepatitis E outbreaks are a serious public health concern in the world. The pilots or air traffic controllers can be incapacitated by severe hepatitis symptoms. If the symptoms of acute hepatitis do not improve, it is not suitable for aviation duties. In this study, we compare of incidence status of hepatitis E virus (HEV) infections, and epidemic aspects between South Korea (from here on, ‘Korea’) and Japan. Methods: The raw data on confirmed of HEV infection cases were obtained from the National Notified Disease Surveillance System of Korea Diseases Control and Prevention Agency, the Ministry of Health and Welfare in Korea, and the National Epidemiological surveillance of Infectious Diseases surveillance system, administered by the National Institute of Infectious Diseases in Japan. Statistically significant differences between the epidemiological aspects and risk factors were determined using the Pearson’s chi-squared test or paired t-test. All data analyses were performed in Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Results: There were 191 cases of HEV infected cases with a prevalence rate (PR) of 0.37 per 100,000 populations of Korea in 2020. During the same year in Japan, there were 454 cases with a PR of 0.36. When compared, there is statistically none significantly differences. Moreover, both PR per 100,000 populations of HEV infections in habitat of two countries were compared, in the provinces (0.39) of Korea were much higher than that in capital city of Seoul (0.27; P

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Comparative Observation of Body Mass Index among Adults in Korea and Japan

Abstract : Background: Obesity is a major public health problem that is causally related to serious medical conditions. In this study, the public health implications of obesity based on body mass index (BMI) with anthropometric measures among adults in the Republic of Korea and Japan in 2019 were compared. Methods: A simple cross-section, nationally representative of the raw data from the National Health and Nutrition Examination Survey in 2019 between Korea and Japan were used. We analyzed the data of those categorized as obese with a BMI of ≥25 kg/ m2 according to the World Health Organization Expert Consultation. Results: The average values of BMI based on body height and body weight among males and females in Korea were 24.6±0.08 and 23.3±0.09, respectively; those in Japan were 23.9±0.08 and 22.6±0.08, respectively. The measured anthropometric values were obviously higher in Korean than in Japan (P

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아토피성 피부염을 가진 조종사의 판정 증례보고

Case Report of a Pilot with Atopic Dermatitis

Abstract : Atopic dermatitis is a condition that makes skin red and itchy. It is common in children but can occur at any age. Atopic dermatitis is chronic and tends to flare periodically. The pathogenesis of the disease has not yet been clearly elucidated but genetic predisposition, immunological dysfunction, and environmental factors are presumed to be involved in the pathogenesis. In general, it is difficult to cure, but as time passes, most of them heal naturally and the symptoms disappear, but the symptoms continue to recur. So, the basic treatment is to relieve the pruritus and prevent it from reoccurring. Treatment involves avoiding things that make the condition worse, daily bathing with application of moisturizing cream afterwards, applying steroid creams when flares occur, and medications to relieve itching sensation. Steroid pills or creams based on calcineurin inhibitors may occasionally be used if other measures are not effective. When examining a pilot with atopic dermatitis, the dermatitis condition, the treatment being used, and the side effects of the medications should be considered. This case involves an otherwise healthy applicant for the 1st class medical certification who has had atopic dermatitis.

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4차 산업혁명 시대의 CRM: 인간과 자율 시스템의 협업 관점에서

Crew Resource Management in Industry 4.0: Focusing on Human-Autonomy Teaming

Abstract : In the era of the 4th industrial revolution, the aviation industry is also growing remarkably with the development of artificial intelligence and networks, so it is necessary to study a new concept of crew resource management (CRM), which is required in the process of operating state-of-the-art equipment. The automation system, which has been treated only as a tool, is changing its role as a decision-making agent with the development of artificial intelligence, and it is necessary to set clear standards for the role and responsibility in the safety-critical field. We present a new perspective on the automation system in the CRM program through the understanding of the autonomous system. In the future, autonomous system will develop as an agent for human pilots to cooperate, and accordingly, changes in role division and reorganization of regulations are required.

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말초성 어지럼 및 이명: 증례보고 및 항공의학적 고찰

Peripheral Vertigo and Tinnitus: Case Report, Aeromedical Assessment of Therapy

Abstract : Aviation medical examiners should always keep two principles in mind when evaluating patients with vertigo: Does this disease render him or her incapacitated? And does this disease recur? Meniere's disease accompanies vertigo and hearing symptoms such as hearing loss and tinnitus and is particularly important because it can render the patient incapacitated and has recurrent consequences. In this case, we intended to investigate the course of a patient who was evaluated with symptoms of dizziness and tinnitus and to review the patient's judgment result according to the principles of aeromedical evaluation.

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기내 심폐소생술과 COVID-19

In-Flight Cardiopulmonary Resuscitation and COVID-19

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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한국형 기내 의학적 상황 대처 방안 안내서

Korean Guideline for Managing In-flight Medical Events

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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Epidemiological Aspects of Hepatitis E Virus Infections between South Korea and Japan

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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항공종사자와 코로나바이러스감염증-19 백신 예방 접종

COVID-19 Vaccination for Pilots and Air Traffic Controllers

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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항공종사자 건강증진활동계획에 반영되어야 할 근거자료: 3년간의 항공신체검사 결과 분석

Analysis of Three Years of Airmen Medical Certificate for Preparing Aviation-related Health Promotion Plan

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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최근 5년간 국적항공사 조종사의 항공신체검사 부적합 판정결과

Survey of Medically Disqualified Airline Pilots in Korea: 2015~2019

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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말초성 어지럼의 이해 및 항공업무 적합성 평가

Understanding Peripheral Dizziness and Evaluating Suitability for Aviation Work

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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COVID-19 감염증이 호흡기 알레르기 질환에 미치는 영향

The Influence of COVID-19 on Asthma and Allergic Rhinitis

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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Fatigue and Associated Factors among Airline Pilots

Abstract : Purpose: This study aimed to identify the prevalence of fatigue and its associated factors leading to the fatigue among Korean commercial airline pilots. Methods: An anonymous, web-based questionnaire collecting data on sleep related characteristics was completed by airline pilots. The final 1,029 samples of completed questionnaires were analyzed. The association of the risk factors with fatigue was determined using logistic regression analysis. Results: The prevalence of fatigue was 60% (Fatigue Severity Scale index≥3.2), disturbed sleep 28% (Pittsburgh Sleep Quality Index≥9), daytime sleepiness 17% (Epworth Sleepiness Scale≥10), and sleep apnea (Berlin Questionnaire≥2) 11%. The fully adjusted logistic regression showed that quality of life (odds ratio [OR]=0.16, confidence interval [CI]=0.11–0.24), daytime sleepiness (OR=1.26, CI=1.18–1.34), sleep quality (OR=1.44, CI=1.29–1.61), mental workload (OR=1.10, CI=1.05–1.14), vigorous physical activity (OR=0.82, CI=0.72–0.92), late starts (OR=1.25, CI=1.06– 1.46) and average weekly flying hours (OR=1.02, CI=1.00–1.03) were associated with higher levels of fatigue. Conclusion: Lower quality of life, disturbed sleep, more subjective sleepiness, shorter sleep duration, higher mental workload, less vigorous physical activity, frequent late starts, and longer flying hour were shown to be risk factors for fatigue in airline pilots. These findings should be taken into account in the development of sleep and fatigue countermeasures for airline pilots.

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5년간의 미국 이민 비자 신체검사 결과 분석

Analysis of Five Years of US Immigration Medical Exams

Abstract : Purpose: The United States of America have pre-migration screening program are mandated through legislation. The one of purpose of this program is to prevent the importation of certain communicable diseases. Examinations of migration applicants are performed by panel physicians who are licensed physicians in the countries of origin that have agreements with the government departments of the country of destination to undertake this activity. In recent decades, the number of US migrants has increased, however COVID-19 impacted this trend of international migrants. The Aim of this study is to examine trends of US applicants and outcomes of tuberculosis and sexual transmitted infections (STIs) screening in South Korean applicants for US visa. Methods: A total of 4,442 applicants participated in US visa health check-up in 2016 to 2020. Results: The numbers of applicant for US visa in males and females was 1,814 and 2,628. The positive results in tuberculosis and STIs screening was noted with 0.66% in nontuberculous mycobacteria (NTM), 0.03% in tuberculosis, 0.03% in gonorrhea, 0.08% in syphilis, and 0.74% in chlamydia. The age groups of 2 to 14 years showed higher positive rate (13.89%) in tuberculin skin test (TST) tests compared to the rate of interferon gamma release assay (IGRA) tests (0.44%, P

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아토피성 피부염을 가진 조종사의 판정 증례보고

Case Report of a Pilot with Atopic Dermatitis

Abstract : Atopic dermatitis is a condition that makes skin red and itchy. It is common in children but can occur at any age. Atopic dermatitis is chronic and tends to flare periodically. The pathogenesis of the disease has not yet been clearly elucidated but genetic predisposition, immunological dysfunction, and environmental factors are presumed to be involved in the pathogenesis. In general, it is difficult to cure, but as time passes, most of them heal naturally and the symptoms disappear, but the symptoms continue to recur. So, the basic treatment is to relieve the pruritus and prevent it from reoccurring. Treatment involves avoiding things that make the condition worse, daily bathing with application of moisturizing cream afterwards, applying steroid creams when flares occur, and medications to relieve itching sensation. Steroid pills or creams based on calcineurin inhibitors may occasionally be used if other measures are not effective. When examining a pilot with atopic dermatitis, the dermatitis condition, the treatment being used, and the side effects of the medications should be considered. This case involves an otherwise healthy applicant for the 1st class medical certification who has had atopic dermatitis.

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항공 피로위험관리를 위한 생체수리적 모델 접근 방안

A Study on the Biomathematical Model Approach for Aviation Fatigue Risk Management

Abstract : In the aviation sector, it is recommended to adopt an aviation safety management system (SMS) from international organizations (International Civil Aviation Organization, Federal Aviation Administration, etc.) and to apply a related system in each organization. Among them, fatigue management recommends fatigue risk management system (FRMS) operating as part of SMS proactive risk management. Advanced aviation organizations are developing and applying various related risk assessment techniques that consider characteristics in order to apply scientific and systematic FRMS. Among which the biomathematical fatigue model (BFM) are representative. The Bio-mathematical Model is designed to represent the level by converting it into a simple numerical score, taking into account various related factors for the measurement object. The BFM is tool to predict the level of fatigue of the crew based on scientific understanding of the factors that contribute to fatigue. The Biomathematical Model is used as a scientific approach that promotes the transition to a performance-based safety management. In this study, the recent trends and implications for the BFM developed and applied in the aviation field are to be reviewed. First, FRMS was considered within the SMS framework, then the characteristics and application methods of the BFM were examined, and finally, the direction of the development of the BFM was suggested.

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기내 심폐소생술과 COVID-19

In-Flight Cardiopulmonary Resuscitation and COVID-19

Abstract : As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-of-hospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

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코로나19 팬데믹과 조종사 정신건강 관리

COVID-19 Pandemic and Pilot Mental Health Care

Abstract : When the COVID-19 crisis hit air transport, the whole aviation industry was affected. The change in the behavior of passengers following the COVID-19 crisis, travel restrictions and the ensuing economic crisis have resulted in a dramatic drop in demand for airline services. The COVID-19 pandemic, with all its associated consequences, has had a significant impact on the mental health and well-being of pilots, which could impact operational safety. As the number of international flights has decreased, pilots are exposed to high levels of psychological stress such as job instability, reduced income and increased risk of infection during flight work. Psychological stress lowers work performance and threatens aviation safety. The pilot needs mental health management during the COVID-19 pandemic, but psychological support is weak. For pilot mental health management, it is important to raise awareness about mental health and to continuously respond. To this end, it is necessary to foster a safe and trustworthy culture in which mental health issues are discussed freely and solved together without hiding them. They should also support the establishment of a peer support program that is easily accessible and that allows pilots to discuss their issues with confidence.

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폐암 수술 후 흉막 내 미세잔류병변 판정사례

A Case of Lung Cancer: Postop Minimal Residual Disease at Pleura

Abstract : For nonsmall cell lung cancer (NSCLC), surgery is indicated only for stage 3 as a curative measure. Even so, there is a high risk of recurrence following stage 3 lung cancer surgery, a third (33.9%) of patients experienced a cancer recurrence mostly within 2 years after surgery. The median survival time for all stages reaches only 21.9 months. For people undergoing surgery for stage 3A NSCLC, a pre-operative course of (neoadjuvant chemotherapy) can improve survival times, by improving the resectability and lowering the risk of recurrence. Pleural metastases are frequently associated with tumors of the lung and breast. Chest radiographs and computed tomography scans of pleural metastases can present as an effusion or smooth or nodular pleural thickening. In the absence of irregular or nodular pleural thickening, it is difficult to distinguish a benign from a malignant pleural effusion. To treat lung cancer, tyrosine kinase inhibitors (TKIs) recently have been used to cope with genetic mutations, apart from cytotoxic anticancer drugs. Compared to cytotoxic drugs, they are effective, have fewer side effects, and are easy to administer. Airman must have no cancer disease to apply for Class-I medical certification. Specifically, if previously operated on cancer, the cancer should not remain in the body at present, and the disease free state should persist at least one year after all kinds of anti-cancer treatments including adjuvant chemotherapy are completed. Here, this case deals with a 41-year-old pilot who has ATP license who had stage 3A NSCLC. The pilot underwent curative lung cancer surgery (lobectomy) a year ago and showed suspicious pleural metastasis at the time of his application for certification and was still using an unauthorized TKI agent alectinib (Alecensa; Roche, Basel, Switzerland).

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