Aircraft Vibration and Other Factors Related to High Systolic Blood Pressure in Indonesian Air Force Pilots

Background:Flight may affect the human cardiovascular system. Pilots are exposed among others to aircraft noise and vibration. This study aimed to investigate the effects of aircraft flight on systolic blood pressure.Methods:A nested case-control study was conducted on Indonesian Air Force pilots doing annual medical check-ups at the Saryanto Institute for Medical and Health Aviation and Aerospace (LAKESPRA) from 2003 – 2008. The data extracted from medical records were age, total flight hours, type of aircraft, fasting blood glucose and cholesterol levels, waist circumference, height and weight (Body Mass Index), and blood pressure.Results: Of 336 pilots, there were 16 with systolic pressure 140 mmHg. The pilot who had high vibration than low vibration had 2.8-fold to be high systolic blood pressure [adjusted odds ratio (ORa) = 2.83; 95%confidence interval (CI) =1.16-22.04). In term of average flight hours, those who had average flight hours of 300-622 hours per year compared to 29-299 hours per year had 5-fold increased risk to be high systolic blood pressure (ORa = 5.05; 95% CI =1.16-22.04]. Furthermore, those who had high than normal resting pulse rate had 2.4 times to be high systolic blood pressure (ORa = 2.37; 95 CI =0.81-6.97; P = 0.115).Conclusion:High aircraft vibration, high average flight hours per year, and high resting pulse rate increase risk high systolic blood pressure in air force pilots

Factors Affecting High Resting Pulse Rate in Military Pilots

Background:Pilots are almost constantly exposed to emergency situations which increase sympathetic activity. This will affect the cardiovascular system, which among others will be reflected by increased resting pulse rate. The aim of this study was to investigate factors that increase resting pulse rate in pilots. Methods:A nested case-control study was conducted on Indonesian Air Force military pilots doing annual medical check-ups at the Saryanto Institute for Medical and Health Aviation and Aerospace (LAKESPRA) from 2003 to 2008. The data extracted from medical records were age, rank, total flight hours, average yearly flight hours, and type of aircraft. Results: Out of 539 pilots, there were 155 with high resting pulse rate. Compared to pilots aged 23-29 years, pilots aged 30-39 years had 66% more risk for high resting pulse rate [adjusted odds ratio (ORa) = 1.66; 95% confidence interval (CI) = 1.17-2.35, P = 0.004], and those aged 40-49 years had a 2.4 risk (ORa = 2.40; P = 0.000]. Compared to pilots of transport planes, jet fighter pilots had a 59% more risk for high resting pulse rate (ORa = 1.59; P = 0.002). Conclusion: Older age and fighter jets increased the risk of high resting pulse rate in pilots. (Health Science Indones 2013;2:51-4

Risk factors of low peak bone mass in Indonesian women

Background: Osteoporosis occurred in 64% of Indonesian women aged 60-64 years. The risk of osteoporosis can be reduced by achieving optimal peak bone mass in ages 25-32 years. However, 33.4% women had low peak bone mass (LPBM).Objective: We aimed to develop a tool to identify women at risk of developing LPBM in order to ameliorate this situation. Some risk/protective factors were explored in a case-control study.Method: We recruited 25 cases, those with LPBM (T-score <1) according to peripheral bone densitometry and 25 controls from Cengkareng District, West Jakarta. They were assessed using questionnaires to explore their historical intake of calcium, tea/coffee, and weight-bearing activity. We also measured BMI and body composition. Parameters among case and control groups were analyzed using independent T-test or Mann-Whitney, and odds ratio in relation to peak bone mass was also computed.Results: Between cases and controls, there were no differences observed in BMI, body composition, weight-bearing activity, and historical tea/coffee consumption. Calcium intake from sources other than milk and its derivatives were also found not to differ. Historical calcium index (HCI), measuring weekly calcium intake since childhood, was found lower in cases (median=160 vs 965; p=0.001). HCI cut-off analysis found that the values of 300 and 1000 yielded good specificity (80%) and sensitivity (92%) for LPBM. OR analysis identified those with HCI <1000 (OR=0.61; 95% CI: 2.05−54.95) as at moderate risk of developing LPBM, and HCI ≤ 300 as at higher risk.Conclusion: We concluded that, as low HCI was the risk factor for developing LPBM, calculation of HCI should be done to earlier identify women at risk, thus prompting earlier nutrition and lifestyle intervention to prevent the occurrence of LPBM and future osteoporosis

Validity and Reliability of Morisky Medication Adherence Scale 8 Bahasa Version to Measure Statin Adherence Among Military Pilots

Background: Hypercholesterolemia is the cause of cardiovascular disease which lead to inflight incapacitation. One of the way to control hypercholesterolemia is using statin medication, however there has not been an instrument to measure statin adherence in military pilots in Indonesia. The aim of this study was to analyze the validity and reliability of MMAS 8 Bahasa version to measure statin adherence among military pilot in Indonesia. Methods: MMAS 8 sistematically translated into Bahasa. Validity and reliability test among 40 military pilots in Halim Perdanakusuma Air Force Base was held on April 06th - May 15th 2016. Validity was confirmed using crirerion-related validity. Reliability was tested for internal consistency and test-retest reliability. Results: Most of the pilots (52.5%) had high cholesterol level and 74.4% had low statin adherence. Negative weak correlation and no significant association between cholesterol and statin adherence level (Spearman coefficient -.199, p=0.218) was found. Moderate internal consistency and excellent test-retest reliability were found (Cronbach\u27s α=0.759; Spearman correlation=0.860). Conclusion: Validity and reliability of MMAS 8 Bahasa version has not been able to be used to measure statin adherence among military pilots in Indonesia. (Health Science Journal of Indonesia 2016;7(2):129-133

The Effect of Enhanced External Counterpulsation Therapy and Improvement of Functional Capacity in Chronic Heart Failure patients: a Randomized Clinical Trial

Aim: to investigate the efficacy of enhanced external counterpulsation (EECP) therapy to improve functional capacity in patients with chronic heart failure (CHF). Methods: a double-blind random clinical trial was performed in 99 patients with CHF who had received EECP therapy at Jade Cardiovascular Clinic, Manado, North Sulawesi, Indonesia between January 2014 and June 2015. Subjects were categorized into 2 groups, i.e. 49 subjects had sham EECP therapy and 50 subjects had EECP therapy. All subjects performed six-minute walking test (6MWT) before and after receiving EECP therapy. Results: there was no significant difference between both groups regarding the basic characteristics of patients with CHF. The 6MWT result before EECP therapy showed that there were 30 patients (61.2%) with walk distance of <300 meter in the sham EECP group; while in the group receiving EECP therapy, we found 34 patients (68%); p=0.24. Post-EECP therapy, there were 33 patients (67.3%) with walk distance of <300 meters in EECP sham group; while in the group receiving EECP alone, there was only 1 patient (2%); p <0.01.The 6MWT walk distance in sham group before EECP therapy was 252.65 (SD 97.55) meters and it was 243.65 (SD 86.96) meters following the EECP therapy; p=0.18. In EECP group, the 6MWT walk distance before therapy was 256.88 (SD 85.56) meters and after EECP therapy the walk distance was 449.46 (SD 92.08) meters; p<0.01. Conclusion: EECP therapy is effective to improve functional capacity in patients with CHF.Key words: chronic heart failure, six-minute walk test, enhanced external counterpulsation (EECP) therapy

The Number of Sectors and Other Risk Factors Related to Fatigue Among Shorthaul Commercial Pilots in Indonesia

Background: Fatigue could impair cognitive function in pilots which may lead to accidents in short-haul flight. Theaim of this study was to identify the risk factors related to fatigue among short-haul commercial pilots in Indonesia.Methods: A cross-sectional study with purposive sampling was conducted among Boeing 737 seriestyped-rating pilots taking medical examination at the Civil Aviation Medical Center, Jakarta from May5-26, 2014. Fatigue was measured with Self-Reporting Questionnaire, Fatigue Severity Scale (FSS). Datawere collected using anonymous self-reporting questionnaire on demographics, workload, sleep restriction(Epworth Sleepiness Scale-ESS), personal factors, and managerial support. Linear regression was used toidentify dominant risk factors related to fatigue.Results: During data collection, 785 pilots were taking medical examination, 382 pilots were willing toparticipate, and 239 pilots met the criteria. The FSS mean was 4.66 ± 1.202. The number of sectors in 24hours, flight times of unplanned flights in 30 days, and sleep restriction were dominant factors of fatigue.Each additional sector increased FSS by 0.371 points [regression coefficient (β) = 0.371; P = 0.000].Furthermore, each additional ESS, increased FSS by 0.043 points (β = 0.043; P = 0.008), while eachadditional unplanned flights increased FSS by 0.033 points (β = 0.033; P = 0.000).Conclusions: Additional number of sectors in 24 hours, additional unplanned flight times within 30 days,and sleep restriction increased the risk of fatigue among short-haul commercial pilots in Indonesia. (HealthScience Journal of Indonesia 2015;6:69-75

The Effect of Workload and Other Risk Factors of Metabolic Syndrome Among Short-haul Commercial Pilots in Indonesia

Background: Metabolic syndrome (MS) could cause sudden incapacitation among pilots in Indonesia.The aim of this study was to identify risk factors of MS among short-haul commercial pilots in Indonesia.Methods: A cross-sectional study with purposive sampling was conducted among commercial pilotstaking medical examination at the Civil Aviation Medical Center, Jakarta from July 27-August 30th,2014. Metabolic syndrome was assessed according to the National Cholesterol Education Program AdultTreatment panel III criteria and criteria. Risk factors were collected using anonymous self-reportingquestionnaire. The laboratory data were extracted from medical records. Cox regression was used toidentify dominant risk factors of MS.Results: During data collection, 2135 pilots taking medical examination, Total male Asian pilots metthe inclusion criteria was 864 pilots. Prevalence of MS was 18.28%. Compared to 20-35 year-old group,subjects aged 56-65 years-old had 88% higher risk for MS [adjusted relative risk (RRa) = 1.88; P = 0.019].In term of number of sectors in the last 24 hours, compared to 0-3 sectors, subjects who had 6-7 sectors inthe last 24 hours had 66% higher risk for MS (RRa = 1.66; P = 0.033), while subjects who had 8 or moresectors in 24 hours had 82% more risk for MS (RRa = 1.82; P = 0.072).Conclusions: The pilot aged 56-65 years-old, who had 6 or more sectors in the last 24 hours, had higherrisk for metabolic syndrome among short-haul commercial pilots in Indonesia. (Health Science Journalof Indonesia 2015;6:81-6

Hurdle Aerobic Exercise Increases Angiogenesis and Neuroplasticity in the Hippocampus and Improves the Spatial Memory Ability of Middle-aged Mice

BACKGROUND: Complex aerobic exercise is believed to induce positive effects on neuron structure and cognitive function. Long-term and continual cognitive stimulation increases neuroplasticity by stimulating the synthesis of neuronal growth proteins and the formation of new synapses. Exercise also increases the ability of neurons to survive and improves brain vascularization. Further investigations should be conducted to explore what types of aerobic exercise are beneficial for cognitive function. AIM: This study investigated the effects of hurdle aerobic exercise on developmentally regulated brain protein-A (Drebrin-A) as a neuroplasticity indicator, and on vascular endothelial growth factor (VEGF) as an angiogenesis marker in the hippocampus. METHODS: This study was an experimental study with post-test only control group design. Thirty-three adult mice were divided into control, hurdle aerobic runner (HAR), and plain aerobic runner (PAR) groups (n = 11 for each group). Fiberglass running wheels were originally designed and modified to assemble hurdles inside with adjustable speed. Speed adaptation was intended to achieve aerobic intensity. The experiment was performed 5 times a week for 8 weeks. The Morris water maze test (MWMT) was used to assess spatial memory ability. One day after the last running exercise and final MWMT, the mice were sacrificed and the right side of the hippocampus was obtained for Drebrin-A analysis by enzyme-linked immunosorbent assay (ELISA). The entire right side brain tissue after hippocampus was removed then used for the neuroglobin ELISA assay. To analyze VEGF expression and calculation of blood vessel, the left side of the brain was prepared for hematoxylin eosin and immunohistochemistry staining. To assess the effect of exercise on vascular widening, the analysis of the slides was performed by calculating the percentage of blood vessels with diameters more than 15 μm. One-way ANOVA and Fisher’s least significant difference test was used for statistical analysis. RESULTS: There was a significant difference in the levels of Drebrin-A between the HAR and PAR groups. Both exercise groups had higher levels of Drebrin-A than the control group. HAR and PAR groups exhibited significantly higher percentages of blood vessels expressing VEGF in hippocampus compared to control. HAR and PAR groups had the higher percentages of larger vessels compare to control. There was no significant difference of neuroglobin levels among the three groups. Both the HAR and PAR groups exhibited better spatial memory than the control group. CONCLUSION: Both aerobic exercises induced positive effects on brain angiogenesis, while the intensity of aerobic exercises did not result in high hypoxic stress in the brain

THE EFFECT OF THE ALTITUDE ZONE ON COGNITIVE FUNCTION FOR MALE PILOTS IN INDOCTRINATION AND AEROPHYSIOLOGY TRAINING IN 2019

Objective: A pilot on duty at altitude can be exposed to hypoxia, both mild and severe. The incidence of hypoxia on a flight can be fatal, especially if hypoxia is experienced by a pilot on duty. One manifestation of hypoxia is decreased cognitive function. A pilot is required to carry out multitasking operations using cognitive functions, especially in an emergency. Therefore, decreased cognitive function due to hypoxia in a pilot can cause accidents in flight. This study aims to determine changes in cognitive function with hypoxia exposure at several altitude zones. Methods: This study used an experimental one-group pretest-posttest design. The subjects were 31 military pilots who participated in Indoctrination and Aerophysiology Training. Subjects filled 6 Cognitive Impairment Test (6 CIT) questionnaires at ground level, efficient physiological zone (10,000 ft), and physiological deficient zone (25,000 ft) in a hypobaric chamber. Results: There was a change of 6 CIT score at 10.000 ft compared to ground level (Friedman post-hoc Wilcoxon, P = 0.001). There was also a change of 6 CIT score at 25,000 ft compared to ground level (Friedman post-hoc Wilcoxon, P&lt;0.001). Conclusion: There was a change in cognitive function in the efficient physiological zone and physiological deficient zone, compared to ground level