Role of medical factors in 1000 fatal aviation accidents: case note study

Abstract

Objective: To study the comparative importance of environment and genes in the development of islet cell autoimmunity associated with insulin dependent diabetes mellitus. Design: Population based study of diabetic twins. Setting: Danish population. Subjects: 18 monozygotic and 36 dizygotic twin pairs with one or both partners having insulin dependent diabetes. Main outcome measures: Presence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase (GAD65) in serum samples from twin pairs 10 years (range 0-30 years) and 9.5 years (2-30 years) after onset of disease. Results: In those with diabetes the prevalence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase in the 26 monozygotic twins was 38%, 85%, and 92%, respectively, and in the dizygotic twins was 57%, 70%, and 57%, respectively. In those without diabetes the proportions were 20%, 50%, and 40% in the 10 monozygotic twins and 26%, 49%, and 40% in the 35 dizygotic twins. Conclusion: There is no difference between the prevalence of islet cell autoantibodies in dizygotic and monozygotic twins without diabetes, suggesting that islet cell autoimmunity is environmentally rather than genetically determined. Furthermore, the prevalence of islet cell antibodies was higher in the non-diabetic twins than in other first degree relatives of patients with insulin dependent diabetes. This implies that the prenatal or early postnatal period during which twins are exposed to the same environment, in contrast with that experienced by first degree relatives, is of aetiological importance.

Medical Incapacitation im Cockpit - Inzidenz, Ursachen und Folgen

“…Daneben gab es Studien zum Lizenzverlust (2), epidemiologische Untersuchungen (1), Fragebogenanalysen (1), Auswertungen von Obduktionen (3) und Flugunfällen (3). Für den Luftfahrtbereich Linienflugbetrieb wurden insgesamt zehn Studien (2,3,4,9,14,15,17,19,21,22) zur "Medical Incapacitation" recherchiert, für die Militärfliegerei vier (6,16,18,23) und für die allgemeine Luftfahrt sieben Publikationen (1,5,7,8,12,20,24). Neben fünf Studien mit internationalen Daten, analysierten sechs Untersuchungen die Inzidenz in den USA, vier in Großbritannien, zwei in Frankreich und jeweils eine in Portugal, China, Deutschland und Indien.…”

“…Zur Bedeutung der "Medical Incapacitation" in der allgemeinen Luftfahrt sind vorwiegend Analysen von Post-mortem-Untersuchungen publiziert (7,20,24). Diese indirekten Analyseergebnisse können allerdings nur als Surrogatmarker dienen, denn auch pathologische Be-funde müssen nicht zwingend die direkte Ursache (z.…”

Under-Reporting of Self-Reported Medical Conditions in Aviation: A Cross-Sectional Survey

“…Particularly medical incapacitation related to disturbance of consciousness, neurological conditions, gastrointestinal system, heart disease or medical impairment reducing essential functions such as vision and cognitive processes all pose a risk to flight safety. It has been reported that medical factors constitute the root cause in about 4.7% of all aviation accidents 5 .…”

BMJ bans "accidents"

“…On the other hand, many of these uses contravene the terminology recommended by safety officials, public health authorities, and Evans in his BMJ editorial. The following are examples from the titles of papers published in the BMJ during the past few years: road traffic accidents,5 playground accidents,6 home accidents,7 aviation accidents,8 accidental drug overdoses,9 accidental carbon monoxide poisoning,10 and medical accidents 11…”