​O Problema
Emergências médicas durante voos comerciais de curta ou longa duração, nacionais ou internacionais, estão se tornando cada vez mais comuns. Isso se deve a fatores já conhecidos, como a expansão da indústria da aviação, a popularização dos voos comerciais e a maior diversidade do perfil do viajante, incluindo passageiros idosos, portadores de doenças crônicas ou usuários de medicações. Junta-se aqui o próprio ambiente de cabine, que impõe, por exemplo, o estresse da hipóxia hipobárica, dos disbarismos pela expansão de gases de cavidades corporais, da exposição ao ar frio e seco, a ruídos, a vibrações e a acelerações, da alteração do ciclo circadiano, da fadiga e da imobilidade. Esses fatores afetam pouco ou nada os organismos sadios, mas podem ser danosos em diferentes graus ao passageiro idoso e/ou portador de doenças crônicas.

​A Situação
Exemplo 1 – Uma avaliação clínica ou pré-operatória - Quando o motivo de uma consulta médica é uma avaliação clínica ou pré-operatória, deve-se questionar e considerar vários aspectos durante a anamnese, o exame físico e os exames laboratoriais, para se chegar a melhor decisão clínico-cirúrgica possível, reduzindo ao máximo possíveis eventos adversos, minimizando desfechos não desejados e otimizando a segurança do paciente no voo. Assim, uma pergunta não deve faltar na anamnese - “Existe o plano de uma viagem aérea num futuro próximo?”. Para que esse questionamento, no entanto, produza um impacto positivo na tomada de decisão, é mandatório que o médico assistente detenha conhecimento sobre as condições estressantes do ambiente de cabine de uma aeronave e as condições do passageiro enfermo, objetivando discutir o planejamento de um voo seguro ou até mesmo o cancelamento ou postergação do mesmo.

Exemplo 2 – Médico a bordo? – Incidentes médicos com passageiros em voos comerciais vêm se tornando mais comuns. No entanto, o ambiente de cabine e os recursos médicos disponíveis a bordo de aeronaves são quase sempre de total desconhecimento dos médicos que se tornam voluntários no atendimento a um passageiro durante um voo comercial. Sistemas de auxílio às tripulações a ao médico voluntário incluem o uso da saúde digital e da telemedicina, as quais, nem sempre estão disponíveis para orientação num incidente médico a bordo. Ainda, muitos casos poderiam ter sido evitados, se, durante a avaliação pré-voo por parte do médico clínico, especialista ou cirurgião, fosse incluído na anamnese do paciente questionamentos relativos a planos de viagens de avião.

​A Solução
A InnovaSpace vem adovagar em favor do ensino da Medicina de Aviação e da Fisiologia Aeroespacial na formação de estudantes de faculdades de medicina, através da inserção de uma série de aulas constituindo disciplinas curriculares novas ou integrando disciplinas já existentes no currículo acadêmico.

Esta iniciativa é apoiada pelas Sociedade Brasileira de Medicina Aeroespacial (SBMA) e
​Sociedade Portuguesa de Medicina Aeronáutica (SMAPor)

December 10th 2021 was indeed a Red letter day for Indian Telehealth. On this day the ISO 13131-2021, certification for Telehealth Services was obtained for the first time anywhere, by Apollo Telehealth Services. This brief note points out the necessity for raising the bar and setting high standards, so that the world will strive to achieve India class.
For decades, Telemedicine/Telehealth services were not centre stage in the healthcare delivery system. COVID-19 changed this. The world has now accepted that the forced lockdown- enforced acceptance of Remote Health Care - will become the new normal even after the pandemic is de notified. Universal acceptance increases the responsibility of all health care providers deploying technology, to ensure constant high quality while bridging the urban-rural health divide.

Final blog from ESA-sponsored Dr Stijn Thoolen, from his series written while spending 12 months at the Concordia research station in Antarctica. Catch up on the rest of his fascinating blogs by following the links: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10, Part 11, Part 12

It’s midnight. Since our departure some hours ago the sun has steadily moved towards the horizon behind us, and it has started to paint the sky in colours that make me think of winter again. Huge icebergs are slowly passing by, and every once in a while there is a bunch of curious penguins waving us goodbye from their ice floe. Not much earlier I saw a seal chilling, and there have been whales too. In the very far distance I can still recognise the enormous ice mass on which we have been living our lives the past year. It’s my last view of the Antarctic, and it’s perfect.

Standing here alone on the deck of the Astrolabe surrounded by all this beauty I have found myself a special opportunity to appreciate once more where the #$%!! (beep) we have been all this time. It is just so different there on top of the ice, so far away from the rest of the world, that as we are slowly being re-introduced to civilisation I am having a hard time believing it actually happened. With all the changes that we have gone through lately and with all the new impressions time has gone fast, and it has made Concordia feel like a distant, almost unrealistic memory. Like ages ago, even though it has only been eight days since we left…

It started when the ‘orange and fat’ people (and kiwis!) arrived at Concordia about a month ago. With the start of the summer campaign our winterover isolation had come to an abrupt end, and I remember the calm, safe and familiar environment of the ESA lab feeling surprisingly pleasant after some intense hours of new social interactions. As a positive summer energy took hold of the station and fresh ESA MD Nick gradually took over the lab, there was no way for me to hide anymore. Unavoidable steps out of our rigid routines, but at that ‘c’est l’Antarctique’ rate of change that isn’t always easy to keep up with.
Our departure from Concordia last week was much the same. Emotionally numb from a lack of realisation of what was happening (or a lack of sleep the night before…) it just passed by so quickly, and surprisingly smooth. I said my goodbyes without any affection for the tears around me. I gave the station a good last look for the sake of memory. But when the plane started accelerating for lift-off, suddenly that strong desire came up to make it stop and bring me back safely into the station. Apparently part of me wasn’t ready to leave at all. Too big steps too quickly I guess, but lucky for me there were pilots taking care of that...

A penultimate blog from ESA-sponsored Dr Stijn Thoolen, from his series written while spending 12 months at the Concordia research station in Antarctica. Enjoy the rest of his fascinating blog series by following the links: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10, Part 11

Today is Sunday. We are on full summer campaign steam for two weeks now. There are about 40 people occupying the station, but today nobody works. Instead, I am wearing three layers on my legs, five on my torso, two pairs of socks, neck warmer, two balaclavas, hat, goggles, glove liners, mittens, radio, and of course my running shoes. I prepared two-and-a-half litres of isotone sport drink and extra electrolyte tablets against the dry desert atmosphere. Extra goggles for when my visor fogs from sweat that cools off in the freeze. Battery-powered heated gloves, air-activated hand- and feet warmers as well as another pair of shoes for when my body becomes unable to pump sufficient blood to my fingers and toes to keep them warm. Bananas and chocolate bars accommodating high energy demands at this altitude and these temperatures. Spare radio battery to make sure I maintain contact with the station. Tape for whatever unforeseen circumstances, and four volunteers and a skidoo standing by to support me with whatever I request.
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Today I am going to run a marathon.

I guess I can sometimes be a bit of a dreamer. Not necessarily in the sense that I tend to lose touch with the world around me in order to float around in some self-invented realm in a galaxy far, far away (no worries, I do that too sometimes), but I do like to fantasise about doing things that are commonly perceived as unachievable. Or at least to say a challenge. Then afterwards I see myself devoting quite some time towards realising (some of) such ideas, because it makes me feel good. Contradicting, right? Well, I have to admit I sometimes do find myself wondering why the … I got myself in an awkward position again, but overcoming a challenge in the end always makes me feel proud, and most importantly the experience that comes with it makes me learn.
As I have probably mentioned in all my previous blogs (hope I am not starting to bore you), I strongly believe that pushing yourself into an unknown (decide for yourself how) and leaving your comfortable space can broaden your horizon. We can allow ourselves to understand the world around us from new perspectives, and see new ways of tackling the difficulties that life will offer us. In that sense, I guess it can make us more resilient. Isn’t that exciting?
It is this curiosity that made me come to Antarctica in the first place, and enjoy the winterover experience that is often said to bring positive psychological impact to those who are able to overcome the challenge of being far from home in isolation and confinement. 

As ESA-sponsored Dr Stijn Thoolen comes closer to the end of his year at the Concordia research station in Antarctica, he begins to reflect on his experiences of the last year and the journey homewards. Enjoy the rest of his fascinating blog series by following the links: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10

It’s 1:00 AM. I am lying outside on the roof, together with Ines (glaciologist), Elisa (cook) and Andrea (vehicle mechanic). There is a full moon shining on us, and Mars is right next to it. I am not much of an astronomer, but its bright color stands out so clearly from all the other celestial objects that even I can recognize it instantly as the Red Planet. Looking to the southwest I see Jupiter and Saturn. Also pretty hard to miss. Usually that is where I find the Milky Way, but there is too much light now, even at this hour. An amber color brightens the horizon, beyond which I now realize again there are just so many miles of ice (something easily taken for granted here, but thinking back to that inbound flight to Concordia last year does the trick) separating us from the rest of the world. In front of it all, I look at the frosty metal bars, which always looked so surrealistic to me when I saw pictures of them back home. They have gone through winter as well…

The return of the sun was cool. ‘Here comes the sun’ (you know, that one from the Beatles) was heard all over the station while we impatiently and excitedly tried to catch a first glimpse of it mid-August. Since that moment the skies have become more and more blue, and the snow more and more bright. I have experienced the gradual return of daylight over the past weeks with a positive and fresh feeling, and a sense of anticipation has started to take hold of the station. Who are the people who will replace us? What are our plans after Concordia? I remember myself some weeks ago, lying in exactly the same position as I am right now, outside against a snow dune, sheltered from the wind and with a pleasant -50 degrees Celsius (I realize this perception must be taken relatively…), alone, and just letting the sunshine touch my face again. A special moment, that reminded me of how pleasant summer conditions are going to be.

We welcome back helicopter flight physician Dr Alessandro Forti, as he recounts the true story of an incredible mountain rescue in the Dolomites. We never truly know when we wake up each morning if this could be our last day of life - we assume that all will be well - as did a keen mountaineer in Italy, whose life unexpectedly hung in the balance and in the responsible hands of a Helicopter Emergency Medical Service team with a Lucas device!
Do also take a look at Alessandro's previous blog, which began his dream to work in the rescue services.

We describe here a case of full neurologic recovery from accidental hypothermia with cardiac arrest, which involved the longest reported duration of mechanical cardiopulmonary resuscitation (CPR) and extracorporeal life support (8 hours, 42 minutes). A 31-year-old man experienced a witnessed hypothermic cardiac arrest with a core temperature of 26C° (78.8F) during a summer thunderstorm on the vertical wall of the Marmolada mountain in the Dolomites, Italy (Figure 1), in the late afternoon on a summer day (day 0). 

A physician-staffed helicopter reached the scene at 7:42 PM, and the unconscious patient was immediately evacuated with a 30-m winch operation. The helicopter landed nearby; the initial cardiac rhythm was a low-voltage ventricular fibrillation (7:48 PM). Resuscitation manoeuvres started immediately with manual CPR, followed after a few seconds by an electrical shock (200 J biphasic); mechanical CPR was started after one complete cycle of manual resuscitation. CPR was continued with a mechanical chest compression device (LUCAS 3; Physio Control, Redmond, WA); initial end-tidal carbon dioxide (ETCO2) level ranged between 14 and 22 mm Hg. At 8:20 PM, the patient was transferred by helicopter under continuous mechanical CPR to the spoke Hospital of Belluno, Italy (43 km; arrival at 8:34 PM), as a direct flight to the hub Hospital of Treviso, Italy, was impossible because of the darkness.

Space psychology is an extremely significant area of study. Combining insights from all areas of the wider field (i.e., organizational, industrial, cognitive, psychiatry), it aims to optimise human behaviour and cognition in space.

In terms of its history, space psychology has received varying degrees of attention over time. Whilst its importance was acknowledged at the inception of NASA in 1958; in the early 1990s Dr Patricia Santy (a NASA flight surgeon and psychiatrist) illustrated the industry’s relative disregard for the area, claiming that the application of psychology to space was running 20-30 years behind most other areas of medicine. However, with ever-increasing pressure from academics (i.e., the Committee on Space Biology and Medicine), the establishment of continuously inhabited long-term research stations with multinational crews (i.e., with astronauts joining cosmonauts on Mir in 1993, and the first stay on the ISS in 2000), and a number of high-profile incidents, for example, the theorised termination of the Soviet Soyuz T14-Salyut 7 mission due to depression and the attempted murder by astronaunt Lisa Nowak, the relevance of psychological issues has become increasingly pertinent.

​Research within the field is predominantly focused on ensuring selection/training programmes prepare astronauts for the psychological demands of space travel, developing effective inflight support strategies and helping individuals re-adapt following their return to Earth. Studies can be conducted both in-orbit, and in terrestrial simulators and space analogs (i.e., undersea vessels and polar outposts), which attempt to produce a degree of environmental realism, and have aided in identifying the consequences of the intrapsychic/interpersonal stressors that astronauts encounter, such as team conflict, impaired communication/”psychological closing”, social isolation, threat of disaster, high-stakes/demanding work, public scrutiny, microgravity, radiation exposure, immobility etc... Such research findings can then be applied to develop models of successful crew performance (i.e., in terms of gender composition, and types of goals) and produce effective intervention strategies, like enhancement medications and therapeutic software. For instance, optical computer recognition scanners have been developed by NASA to track astronaut facial expressions and assess potential changes in their mood, allowing for personalized intervention strategies (i.e. computerized CBT treatment). Notably, whilst much research focuses on studying/overcoming the negative aspects of space travel, a robust finding is the salutogenic “overview effect” (White, 1987), which refers to how viewing the Earth from space fosters a sense of appreciation/wonder, spirituality and unity amongst crew members. It is theorised by Yaden et al. (2016) that this emotional reaction is a result of the juxtaposition between the Earth’s features and the black backdrop of space, which emphasises the beauty, vitality, and fragility of Earth.

​With forecasted missions focusing on the potential for interplanetary (and eventually interstellar) travel, we need to prepare accordingly. Not only will these missions be much more protracted in terms of their distance/duration (with the longest period spent in space currently standing at 14 months, and a round trip to Mars predicted to take 2.5 years), they will also be subject to the pressure of larger, multinational crews, with no hope of evacuation, lack of protection from the Earth’s magnetic field, and distance-related communication delays (averaging 25 minutes to Mars/500 minutes to Neptune and back). Additionally, astronauts will not be able to observe the Earth and derive the aforementioned associated benefits of this experience; coined the ‘Earth-out-of-view phenomenon’ (Kanas, 2015; Kanas & Manzey, 2008), which may magnify potential feelings of homesickness and isolation. As such, we need to develop effective strategies to counteract these novel stressors, with researchers considering the benefit of fitting protective outer shields to isolated parts of spaceships (where astronauts spend the majority of their time) in order to mitigate against the effect of radiation from cosmic rays, email messages that conclude with suggested responses in order to reduce communication times, and virtual reality systems/on-board telescopes to minimise feelings of separation from Earth.

​Having discussed the historical development of space psychology, the scope of research conducted, and the forecasted future of the field, I hope I have impressed on you the significance of such an exciting area of study. Managing human behaviour in space is an interdisciplinary effort, and as the government monopoly on spaceflight diminishes (i.e., with the launch of commercial/private space ventures like SpaceX), and the number/complexity of missions increases, the importance of space psychology will become ever more apparent.

ESA-sponsored Dr Stijn Thoolen delivers the last part of his 'Let's Talk Science' blogs, written during his year at the Concordia research station in Antarctica. Catch-up with his previous blogs at Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9

But there is more to the ESA lab, and I have saved the best for last. So, now that you are probably overloaded with theories and facts, let’s talk about something very different. Let’s talk about sex!
And before we continue, you have to promise me to turn on another song, to end this blog with some appropriate groove.

But maybe there is more to it than it seems, and what Cherry-Garrard says is not necessarily easy to do. We are human, after all. Sexuality is one of our core features, vital for our existence, and for many it is a fundamental source of pleasure, intimacy, bonding, and social relations. Researchers have shown how sexual deprivation can lead to frustration, anger and even depression, and also seen from a group perspective anecdotal accounts have shown that sexual desire and related feelings of jealousy and competition can lead to adaptation problems in extreme environments. Including Concordia!
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But the problem with sex it that we don’t easily talk about it. Perhaps it is so close to our core that opening up about it can make us feel vulnerable. A sensitive topic, and while researchers are currently busy figuring out how to compose future space crews in terms of culture, personality and gender, data about sexual behaviour and its effects on team dynamics in extreme environments is basically non-existent! How do we cope? How, why, and when do we suffer? Recent political debates and scandals of sexual harassment have already highlighted the importance of having a work environment free of sexual hostility, and if you ask me, it would be irresponsible to send humans on a multi-billion dollar long-duration mission to Mars without being able to answer these questions!

As such, the project SWICE (‘sexual well-being and sexual security in isolated, confined and extreme environments’), for the first time in spaceflight research history, is breaking the taboo. As the first study of its kind, it aims to gather basic information about human sexuality while living in isolation and confinement, and it does so by making us in Concordia talk:
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‘How often does another Concordia inhabitant asks me for sexual favours?’ (we better forget the jokes at the dinner table…), ‘How often does another Concordia inhabitant produces sexually explicit graffiti for display at Concordia?’ (we better forget the sexually explicit Play-Doh creations we made with the whole crew last month…), ‘How enjoyable is your sexual life right now?’, ‘How often do you masturbate?’, ‘How often do you experience an orgasm?’ (Damn, you want to know everything!).