Advances over the past decades in space flight technology have allowed U.S., Russian, and other space programs to not only increase the frequency of manned space flights but also to increase the ...duration of these flights. As such, a large body of knowledge has been developed regarding the ways in which space flight affects the health of the personnel involved. Now, for the first time, this body of clinical knowledge on how to diagnose and treat conditions that either develop during a mission or because of a mission has been compiled by Drs. Michael R. Barratt and Sam L. Pool of the NASA/Johnson Space Center.
Providing medical care capability in a multinational setting in space is a daunting challenge. As the International Space Station (ISS) has taken shape over the last decade the space medicine ...community of the ISS partners has established a foundation with which to govern medical policy, medial processes, and medical care during the ISS Program. This foundation was predicated on a rich history of bilateral and multilateral cooperation among space faring nations. Three key organizations were established, they include the agency or senior level Multilateral Medical Policy Board (MMPB), the Multilateral Space Medicine Board (MSMB), and the Multilateral Medical Operations Panel (MMOP). All three are staffed by senior medical personnel within each of the partner organizations of the ISS and each has specific roles and responsibilities. These three entities strive to protect the human element of spaceflight through highly effective interaction in a multilingual, multicultural program. This paper reviews the creation of this tripartite approach to the development of medical policy for ISS.
To compare the relative contributions of gravity and vascular structure to the distribution of pulmonary blood flow, we flew with pigs on the National Aeronautics and Space Administration KC-135 ...aircraft. A series of parabolas created alternating weightlessness and 1.8-G conditions. Fluorescent microspheres of varying colors were injected into the pulmonary circulation to mark regional blood flow during different postural and gravitational conditions. The lungs were subsequently removed, air dried, and sectioned into approximately 2 cm(3) pieces. Flow to each piece was determined for the different conditions. Perfusion heterogeneity did not change significantly during weightlessness compared with normal and increased gravitational forces. Regional blood flow to each lung piece changed little despite alterations in posture and gravitational forces. With the use of multiple stepwise linear regression, the contributions of gravity and vascular structure to regional perfusion were separated. We conclude that both gravity and the geometry of the pulmonary vascular tree influence regional pulmonary blood flow. However, the structure of the vascular tree is the primary determinant of regional perfusion in these animals.
This paper summarizes medical experience during the six NASA-Mir flights from March 14, 1995, to June 4, 1998. There were 7 U.S. astronauts who were part of 6 Mir space crews and worked jointly with ...12 Russian cosmonauts. Advances in space medicine have created a safer environment; however, experience shows that crewmembers experience traumatic injuries and illnesses of diverse etiologies during spaceflight. During these joint flights both Russian and U.S. medical kits were available to crewmembers who could access either medical kit as appropriate. The Russian medical team had primary responsibility for monitoring and care of all crewmembers and analyzing medical results. When medical incidents occurred, the appropriate Russian or U.S. medical team determined the plan for diagnosis and treatment. Each team kept the other informed regarding medical situations during the flights and strictly observed the principles of medical confidentiality. A summary of medical incidents by programmatic element is described as experienced by the crewmembers and the ground support medical teams. The most frequent medical cases were small traumatic injuries to the skin and mucous membranes and fluctuations in the cardiovascular system, manifesting primarily in the form of cardiac dysrhythmias. The ability to use both the Russian medical aids and the U.S. medical kit significantly increased the effectiveness and reliability of therapeutic and prophylactic care. The degree of medical care and cooperation established precedents for integrating these systems for the medical support of expeditions on the International Space Station.
This Workshop was designed to assist in the ongoing development and application of telemedicine and medical informatics to support extended space flight. Participants included specialists in ...telemedicine and medical/health informatics (terrestrial and space) medicine from NASA, federal agencies, academic centers, and research and development institutions located in the United States and several other countries. The participants in the working groups developed vision statements, requirements, approaches, and recommendations pertaining to developing and implementing a strategy pertaining to telemedicine and medical informatics. Although some of the conclusions and recommendations reflect ongoing work at NASA, others provided new insight and direction that may require a reprioritization of current NASA efforts in telemedicine and medical informatics. This, however, was the goal of the Workshop. NASA is seeking other perspectives and views from leading practitioners in the fields of telemedicine and medical informatics to invigorate an essential and high-priority component of the International Space Station and future extended exploration missions. Subsequent workshops will further define and refine the general findings and recommendations achieved here. NASA's ultimate aim is to build a sound telemedicine and medical informatics operational system to provide the best medical care available for astronauts going to Mars and beyond.
A fundamental goal of space medicine is to maintain the health and fitness of spacecrews. Meeting this goal requires reliable, effective, up-to-date medical support systems for use in microgravity. ...This article describes some of the factors considered in the design and assembly of Russian and U.S. in-flight medical care systems. The successful mutual use of U.S. and Russian medications and medical equipment under the NASA-Mir program conclusively demonstrated the importance and advantages of cooperation among participating space agencies. Continued progress toward the integration of U.S. and Russian flight medical systems will further increase the effectiveness of the medical support of joint missions aboard the International Space Station.
Information has been collected regarding the immediate physiological effects of spaceflight on humans. However, little is yet known regarding long-term effects. The purpose of this paper is to ...describe the Longitudinal Study of Astronaut Health (LSAH) and report current mortality data.
All astronauts selected for the United States Space Program are followed from selection throughout their lifetime or until the end of the study. Comparisons are ground-based Johnson Space Center (JSC) employees matched to the astronauts at a 3:1 ratio by sex-specific age and body mass index. They are followed in the same manner as astronauts. Morbidity and mortality data are obtained from medical records supplemented with study questionnaires. Checks for death certificates are made to ascertain death of participants who miss routine examinations.
Current cause-specific mortality rates for astronauts selected from 1959 through 1991 are not statistically different from rates for comparison participants for cardiovascular (p = 0.8112), cancer (p = 0.2382), or other disease (p = 0.5040) mortality. Astronauts have a significantly higher mortality rate due to accidents and injuries (p < 0.0001).
Astronauts have a similar risk of death due to chronic diseases as ground-based participants, but are at greater risk for occupational-related accidental death.
The potential for occupational radiation exposures in the U.S. Space Program makes cancer risk a major health concern.
The NASA Medical Operations Branch and KRUG Life Sciences Epidemiology Section ...at the Johnson Space Center (JSC) investigated the rate of cancer mortality among the astronauts and the comparison participants of the Longitudinal Study of Astronaut Health (LSAH). Medical records are maintained by the JSC Flight Medicine Clinic, JSC Occupational Medicine Clinic, and LSAH. Cause of death data from death certificates were reviewed for cancer mortality. These data were compared with cancer mortality data for the general population residing in the Texas Gulf Coast area.
The astronauts had a higher age-specific risk of cancer mortality than the comparison group (SMR = 345; 95% CI = 69.5-756.2), but the difference did not reach statistical significance. Both the astronauts and the comparison group had lower age-specific rates than the general population (SMR = 47, 95% CI = 9.6-105.1; SMR = 17, 95% CI = 3.5-37.9, respectively).
The National Aeronautics and Space Administration (NASA) has used iodination as a method of microbial disinfection of potable water systems in U.S. spacecraft and long-duration habitability modules. ...A review of thyroid function tests of NASA astronauts who had consumed iodinated water during spaceflight was conducted.
Thyroid function tests of all past and present astronauts were reviewed. Medical records of astronauts with a diagnosis of thyroid disease were reviewed. Iodine consumption by space crews from water and food was determined. Serum thyroid-stimulating hormone (TSH) and urinary iodine excretion from space crews were measured following modification of the Space Shuttle potable water system to remove most of the iodine.
Mean TSH significantly increased in 134 astronauts who had consumed iodinated water during spaceflight. Serum TSH, and urine iodine levels of Space Shuttle crewmembers who flew following modification of the potable water supply system to remove iodine did not show a statistically significant change. There was no evidence supporting association between clinical thyroid disease and the number of spaceflights, amount of iodine consumed, or duration of iodine exposure.
It is suggested that pharmacological doses of iodine consumed by astronauts transiently decrease thyroid function, as reflected by elevated serum TSH values. Although adverse effects of excess iodine consumption in susceptible individuals are well documented, exposure to high doses of iodine during spaceflight did not result in a statistically significant increase in long-term thyroid disease in the astronaut population.
PDF
