Food allergies can result in some health problems and potential risks. If you take pre-flight measures, your flight will be safer and more pleased.

If you are allergic to dry-roasted nuts, such as hazelnut and peanut, you may make meal preferences accordingly during the flight. Since foods derived from nuts will be available in all aircrafts, you may better avoid them in your meals for your health. Other passengers can also bring nuts to the aircraft. Crumbs and particles of those foods can contaminate seats and disseminated to the aircraft by the air recycled in the aircraft.

To avoid contact with your skin, check your seat and wipe out any food particle or crumbs, if any. Eating food on a dirty surface may trigger an allergic reaction.

Studies demonstrate that approximately 9% of people with peanut allergy suffer from an allergic reaction in the flight.

You can reduce risk of respiratory tract infections by disinfecting your hands frequently and using cleaning liquids. Do not take risks about foods that may cause a health issue during your flight. Show attention to consume foods that are beneficial for your health.Please ask whether the airline company allows pets to travel in passenger cabin before the flight. If another passenger has made a reservation for his/her pet, ask a seat far from the pets. Even though there is no pet on the aircraft, pet hairs can be exposed in all flights. The underlying reason is the pet hair carried by garments. In this case, you should keep your medications with you in order not to have an allergic problem. Besides, do not forget that you can ask flight attendants to change your seat.

Learn if there are local doctors who are specialized in allergic conditions in your destination. Please be sure whether those physicians can prescribe your allergy medications in case of need. Check out overall types of allergies in your destination country. This search can be a guide for your allergy regarding the foods that you will eat for the first time.

Reference

• Mario Sánchez-Borges, In-flight allergic emergencies, World Allergy Organ J. 2017; 10(1): 15.Published online 2017 May 4.

Expectant mothers may need air travel to many reasons, including but not limited to business travels, holidays, family visits and emergencies. Recently, many pregnant women have concerns about flight. Whereas flight is not a contraindication for expectant mothers up to 28 weeks, if there is no high risk factor.

Pregnant passengers should submit a “fit to fly report” that is issued by their doctors to have flight from the beginning of 28 weeks (seventh month) to the end of 35 weeks. No expectant mother is allowed on board in and after Week 36 even if the passenger submits a medical (fit-to-fly) report.

The second trimester (second three months of pregnancy) – ranging from Week 17 to Week 27 – is the ideal time for flight during pregnancy. This period is characterized with low risk, disappearance of nausea and most pleasant trimester of the pregnancy.

Pregnant women should watch for certain issues in a flight. Pregnant women should not stay immobile for prolonged time in long-haul flights and they should mobilize at least once every 2 hours. Expectant mothers may walk down the aisle. Since average flight time is 2 hours for domestic flights, such a measure is unnecessary. Moreover, cabin exercises are recommended that are done in the seat. For long hauls, above mentioned measures should be supplemented by compression socks.

Deep venous thrombosis (DVT) refers abnormal clot formation in the vessel. Although DVT is most common in legs, it can also occur in the arms, femur or other parts of the body. When the blood clot enlarges, it may stop the blood flow over the time. This may impair functions of other organs in the body. Studies report that DVT is observed in people who fly frequently. Here, the considerations are the frequency and the class of the seat. Pregnant state is deemed in the group of moderate risk for the DVT. Studies demonstrate that the risk of DVT is higher for pregnant women than other women.

Reference

• Morteza Izadi, Do pregnant women have a higher risk for venous thromboembolism following air travel?, Adv Biomed Res. 2015; 4: 60. Published online 2015 Feb 23.

Alcohol consumption before and in the flight has some negative influences on the health.

Alcohol consumption should be limited before and in the flight especially as it worsens the dehydration, or alcohol is avoided, if possible.

Studies demonstrate that alcohol consumption usually begins before the flight. People may prefer consuming alcohol for fun, celebration or only coping with stress at airports.

The barometric pressure in the cabin is below many places around the world. Considering that average elevation of mountains is 1800 meters, it is accepted that you will be always above the mountains in the flight. Depressurized environments eliminate oxygen absorption capability of human. This leads to inebriation. Inebriation occurs even when no alcohol is consumed. This is called hypoxia or low oxygen supply to the brain. Alcohol consumption in the flight accelerates onset of the inebriation. Drinking a glass of alcoholic drink in flight differs from consuming alcohol on the ground due to low oxygen concentration in blood. Therefore, the effect will be exaggerated due to low oxygen concentration in the sky. Passengers who consume alcohol in the flight are recommended to limit the amount of alcoholic drink in order to avoid this effect. Since the cabin is specially ventilated to arrange the cabin pressure and the relative humidity is too low in the cabin, alcohol poses another negative effect on the health – excessive urination. Alcohol impairs the balance of body. Considering its effects on the health, the amount of alcohol consumed before and in the flight should be taken into consideration or even, no alcohol is consumed, if possible.

Some studies investigated effects of alcohol on human health and they linked it to suppressed inflammatory activities of the immune system and increased risk of both bacterial and viral infections.

Reference

• Howard C. Becker, Ph.D., Effects of Alcohol Dependence and Withdrawal on Stress Responsiveness and Alcohol Consumption, Alcohol Res. 2012; 34(4): 448–458.

Sleep deprivation is a factor that influences body health adversely. When stress and tiredness overlap, the immune system weakens, resulting in certain diseases. Studies demonstrate that certain diseases, such as heart disease, heart attack, hypertension, stroke and diabetes, are more prevalent in people with sleep problems. What is the underlying reason of sleep deprivation?

Melatonin is a hormone that is released at night and makes us sleep. This hormone also starts the puberty, poses effects on reproduction, has antioxidant characteristics and regulates the body temperature. Melatonin, briefly known as sleep hormone, has numerous benefits. Sleep deprivation occurs when this hormone is not released sufficiently. Changes in sleep pattern cause impaired melatonin release. Traveling is a cause of changed sleep pattern. Although the common view is that the cabin noise in a flight leads to sleep withdrawal, studies revealed out different views.

The study conducted by Penning et al. to measure the effect of cabin noise on the comfort of passengers demonstrated a direct link between the noise and level of comfort. Moreover, other studies reported that the cabin noise helps falling asleep, as it acts like white noise. Or even, there are people who listens to cabin noise in various voice platforms to fall asleep easily.

White noise is a tool that is rather used to eliminate sleep problems in babies. Since the noise is similar to the howl that the fetus hears in the mother’s womb, it instills sense of confidence to the baby. It helps the baby feel comfortable and happy again. Thus, it facilitates falling asleep easier. Many studies are conducted on white nose to reveal out its positive effects on the sleep and positive outcomes are yielded.

Reference:

• Pennig S1, Quehl J, Rolny V., Effects of aircraft cabin noise on passenger comfort., 2012;55(10):1252-65

During the flight, the humidity level of the cabin is low. While the humidity level at your home ranges from 30% to 65%, it may be even below 20 percent in an airplane. It keeps decreasing in long-haul flights.

Low humidity in cabin commonly leads to dry skin, eye, throat and nose. This reduced humidity does not ensure that you take more fluid. Hydration is very important during flight due to several different reasons. Another condition that causes dehydration is the altitude. Although altitude changes start with take-off, it is associated with health problems after 2000 to 2500 meters. Human body starts producing abnormally high amount of urine and breathing rate increases in order to adapt to the high altitude.

Since the air circulation in plane poses the most remarkable effects on humidity and fluid balance of the body, severe dehydration (loss of body fluid) is faced during the flight. Therefore, fluid intake is needed. Moreover, dry skin is another condition that is caused by air circulation and pressure. Many factors play role in the development of dry skin. The most common conditions are stuffy nose and mouth breathing due to pressure changes. Therefore, dry mouth develops. Salivary glands activate to humidify lips and mouth cavity. Sequential dryness and moisturizing cycle leads to dry lip. Dry lip is manifested by symptoms such as cracks, stiffness, tenderness, bleeding and scale on the skin. Dry lips may influence eating behaviors especially if skin of the person is sensitive; it poses effects on gestures and facial expressions and may lead to distress. Cleft formations and bleeding in lips will, undoubtedly, influence the social life adversely. Fluid intake during flight may not be enough to prevent dry lips.

The cabin air also influences your sense of smell during the flight. A study conducted by The Fraunhofer Institute for Building Physics in Germany in 2010 reported that the combination of dry air and low pressure decreases the sweet and salty food sensity of taste buds by 30 percent.

Passengers drink two glasses of water or less during long-haul flights. If one fails drinking water sufficiently especially in flights that last longer than four hours, dehydration develops. Therefore, passengers should take fluid before, during and after flight in order to keep the body well hydrated. Passengers usually forget taking plenty of fluids during flight. Start taking fluids before boarding in order to prevent dehydration. Drink water during flight in every opportunity. However, you should always remind that not all fluids are a good idea. Alcohol may worsen the dehydration. Same applies to caffeinated drinks, such as coffee, tea and coke.

Reference

The Fraunhofer Institute for Building Physics in Germany, Combination of dry air and low pressure, 2010

The cabin is cleaned with antibacterial cleaners after each flight. The high passenger capacity of planes makes the hygiene more important. Although airline companies act responsibly regarding hygiene, it may not be possible to eliminate diseases that may transmit during the flight. Flu, measles and varicella are some examples of air-borne diseases. Flu and common cold may become a hazardous condition especially during the flight. Plane cabins offer a very appropriate environment for viruses to colonize and spread. Many passengers exist all together and cabin air offers the virus what it needs to spread.

A study conducted in Canada in 2004 and published in the Journal of Environmental Health Research reviewed passenger health histories after a five-hour flight from San Francisco to Denver. The study revealed out that passengers are infected by the common cold virus during the flight rather than routine daily life. Authors believe that it is due to various reasons, such as close proximity of seats, common air and very low humidity level. Do not forget that despite all those factors, you can take some measures against flu and common cold.

A series of measures should be taken to prevent diseases during a flight. The cabin air, rate of oxygen and humidity in the inhaled air and microbes that may be transmitted by passengers who sit close to you require attention.

Airplanes are cleaned in line with rules of hygiene before each next flight. This comprehensive cleaning covers the cabin, restroom, food trays and seats. However, this cleaning might not protect your immune system. A group of investigators, who studied hygiene in an airplane, reviewed swab specimens collected from five different airline companies. The study revealed out that the most heavily contaminated area is the food trays in the airplane. If you eat lunch or dinner at the airplane, sterilize your food tray with a wipe. Moreover, you should necessarily wash your hands before and after you eat your meal.

The study also demonstrated that the knob of toilet flush tank is another source of infectious hazard in airplanes. As the knob is used by passengers following each visit to the restroom, you are exposed to bacteria and microbes. Accordingly, you should not directly touch this knob and you should use a handkerchief/wipe when you touch.

Reference:

Professor Martin B. Hocking1 and Harold D. Foster, Common cold transmission in commercial aircraft: Industry and passenger implications, Journal of Environmental Health Research

We face metallic door detectors in many aspects of our life and they are also used for security purposes in the airports. It is a generalized concern if those devices are harmful. Studies show that the full body screening through the X-ray devices used for security purposes in airport entrances does not harm the health and the potential harms are minimized.

The luggage are screened using X rays in airport entrances, but these devices are covered by lead shields in order not to harm the human health. Moreover, these rays does not cause accumulation of radiation in our belongings.

A study conducted by Doctor Rebecca Smith-Bindman, Professor of Epidemiology and Biostatistics in School of Medicine of California University, reports that the radiation exposed due to full body screening in an airport is 0.03 micro-Sievert (a unit of ionizing radiation that is equal to 1 Gray of X and G rays or the amount of radiation that creates the same biological effect). It is known that the dose of radiation exposed by a person in average in a year is 2.4 million Sievert.

According to the results of the study, a full body screening in airports is one per 24 thousand of the natural radiation we expose in a year.

Accordingly, the social bias on the X-ray screening is not supported by scientific studies.

Reference

Mehta P, Smith-Bindman R. Airport full-body screening: what is the risk? Arch Intern Med. 2011 Jun 27; 171(12):1112-5. PMID: 21444831; PMCID: PMC3936792.

Air travel is one of the safest transportation means worldwide. It adds a new dimension to the transportation in terms of time and comfort and thus, it is enormously preferred. The worry or the nervousness that emerges during take-off, landing or turbulence can cause anxiety disorder in some passengers.

A significant part of the population occasionally faces anxiety, which elevates the level of panic. Moreover, they take a feeling of befall for granted in anxiety intervals and they may regard it hazardous.

A study is conducted on anxiety disorder related to air travel on a sample of 238 participants (two thirds were women) and the results show that the causes of anxiety reported by participants include landing and take-off (40%), delays (50%) and passport and luggage procedures (one third). The anxiety is more common in women than men and in persons with an existing health problem than persons with no health problem.

As indicated by the results of the study, the anxiety related to the air travel is a common problem of passengers. If you also feel anxiety related to your flight, you may watch our video prepared within the scope of our “Fly Good Feel Good” project and get professional support about golden standards from Turkish Airlines Flight Academy for factors that cause anxiety, such as turbulence.

Reference

lain B. McIntosh, Vivien Swanson, Kevin G. Power, Fiona Raeside, and Craig Dempster, Anxiety and Health Problems Related to Air Travel, Journal of Travel Medicine, Volume 5, Issue 4, 1 December 1998, Pages 198–204.

Today, the air travel is the fastest and the most useful means of transportation. However, it may have some side effects on the human health, if the passengers do not act carefully. Formation of edema in legs is one of the most common health problems that influence the passengers. It is a common problem for passengers especially during and after the long haul flights. Therefore, it is very important to move during the flight to facilitate the blood circulation and to have a healthy travel, especially in long haul flights.

In a study conducted by 20 persons, including half of them at risk of vein thrombosis, it is reported that the participants fly from/to Washington and Vienna at 2-day intervals. It is emphasized that based on the body volume measurements made before, during and after the flight, the volume of the leg increases from 8242 ± 1420 ml to 8496 ± 1474 after the flight. It is reported that the volume elevates especially in the lower leg and the thigh and that the condition persists for several days after the flight.

The fluctuating pressure and the low humidity in the cabin and the turbulence influence the human physiology while you are on board. In-flight exercises relieve the negative effects of flight on the human body. Minor workout on your seat not only makes your flight more pleasant, but it may also protect your health.

Reference

Formation of Edema and Fluid Shifts During a Long-haul Flight, Journal of Travel Medicine, Volume 10, Issue 6, 1 December 2003, Pages 334–339.

The air breath in the aircraft is substantially healthy. There are various filters equipped in the plane. The fresh air fed outside of the plane are continuously vacuumed into the cabin by the compressors found in the jet engines. Fifty percent of the air is fed into the system, while the rest 50% is exhausted. On the other hand, 50% of the air already existing in the cabin is mixed with the fresh air. At this phase, the air is pressurized until it is equalized to the cabin pressure.

Pressurizing the air heats the air. This air is called “High Efficiency Particulate Air (HEPA)”. The particulate air is first cooled, before it is fed through the filters. This procedure ensures that minimum 99.97% of the bacteria, particles and viruses are caught by the filters. The particulate air is mixed with the air circulated in the cabin and it is made ready for breathing. These filters help mixing the fresh air outside of the plane with the cabin air.

Passengers cannot even recognize presence of a such system. Here, another important issue is the circulation. The cabin air is released from the plane by the exhaust valves. Therefore, the cabin air is continuously cleaned by the fresh air fed outside of the plane. The air HEPA filter equipped in the plane circulates the air for 20 times in average. Therefore, the cabin air is far cleaner than the air we routinely breathe.

Studies show that HEPA-filtered air protects passengers against microbes and infections. This protective shield, called air barrier, is kept efficient through the flight.

Recently, a series of technical papers and journal articles is authored on the belief of the poor cabin air quality. Typical relative humidity of the pressurized air used to ventilate the cabin is low – ranging from 5% to 25 percent. The complaints about the conditions of the cabin air include dry air, nasal congestion and the temperature. Most complaints on the quality of the cabin air were originating from a preventable cause, namely smoking, before most airliners forbid smoking aboard. Thus, the events arising out of the poor quality of cabin air is somewhat reduced, as the smoke cannot reach the cabin.

References:

• Thibeault C. 2002. Airliner cabin air quality. See Ref. 31, pp. 279-92.
• Thibeault C. 2002. The impact of the aerospace industry on environment and public health. See Ref. 30, pp. 645-68.

In comparison to land travel and sailing, air travel is faster and comfortable, but the risk of infection has always been a concern. Because crowded people travel in a limited area for a long time. Although the cabin is cleaned in line with “Aviation Hygiene and Health Guidelines” that is issued by Ministry of Health and World Health Organization (WHO) and the cabin crew follow all hygiene rules, there are some risks that require attention.

Many passengers fly concomitantly and long times are spent in limited areas. Accordingly, chairs, belts, table, sun visor, overhead indictors, toilet door, closet and faucets become dirty places that many people touch and contaminate.

In a study that examined samples collected from various points in the plane to evaluate risk of infection in a plane, samples are collected from flights of two major airline companies in 5 different airports. It is revealed that unacceptable microbial counts are obtained in seats, trays, tables, sun visors, toilers and seatback pocket. However, the surprising finding is that dirtiest location is seatback tables rather than toilets.

Bacterial count is 265 CFU/ square inch in the button of the toilet flush, but it is 8 times higher in seatback tables (2.155 CFU). This finding is considered due to the fact that toilets are regularly cleaned between flights. It is also noted that overhead air conditioner button is dirtier than the toilet (285 CFU). The door lock of the toilet was the most clean location (70 CFU).

This study objectively indicates and it is also scientifically advised that cleaning hands is the first anti-infectious measures, which can be taken in planes. Other hygiene rules also reduce the risk of infections.

If passengers expose to a passenger with a potentially infectious disease, anti-infectious measures become a very important issue. Although airliners have the right to refuse passengers with an infectious disease or a medical problem that contraindicates the flight, it is not easy to screen passengers for infectious diseases and to refuse the passengers with signs and symptoms of infectious diseases. In this case, the healthcare professionals should identify the persons. Prevention of an outbreak is the most important control means and therefore, sick passengers are recommended to postpone the flight. Moreover, studies evidence that a proper hand hygiene reduces the risk of getting infected. Use of a mask plays a very important role in the infection control.

References:

• Gendreau M, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med 2002; 346: 1067–73.
• Ryan E, Wilson M, Kain K. Illness after international travel. N Engl J Med 2002; 347: 505–16.
• National Research Council. The airline cabin environment and the health of passengers (2002). Washington, DC: National Academic Press, 2002.

Deep vein thrombosis (DVT) refers abnormal clot formation in the vessel. Although DVT is most common in legs, this condition can also occur in the arms, femur or other parts of the body. Persons with active DVT or health history of this condition, stroke survivors, cancer patients, the walking disabled and persons with health history of major surgery are regarded in the group of high risk for DVT.

Studies report that DVT is observed in people who fly frequently. Here, the considerations are the frequency and the class of the seat. Frequent flight, long-haul flights and immobility in the flight are the other risk factors of DVT.

The link between the flight, occurrence of DVT and the subsequent “pulmonary embolism” and “thromboembolic disease” is first identified by a doctor in 1954 in a report that addressed a case of DVT following a 14-hour flight. The popularity of the air flight has significantly increased since then. Medical and popular press published too many essays on the link between the flight and the occurrence of DVT and PE. This condition boosted the reports on “economy class syndrome” and in conclusion, travelers were warned about the risk of thrombosis.

It is reported that some cabin factors increase the risk of DVT and PE. Among them are narrow seat positions, immobility, alcoholic drinks, other diuretics such as tea and coffee, low humidity of the cabin and potential dehydrates such as decreased barometric pressure.

Cabin exercises can be tried to prevent the risk of DVT.

Reference

• Air Transp. Comm., Aerospace Med. Assoc. 2001. Travellers’ thrombosis: a review of deep vein thrombosis associated with travel.

Stress can be faced before the flight along with any moment of our life.

Despite anecdotal evidences, which indicate that flight is a subjective preference, there are scarce studies that address the air travel stress.

Check-in line, necessity to arrive the airport 2 to 3 hours before the flight for the luggage and security check and subsequent process are regarded among most important causes of the pre-flight stress. Moreover, it is emphasized that media news, crowded airports, delays and cancellations play significant role in the air travel stress.

The studies show that the unique nature of air travel interestingly requires stress for a safe and valid air travel. Previous research emphasize that the perceived air travel stress may lead to strong emotional reactions, including anxiety and anger. Components of anxiety may include the anxious effect, concerns about future negative events and somatic reactions such as tachycardia.

On the other hand, when the pre-flight stress is evaluated as the sole factor, it is emphasized that the pre-flight processes have strong influence on the human affect. This may cause anger, anxiety and psychosocial stress. The term “psychosocial stress” means losing temper and acting accordingly after the plane takes off. You can watch flight preparation videos or follow the advices written in our articles to cope with the pre-flight stress. Thus, you can experience a pleasant and stress-free air travel.

Reports issued by aviation industry reveal out that the air rage is steadily increasing and it had reached serious figures over the time. This condition is primarily threatening the flight safety. We, hereby, recommend a stress-free life not only for daily routines, but also for your travel.

References:

• Deheart, Roy L. "Health Issues of Air Travel." Annual Review Public Health, 7 Nov. 2002.
• Jonathan B. Bricker "Development and Evaluation of the Air Travel Stress" Journal of Counseling Psychology, 2005, Vol. 52.

Although modern aircrafts are far comfortable than their ancestors, passengers may, at times, encounter physical or psychological challenges that are caused by the flight environment. Some of these challenges are addressed in investigations.

One of the most common challenges is hypoxia – oxygen deficiency. Partial oxygen pressure decreases by 20% relative to the sea level while flying at a certain altitude. This mild hypoxia does not cause a problem for health people. However, it is not the case for people with certain health problems, such as heart disease, chronic respiratory tract disorders and anemia.

It is known that the barometric pressure fluctuations in the cabin influence certain body parts, such as middle ear, paranasal sinuses and the bowel. While the plane is climbing, the cabin pressure decreases, resulting in up to 30% expansion of gases. This would not lead to serious problems, other than mild abdominal discomfort and blocked or clogged ears, under normal circumstances. People suffering from such problem may follow the techniques, such as Valsalva Maneuver, that are explained in detail in our pages nasal congestion and ear problems.

Motion sickness can be one of the physical effects exerted by the flight. A study on motion sickness while flying reported that 0.5% of passengers vomited and 8.4% felt nausea (upset stomach) during the flight. Motion sickness can be severe if exposed to turbulence in the flight. The predisposed people are recommended to take necessary measures before the flight.

Reference

• Dowdall, Nigel. "Customer health: a new role for occupational physicians." In Depth Review, 3 Dec. 2002.

The studies on influence of the route of the destination on the performance generate conflicting results. Some data report that traveling to east is more hazardous for the performance. It is emphasized that the underlying factor is about the normally longer circadian rhythm longer – >24 hours or approximately 25 to 26 hours. In conclusion, it is reported that the body adapts more easily to the changes, which prolong the day rather than shortening it.

Many studies show that the eastward passengers experience more labile symptoms of jet lag, which require longer time for re-synchronization, as the body follows a quicker adaptation due to the phase latency. The studies conducted by Lemmer et al. report that symptoms of jet lag following westward flight are predominantly faced in the first three days and that the symptoms are more severe following eastward flight and they persist even 7 days after the arrival.

The jet-lag and these results related with adaptation should be taken into consideration by people, who have busy schedule and require more physical activity, and especially by athletes. Based on results of this study, business or sports schedule is a critical factor that influence the performance following the travel. In case of a disadvantageous travel schedule, it can be advantage to synchronize the body clock gradually before the flight. You can watch our videos to learn how to do this.

References:

• Lemmer B, Kern RI, Nold G, et al. Jet lag in athletes after eastward and westward time-zone transition. Chronobiol Int 2002;19:743-64.
• Reilly T, Edwards B. Altered sleep-wake cycles and physical performance in 88 athletes. Physiol Behav 2007;90:274-84.
• Loat CE, Rhodes EC. Jet-lag and human performance. Sports Med (Auckland, NZ) 1989;8:226-38.

Every year about 2 billion people make aircraft journeys, and the issue of jet lag has always been a point of discussion. Jet lag describes the temporary disruption to the circadian rhythm associated with long-haul flights which causes physical symptoms such as daytime fatigue, insomnia, loss of appetite, digestive complaints like constipation, lapses in psychomotor coordination and sluggish mental performance. 

Jet lag occurs as a result of a disturbance in the synchronization of your body's internal clock. According to the jet lag studies carried out by Dr. Waterhouse and colleagues published in 2007, this is a result of a discrepancy between the time zone in the suprachiasmatic nucleus of the hypothalamus and the new light-dark cycle, and the synchronization problems this causes in the brain. Jet lag is a manifestation of the difficulty the body has in adapting to the change in the light/dark cycle. 

In a simulation study carried out by Burgess and colleagues in 2003 and published in the Journal of Biologic Rhythms, in order to set the circadian rhythm appropriately, it was shown to be of benefit to go to bed 1 hour earlier and to be exposed to bright light upon waking up for 3 days before traveling east. It was also shown in the study that the more time you apply this phase therapy and plan your sleep before traveling, the more effective it will be. It has the potential to prevent jet lag altogether. 

References 

• Waterhouse J, Reilly T, Atkinson G, Edwards B. Jet lag: trends and coping strategies. Lancet 2007; 369: 1117-29. 
• Burgess HJ, Crowley SJ, Gazda CJ, Fogg LF, Eastman CI. Preflight adjustment to eastward travel: 3 days of advancing sleep with and without morning bright light. J Biol Rhythms 2003; 18: 318-28.

The cabin environment can affect passengers of different ages and conditions of health in different ways. Flight cabin pressure can directly affect the digestive system. Many people who fly fear that it is just them affected by gas and bloating, and embarrassed, they suffer in silence. 

Low cabin pressure leads to gas expanding. According to Boyle's law, gas expands by 35% when it is 8,000 feet above sea level. Even though the cabin pressure set on aircraft used by modern airlines endeavors to save passengers from the effects of the real pressure at cruising altitude, the change in pressure means it is still as if the body has instantly climbed a tall mountain. 

Despite the hypothesis that spaces in the body filled with air can be affected by pressure when flying, it is only really felt in the ears and as bloating. These spaces include the inner ear and sinuses, the intestines, the pleural spaces of the lungs, some dental fillings, and the skull. Because take-off and landing are quite gradual processes, the change in pressure is quite slow and so the effects on the body are limited. 

Several studies have been carried out on complaints of gas and bloating. In their study carried out in 1995, Enck and colleagues looked at the difference in indigestion complaints between ground staff and cabin crew. In 2000, Vejvoda and colleagues showed in their study that the rate of complaints of bloating was much higher in cabin crew working on long-haul flights compared with ground staff. The study published by Hinninghofen and colleges in 2006 underlined that what you eat while flying is directly related to gastric emptying time, and at an altitude of 2,500 m, gastric emptying time is negatively affected, thus increasing the chance of indigestion. The study also showed that gastric emptying time is extended by around 50 minutes, and this leads to more gas, bloating and nausea. 

So, studies show that these problems are common when flying, and that you are certainly not alone. 

References 

• Hinninghofen, H., Musial, F., Kowalski, A., Enck, P., 2006. Gastric emptying effects of dietary fiber during 8 hours at two simulated cabin altitudes. Aviat. Space Environ. Med. 77 (2), 121-123.  
• Vejvoda, M., Samel, A., Maas, H., Luks, N., Linke-Hommes, A., Schulze, M., Mawet, L., Hinninghofen, H., 2000. Study on strain, workload, and circadian rhythm in cabin crews during transmeridian flights. Research Report 2000-32. Deutsches Zentrum für Luft-und Raumfahrt (DLR), Cologne. 
• Enck, P., Mueller-Sacks, E., Holtmann, G., Wegmann, H., 1995. Gastrointestinal problems in airline crew members. Z. Gastroenterol. 33, 513-516.

When flying, swelling of the feet can be a direct result of age, the health of vein walls, anatomical composition, pregnancy or varicose veins. The muscles which prevent fluid retention need to move in order to do their job. When sitting for long periods, blood flow stops as a result of reverse pressure, and fluid begins to gather in extremities. 

In 1996, Shuster and colleges first published their research on feet swelling during flight in the respected medical journal, The Lancet. A study was conducted which featured a simulated flight of 12 hours, with one group having a daytime flight, the other having a nighttime flight. 

The results of the research showed that water retention occurs more severely at night. The condition was seen most commonly in women over 30 and those with varicose veins. The study underlined the impact of in-flight ambient temperature and cabin pressure, and indicated that the condition is a natural result of these. 

Scientists also state that exercises and massage while flying can have a positive effect on the condition. It was also highlighted in the research that wearing tight socks before traveling makes the condition worse. People who suffer from feet swelling are advised to wear loose-fitting socks and to do exercises which work the ankle. 

References 

• Shuster S. Jet flight leg and hypobaric pressure. Lancet. 1996 Oct 5;348(9032):970. PubMed PMID: 8843849. 
• Shuster S. Jet flight leg. Lancet. 1996 Mar 23;347(9004):832-3. PubMed PMID: 8622363.

Human beings live in an environment with stable direction and magnitude of gravity force. Passengers may, directly or indirectly, perceive vibrations, motion and centrifugal forces during flight. In addition, the turbulence in a flight may create a linear movement on the vestibular (balance) system. Vertical or circular movements in the vestibular system are accompanied by particular complaints, such as nausea and dizziness. Balance problems may also lead to motion sickness.

The study titled “Airsickness and aircraft motion during short-haul flights” conducted by Turner et al. on 923 passengers in 38 flights revealed out that vomiting is reported by 0.5% of passengers and nausea is reported by 8.4%. The study found positive correlations between symptoms and low-frequency lateral and vertical motions. Moreover, it is reported that selection of seat or demographics of passenger are not directly correlated to those findings.

Studies on airsickness emphasize the importance of reducing exposure to vibration and seeing the horizon line. The Health Info articles on airsickness published by University of Maryland and Mayo Clinic recommend passengers to prefer seats over the wing or the front section.

The Flight Phobia video that is shot within scope of the Fly Good Feel Good project will guide you to cope with the airsickness. Moreover, our ginger teas may help preventing the nausea. Have a nice flight.

References 

• Turner M, Griffin MJ, Holland I. Airsickness and aircraft motion during short-haul flights. Aviat Space Environ Med. 2000 Dec;71(12):1181-9.
• Schmal F. Neuronal mechanisms and the treatment of motion sickness. Pharmacology. 2013; 91(3-4):229-41.

Have you ever felt in a long-haul flight that your contact lenses dried or even your eyes are irritated? The condition is caused by the environmental conditions of the cabin. Passengers with contact lenses may face such problems due to pressure alterations in the cabin.

Aircraft cabin exposes the passengers to low atmospheric pressure, oxygen and humidity as well as dry air. The underlying cause is the artificial low atmospheric pressure that is created to fly at an altitude of 35 thousand feet. Those conditions may cause ocular discomfort in passengers with contact lenses especially in flights lasting longer than 3 hours. Studies report that moisturizing eye drops approved to be used with contact lenses may help curb the dry eye during flight. As the dry eye causes irritation and infection, passengers who wear contact lenses are recommended to remove lenses aboard.

You should also be careful not to fall asleep with contact lenses on your eyes during the flight. Contact lenses stiffen due to partially low oxygen and dry air, resulting in the risk of corneal abrasions. You are recommended to keep your contact lenses and irrigation solutions in your bag during flights. The 100 ml limit set for liquids aboard does not apply to lens solutions, but such solutions should be declared at the security check. You may also prefer travel type lens solutions or smaller packages. If you do not have small packaged lens solution, you may need to pour some of the solution to another container. This approach may go up in flames regarding infection.

Preferring eyeglasses rather than contact lenses especially in long-haul flights can be much healthier.

References 

• Backman H, Haghighat F. Air quality and ocular discomfort aboard commercial aircraft. Optometry 2000; 71(10):653-6.
• DeHart RL. Health issues of air travel. Annu Rev Public Health 2003; 24:133-51.

There are hundreds of studies conducted on nausea and vomiting that are among the most important symptoms of the motion sickness. The underlying causes of those symptoms include environmental factors that influence the vestibular (balance) system, such as vibration. It is known that vibration and vertical motions cause nausea in passengers in a flight.

Natural solutions can be used for nausea – a symptom of the motion sickness. Ginger has been used as a wide-spectrum antiemetic agent (that curbs the nausea) in traditional medicine for more than 2000 years. Various pre-clinical and clinical trials show that ginger poses antiemetic effects on various factors, which induce nausea. Although there are studies reporting that same effect does not apply to everyone, many research reports claim that ginger is a natural anti-emetic substance. A study conducted by Lien et al. in 2003 demonstrates that the ginger is efficacious in alleviating the nausea induced by circular vection. It is, therefore, reported that ginger can be a new agent in prevention and treatment of motion sickness.

Within scope of the Fly Good Feel Good project, detailed information about ginger teas is available at Special Teas page. You can try our special teas to cope with nausea during flight.

References 

• Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang C. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol. 2003; 284(3):G481-9.
• Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. B J Anaesth. 2000;84(3):367-371

Airline travel is regarded among most common causes of the middle ear barotrauma (the airplane ear). Although the infants and children, nowadays, often travel by airlines, the literature on this issue is scarce. The studies on infants and children during a flight are usually limited to case reports and observational studies. 

While airplanes start climbing above the sea level, external pressure decreases and the middle ear starts absorbing air to balance the pressure difference. When the airplane starts descending, external pressure increases and the middle ear increases the pressure to reach a balance. However, when the pressure changes cannot be regulated due to a pathology, babies and infants may feel acute and severe ache. Since babies cannot specify nature and location of the complaint, they are more prone to this condition and the ache can cause onset of anxiety. 

When the pressure adaptation fails, the eardrum stretches and even it may, sometimes, cause local cracks. These conditions are common especially in the infants and children who have active upper respiratory tract infection and ear infection or are sleeping. Children are recommended to swallow or do “Valsalva Maneuver” that is instructed in the video content of the Fly Good Feel Good project in order to avoid barotrauma or the airplane ear that is caused by pressure fluctuations. 

Sucking hard candies and chewing gum are not recommended, because they may cause the risk of aspiration. The adverse weather conditions at flight altitudes may lead to instant altitude changes that can be felt while traveling by plane. A possible excitement during such an event may cause aspiration of the gum or the candy into the airway, resulting in blockage and choking. Studies show that fluid (water or soft drinks) consumption or breastfeeding is the best method to prevent barotraumas in infants and children in such circumstances. 

You may watch our video to learn about maneuvers to perform against barotrauma and to eliminate the stuffy ear. 

References: 

• Samuels MP. The effects of flight and altitude. Arch Dis Child. 2004 Mar;19(5):448-55. Review. 
• Rosenkvist L, Klokker M, Katholm M. Upper respiratory infec- tions and barotraumas in commercial pilots: a retrospective survey. Aviat Space Environ Med. 2008;79:960-3. 
• Brown TP. Middle ear symptoms while flying. Ways to prevent a severe outcome. Postgrad Med. 1994;96:135.

It is known that airline companies have established facilities to treat the fear of flying of passengers by cooperating with private entrepreneurs or mental health experts. According to a review paper issued in 2000, while 43 out of 212 airline companies that could be contacted were actively working on this issue, only 15 companies provided passengers with detailed information and training, but the figure quickly reached 36 companies in 2004. The increase in number of training facilities might have originated from the increased demand to treatment by people with fear of flying or a factor that caused airline companies be more interested in rendering more services in this field. Nevertheless, sufficient knowledge was not available in the scientific and professional literature while such education programs were initiated. 

The studies report that the prevalence of the fear or phobia of flying ranges from 10% to 40%. The studies that discuss and address safety, health and comfort of passengers argue that the stress emerges on the way to the airport rather than during the flight. It is emphasized that arrival to airport, boarding on time, checking in with heavy luggage and even security control cause stress. If the fear of flying is added to those stresses, a considerable number of passengers gives up the flight. 

There has been a wide variety of methods and protocols used to date for the fear or phobia of flight. However, when these figures climbed, experts thought that the “best” major components of the fear of flying support educations should be standardized. Therefore, there are now gold standards that are commonly agreed and meet these requirements. If you have fear of flying or concerns about traveling by plane, you may watch our video prepared within the scope of our “Fly Good Feel Good” project and get professional support about golden standards from Turkish Airlines Flight Academy. 

References: 

• Van Gerwen LJ, Diekstra RF, Arondeus JM, Wolfger R. Fear of flying treatment programs for passengers: an international update. Travel Med Infect Dis. 2004 Feb;20(1):27-35. 
• Rayman RB. Passenger safety, health and comfort: a review. Aviat Space Environ Med 1997;68:432-440. 
• Jones DR. Fear of flying--no longer a symptom without a disease. Aviat Space Environ Med. 2000 Apr;37(4):438-40.

Airline transportation has become a very popular form of travel as companies that offer affordable prices engaged in more competition. As the case for all other travel means, transportation has unique risks. Having a snack or eating on airplanes makes an important part of these air travels. However, passengers may face risks, such as food poisoning, as many companies prefer cheap options for catering services. 

Food-borne illnesses are extremely rate in modern airline transportation sector. However, you should consider this risk along with the price, while buying your ticket. What if all passengers are caught by a foodborne disease and the condition also involves the flight crew? The results of this picture in transatlantic flights may pose fatal risks that may not be as cheap as the ticket you bought. 

The studies show that prevalence of food poisoning ranges from 3% to 24% and it is observed that the prevalence is especially high in developing countries. Chicken, cream desserts and sea foods are the most common examples of in-flight catering that cause poisoning. When the risk analysis and etiological factors are reviewed, an infection that develops during the flight may be manifested after the travel and passengers may not recognize the condition. Therefore, it is necessary, as recommended by relevant research, to know how in-flight foods are prepared and cooked and to be aware of various food safety standards. 

Those studies briefly report that food preparation and storage should meet high standards to ensure quality and safety of in-flight catering. These standards are not only valid for airport kitchens, but also apply to vehicles that transfer foods from premises to the aircraft and to the airplane kitchens. Turkish Airlines fulfills such standards and offers fresh foods and snacks in homemade format. In-flight foods and snacks are prepared in line with high standards and they make the travel more pleasant and healthy. 

References: 

• Lambiri M, Mavridou A, Papadakis JA. The application of hazard analysis critical control point [HACCP] in a flight- catering establishment improved the bacteriological quality of meals. J Roy Soc Health 1995;115:26-30. 
• McMullan R, Edwards PJ, Kelly MJ, Millar BC, Rooney PJ, Moore JE. Food-poisoning and commercial air travel. Travel Med Infect Dis. 2007 Sep;17(5):276-86.

The inability to adapt to the destination after intercontinental long-haul flights originate from a transient sleep disorder that is medically called “jet lag”. Jet lag causes you feel tired and exhausted at the destination and it is well known by passengers who travel often. Jet Lag will, especially, be more severe when you fly east. 

People generally live in a 24-hour time zone. Every cell in body works like a clock and self-arrangement is made according to the signal received from the brain. However, crossing multiple time zones rapidly disrupts the synchronization. Jet Lag refers the sleep disorder in people who rapidly travel across different time zones of the world. 

Jet-lag is caused by desynchronization of the body clock. Potential psychiatric complications of jet lag have not been studied to date. However, the referenced study discusses symptoms of jet lag in general population, its psychological aspects and the potential relation between the jet lag and psychology. The study concludes that the sleep deprivation arising out jet lag secondary to impaired biological rhythm can exacerbate the existing psychological conditions.

Each corner of the world is, now, more accessible especially as intercontinental flights have become widespread. Pregnancy should be regarded as a natural period of life rather than a disease period that requires limitations and delay of holiday plans and accordingly, ordinary life should be maintained. 

Expectant mothers may need air travel to many reasons, including but not limited to business travels, holidays, family visits and emergencies. Recently, many pregnant women have concerns about flight. Whereas flight is not a contraindication for expectant mothers up to 28 weeks, if there is no high risk factor. It is only required to know some health-related conditions that are caused by flight. 

The second trimester (second three months of pregnancy) – ranging from Week 17 to Week 27 – is the ideal time for flight during pregnancy. This period is also characterized with low risk, disappearance of nausea and most pleasant trimester of the pregnancy. 

A study conducted in 2001 on 138 pregnant women, who attended routine sonographic screening and had international flights, including more than half in the 3rd trimester, shows that most participants are open up to long-haul flights, but they are not always well prepared. In this study, more than one third of participant pregnant women had long-haul flights, i.e. outside Europe. However, only one third of them consulted the doctor and sought information about health-related issues before the flight. 

It is necessary to know and take some measures to ensure safety of both you and your baby during a flight. You can take a glance at our video content prepared for pregnant women within scope of “Fly Good Feel Good” guide.

Flight pioneers all other transportation means, as it provides many advantages. It is often used especially as it saves time. Despite all these pros, it may also, rarely, cause health problems. Headache is one of the health problems that develops especially while the plane is descending. The tube located behind the eardrum works heavily to balance the air pressure during take-off and landing. Thus, it helps balancing the air pressure inside the ear. Accordingly, it is expected to feel pressure and ache in ears during take-off and landing. 

Headache during flight is also discussed in studies. The study titled “An Unusual Case of an Airplane Headache, Atkinson V, Lee L” that was published in 2004 addressed causes of headache that develops during flight and focused on barometric headache. 

These conditions are caused by pressure and called barotraumas. Barotrauma is subject to interpersonal variations. For example, the pressure is felt more strongly by the children, as their ears are more sensitive. You can do one of the maneuvers recommended in our “Fly Good Feel Good” guide to relieve the effect of barotraumas.

Today, the air travel is one of the fastest and the most useful means of transportation. However, it may have some side effects on the human health, if the passengers do not act carefully. One of the most common problems that influence passengers of flight is the dehydration that is secondary to low humidity in cabin air and insufficient fluid intake.

The dehydration secondary to the air travel is especially caused by low humidity level in the cabin. Normal indoor humidity level ranges from 30% to 65%. However, the humidity level in the cabin is usually 10% to 20%. Accordingly, measures are necessarily taken to take enough fluid during flight.

Research show that especially in long distance flights, hydration of the skin surface decreases quickly. Since very dry air is circulated in the cabin, you should carry a humidifier to prevent this condition.

Moreover, plenty of water should be sipped to avoid dehydration in the flight. Dehydration worsens symptoms of the jet-lag. Resulting from loss of fluid, edema makes passengers feel more “swollen” and uncomfortable. To avoid this, try to drink warm water.

Reference:

Guéhenneux S1, Gardinier S, Morizot F, Le Fur I, Tschachler E. , Skin surface hydration decreases rapidly during long distance flights, Skin Res Technol. 2012 May;18(2):238-40.

The most important flight-related health problem in babies occurs in ears. Babies may cry loudly as they feel fullness and ache in ears due to fluctuations in cabin pressure especially while the plane is ascending and descending. The baby should be fed to relieve in order to avoid the condition. As babies suckle to swallow, ear ache can be relieved, if babies are breastfed during descent.

Research show that non-feeding infants cry more than feeding infants while the plane descends.

However, it is necessary to keep in mind that if you continuously feed your baby to keep her calm, stomach of the baby will strain and this will result in more crying. To prevent this, use of a pacifier is more appropriate if the infant is satiated.

Reference

Byers PH, Infant crying during aircraft descent, Nurs Res 1986 Sep-Oct;35(5):260-2.

Biological clock is defined as metabolic and hormonal cycles that regulate all bodily systems and the clock itself is usually regulated by the day light. Although your biological rhythm is adjusted such that we need to fall asleep at a particular time, the balance can disrupt due to many reasons, such as headache, tiredness after a journey, and extra stress.

Sleep deprivation is a factor that influences body health adversely. When stress and tiredness combine, the immune system weakens, resulting in certain diseases. Insomnia occurs when melatonin secretion, which is also known as sleep hormone, is insufficient. Changes in sleep pattern cause impaired melatonin release. For instance, if an individual sleeps at day time and stays awake in the evening and at night, he may complain of not having enough sleep, although he sleeps well regarding length of sleep. Supplements are available that stimulate secretion of this hormone. However, it is also possible to balance secretion of melatonin using natural foods with no need to medicines.

Studies revealed out that cherry and cherry juice increase secretion of melatonin. Research is tried on adults. It has been reported that the group members who drank tart cherry juice could restore healthy sleeping cycle. It is observed that sleep problems – including difficulty falling asleep and waking up at frequent intervals – did not persist.

You can try “relaxation” tea that is included in special range of tea to help insomnia within scope of “Fly Good Feel Good Project”.

Reference: 

Wilfred R. Pigeon,corresponding author1,2 Michelle Carr,1 Colin Gorman,1 and Michael L. Perlis3, Effects of a Tart Cherry Juice Beverage on the Sleep of Older Adults with Insomnia: A Pilot Study, J Med Food. 2010 Jun; 13(3): 579–583

Nowadays, commercial aviation is one of the most preferred travel means. Passengers prefer it, as it is comfortable and saves time. The cabin pressure fluctuations in take-off and descending of planes may cause, albeit not always, health problems in some long-haul flights. It is assumed that the cabin air is equal to the altitude of 800 to 2.600 meters. This means that pressure of the cabin air is lower than the air at the sea level. Gases start expanding as air pressure in the plane decreases. The rate of gas increases as the plane keeps ascending. This condition is manifested by feeling pressure in stomach and intestines. Gas and distension are usually confused with each other. Especially, postprandial distension is confused with gas or flatulence. Distension is secondary to foods that are not digested by intestines. When undigested foods are transported from small intestines to the colon, they spoil due to non-hazardous bacteria of the colon. Hydrogen, carbon dioxide and methane gases are released. If this cycle does not operate properly, indigestion problems develop.

A healthy human passes gas 14 to 15 times a day in average. A large part of the gas is removed by belching. The rest flows through and partially absorbed in the bowel. If you suffer from stomach and bowel problems at frequent intervals, you should better eat light foods and probiotics before the flight. It is necessary to avoid foods that provoke flatulence in flight. Broccoli, onion, white bean, shell beans, haricot bean salad, cabbage and whole-meal foods increase gas formation in intestines, if they are consumed before the flight. Take care of fluid intake during flight in order to avoid stomach and bowel problems.

A team of Danish and British gastroenterologists and Jacob Rosernberg, a member of this team, issued a report on the wind inside planes by inspiring from a flight from Copenhagen to Tokyo. The paper reports that an average person breaks wind, an inevitable result of digestion, approximately 10 times per day. The paper authored by Hans Christian Pommergaard, Jakob Burcharth, Anders Fischer, William Thomas and Professor Rosenberg and published in New Zealand Medical Journal stated that patients prefer holding it in the bowel rather than breaking the wind, but it is undesirable. Passengers may break wind more in flights due to fluctuations in volume of bowel gases as the cabin pressure changes.

Although the wind that is the worst scenario in flights is mostly embarrassing, studies reveal out that flatulence is a common complaint in flights. You are not alone for this condition with known causes.

Reference

• Jacob Rosenberg, University of Copenhagen Herlev Hospital · Department of Surgery, How to tackle the most embarrassing problem on planes, A statement by Hans Christian Pommergaard, Jakob Burcharth, Anders Fischer, William Thomas and Jacob Rosenberg in the New Zealand Medical Journal.

Turbulence is one of the most common terms we hear following widespread use of commercial aviation. Turbulence – a term that annoys and is a source of fear for most people – is, in fact, violent movement caused by wind, thunderstorm, close proximity to mountains and other factors. You may also face a storm during a road trip. As is the case with this condition, sudden-onset events may occur that you are not prepared for. It also applied to turbulence. It cannot be predicted.

Turbulence may cause panic in passengers in a flight. Turbulence can occur in all flights. It is more common in long-haul flights and it is usually non-hazardous. However, it may make you feel discomfort and fear. There are many underlying factors and severity of turbulence may change (air flow, close proximity to mountains, thermal flow etc.) Therefore, effects may vary according to the type of turbulence. Also defined as rocking or fall of planes into an air pocket, turbulence is, in simplest term, the air flow caused by intermittent wind from different and unexpected direction.

It is difficult to predict turbulence before the flight. However, pilots known the conditions that may cause turbulence in flight in most cases. Weather report, cockpit radar and reports sent by other aircrafts help the pilots in the flight. Therefore, pilots may switch on the safety belt sign when the plane is close to the turbulence. It is necessary to follow announcements by pilots and warning signs in the flight.

Irrespective of the severity of turbulence, safety of the plane is rarely the case. Pilots are trained to ensure that all necessary measures are taken in case of a danger. They know types and effects of turbulence and ensure safety of the plane.

According to studies conducted by Federal Aviation Administration, the most important factor in injuries during a turbulence is ignorance of safety warning lights by passengers. The study reports that the passengers with the seat belt fastened may not get injured in the turbulence.

Dangers caused by turbulence are still an important topic of agenda in the commercial aviation. Studies demonstrate that the improper safety is the major factor for injury of passengers and flight attendants in the flight. It is rational to be careful and take measures.

Reference

• Wayne L. Golding, Turbulence and Its Impact on Commercial Aviation, Number 2 JAAER Winter 2002

Nowadays, back pain is one of the most common health problems. Being prevalent especially in industrialized Western communities, this condition is recently deemed as an outbreak by experts. Such that it is the most prevalent disease for the population younger than 45 in the U.S., while approximately 25% of the population suffers from back pain in the U.K. In our country, back pain is observed especially in people with desk job and in frequent travelers. The back pain is secondary to sitting still for a long time and it is among the most common complaints reported to commercial airlines. Flights may be difficult for you, even if you have no back problem. The underlying reason is that the body is not appropriate for sitting still for long hours.

The back rests of the seats are made of foam fillers. When you sit for prolonged time, the foam is ever increasingly compressed and therefore, the air in the foam decreases. If you are especially tall and strongly built, you cannot move easily while sitting. Your back is exposed to these conditions especially in long-haul flights. Back pain is usually a sign of strain in the back. Therefore, frequent travels will make future back problems likely even if your back is strong and flexible. If you are among the ones who are already suffering from back problems, sitting in a cabin seat in constrained posture for eight hours or a longer time may worsen an existing problem.

Many people suffer from acute back pain episodes. A back pain that you recognize following a long-haul flight may become chronic. These pains almost always originate from the accustomed weak postures. Although the health effects observed in a study conducted on back pain and exposure to whole body vibration in helicopter pilots arise out of vibration or constrained posture, it is demonstrated that it is most likely due to concomitant exposure to both factors. Tennis, swimming or exercise strengthen the muscle that keep your vertebral column erect. If you do not like exercise or sports, the muscles, tendons and ligaments that hold the bones in your vertebral column will weaken. Poor posture and weak spinal muscles may cause permanent damages in your back.

Reference

• Bongers PM1, Hulshof CT, Dijkstra L, Boshuizen HC, Groenhout HJ, Valken E., Back pain and exposure to whole body vibration in helicopter pilots., Ergonomics. 1990 Aug;33(8):1007-26.

Various factors may play a role in a heart attack, which is the most common cause of death both in our country and around the world. Occluded blood vessels are among the leading factors causing heart attack. However, there are also other factors that we are exposed to in daily life which may trigger a heart attack. 

Unhealthy eating, sedentary life, high blood cholesterol, hypertension (high blood pressure), stress, overweight and smoking increase the risk of heart attack. Heart attack is, in fact, a multi-factorial condition. This fact clears out that the genetic factor alone is not the only causative mechanism. 

Shoulder pains may not always indicate the risk of heart attack. However, a high index of suspicion is required, if the shoulder pain is followed by left arm pain, as the persons with increased risk of heart disease are more likely to suffer from a complaint in shoulder. On the other hand, since there may be many underlying causes of the left arm pain, one should not confuse all pains with a sign of heart attack. It may also arise out of stress and panic attack. 

The researchers of studies published in the Journal of American College of Cardiology found that heart failure, irregular heart rhythm, hypertension, high blood cholesterol and high blood glucose are more common in persons who expose to noise pollution. 

Investigators state that noise boosts secretion of stress hormones. Loud sounds (sounds with high decibel) are harmful, but especially night noise may cause stress. A study reported that noise increases production of a stress hormone, namely cortisol, which may elevate the blood pressure even while sleeping. 

Stress can be faced in the flight along with any moment of our life. Studies revealed out that the patients with heart failure are more likely to suffer from respiratory distress, anxiety, stress, heart decompensation and venous thromboembolism (VTE) in the flight. Therefore, people with acute heart failure syndrome are recommended to avoid flight until full recovery is achieved. 

Reference: 

Izadi M., Air travel considerations for the patients with heart failure., Iran Red Crescent Med J. 2014 Jun; 16 (6)

A series of measures should be taken to prevent diseases and ensure hygienic conditions on the airplane in a flight. Attention should be paid to the cabin air, rate of oxygen and humidity in the inhaled air and microbes that may be transmitted by passengers who are sitting in close proximity to you 

Airplanes are cleaned in line with rules of hygiene before each flight. This comprehensive cleaning covers the cabin, restrooms, food trays and seats. However, this cleaning might not protect your immune system. A group of investigators, who studied hygiene in airplanes, reviewed swab specimens collected from five different airline companies. The study revealed out that the food trays of airplanes require the most attention. 

The study also demonstrated that the knob of toilet flush tank is another location on airplanes which requires attention. As the knob is used by passengers following each visit to the restroom, you are exposed to bacteria and microbes. Accordingly, you should avoid direct contact with this knob and use a handkerchief/wipe when you touch them. You need to act carefully when you touch the restroom equipment and cubicles, as they are among the most heavily contaminated areas of airports and aircraft. You must use paper tissue to grab door handles, you should clean the faucet knobs in advance, place cubicle cover before you seat on the cubicle and finally, you must not lean against the cubicle or the faucet. 

Certain considerations about the flight may prevent the diseases and ensure the flight hygiene. Stay away from the sick passengers, who sit close to you, as much as possible. Further attention is required especially if you have a child. Children are more vulnerable to microbes as their immune system is relatively weaker. Pay attention to your personal hygiene, if there is a sick passenger sitting in close proximity to you. 

Although the restrooms of airplanes are cleaned frequently, try to avoid direct contact especially to the handles, as restrooms are common areas visited by many passengers. Therefore, try to wash your hands very frequently. If you do not have an opportunity to wash your hands frequently, disinfect your hands with antibacterial wet wipes. 

Reference: 

Lacey SE, Exposure to human waste from spills while servicing aircraft lavatories: hazards and methods of prevention., Ind Health. 2010;48(1):123-8

Fluctuations in cabin air pressure during the take-off and descending of planes may cause, albeit not always, health problems in some long-haul flights. It is assumed that the cabin air is equal to the altitude of 1800 to 2600 meters. This means that pressure of the cabin air is lower than the air at the sea level. Gases start expanding as air pressure in the plane decreases. The rate of gas increases as the plane keeps ascending. This condition is manifested by feeling pressure in stomach and intestines. Gas and distension are usually confused with each other. Especially, postprandial distension is considered as gas. Distension is secondary to foods that are not digested by intestines. When undigested foods are transported from small intestines to the colon, they spoil due to non-hazardous bacteria of the colon. They emit hydrogen, carbon dioxide and methane. If this cycle does not operate properly, indigestion problems develop. 

The study conducted by Danish surgeon Jacob Rosenberg and his colleagues from Copenhagen University and published in the New Zealand Medical Journal reveals out that volume of the gas in the bowel increases, when the cabin pressure decreases, and breaking wind becomes inevitable, as there is limited room for the gas in the large intestine or colon. 

A healthy human passes gas 14 to 15 times a day in average. A large part of the gas is let out by belching. The rest flows through and partially absorbed in the bowel. One should seek medical help in case of belching frequently, gastroesophageal reflux while belching and stomach ache after passing gas. If you suffer from stomach and bowel problems at frequent intervals, you should better eat light foods and probiotics before the flight. It is necessary to avoid foods that provoke flatulence in flight. Broccoli, onion, white bean, shell beans, haricot bean salad, cabbage and whole-meal foods increase gas formation in intestines, if they are consumed before the flight. Take care of fluid intake during flight in order to avoid stomach and bowel problems. Moreover, stay away from fizzy drinks, such as carbonated water. 

Reference: 

Hans C Pommergaard, Jakob Burcharth, Anders Fischer, William E G Thomas, Jacob Rosenberg, Possible strategies to cope with flatulence on an airplane, 15th February 2013, Volume 126 Number 1369