Screening for type 2 diabetes and hypertension in seafarers' medical examinations.

BACKGROUND: The aims of the study are: 1) to replace the urine glucose test for diabetes with more than 50% false negatives, with an accurate screening for type 2 diabetes and hypertension in the mandatory biannual fit-for-duty medical examinations of seafarers; 2) to produce data driven "Green Ship" health pro-motion in the ships. A new health promotion and disease prevention public health intervention programme integrated in the fit-for-duty medical examinations for seafarers is being developed. MATERIALS AND METHODS: The lack of an accurate diagnosis of type 2 diabetes is replaced by accurate HbA1c and/or fasting glucose tests and the test for hypertension in various disease stages is based on the International Associations' Guidelines. A "Green Ship" health promotion programme is proposed for all on board, not only for diseased crew members. RESULTS: A protocol for an accurate biannual screening for diabetes and hypertension is presented. Educational programmes for medical doctors and seafarers on the management of hypertension and diabetes on board will be developed. Presuming that all crew members are potentially on their way to be pre-diseased or are diseased, the "Green Ship" health promotion programme is implemented for the whole crew. CONCLUSIONS: The International Labour Organization and the National Maritime Authorities are prompted to revise the International and the National Guidelines for Seafarers Medical Examinations, respectively. Con-certed actions are requested to implement public health promotion projects in shipping. Maritime medical doctors are prompted to use health dialogues and to report the clinical data in the Excel file. Sustainability is obtained by complying with the Sustainable Development Goals (3, 4, 8, 10, and 17).

Early diagnosis of T2DM using high sensitive tests in the mandatory medical examinations for fishers, seafarers and other transport workers.

Transport workers like seafarers, truck-, bus-, train- and taxi drivers and fishers have a known great inequity in health at work including high risk of developing type 2 diabetes. Their routine mandatory medical examinations use urine glucose for diabetes check with more than 50% false negatives, which should be replaced by high sensitive tests for diabetes-2, like A1C, Fasting Glucose (FPG) or Oral Glucose Tolerance Test (OGTT).

Acute occupational phosphine intoxications in the maritime shipping sector: a scoping review.

The aim is to assess the prevalence and knowledge on acute occupational exposure to phosphine in the shipping industry. We followed PRISMA guidelines for scoping review. We searched in 4 databases without language and date restrictions for scientific articles in peer-reviewed and gray literature. We found 13 peer-reviewed articles and 63 articles in gray literature. These covered 56 incidents from 1963 to 2019 for a total of 254 victims and 22 fatalities. There is an increase in the number of reported cases over the last 20 years. Neurologic and gastrointestinal symptoms are predominant, and hospitalization is needed in 80% of cases. Our review underlined the principal risk as gas exposure through leaks between holds and the ventilation system. Further studies on the knowledge and the prevention in order to improve good practices onboard, prevent the risk of fire explosion, and a global reporting system of new cases are recommended.

A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities.

Hyperbaric oxygen therapy (HBOT) consists of using of pure oxygen at increased pressure (in general, 2-3 atmospheres) leading to augmented oxygen levels in the blood (Hyperoxemia) and tissue (Hyperoxia). The increased pressure and oxygen bioavailability might be related to a plethora of applications, particularly in hypoxic regions, also exerting antimicrobial, immunomodulatory and angiogenic properties, among others. In this review, we will discuss in detail the physiological relevance of oxygen and the therapeutical basis of HBOT, collecting current indications and underlying mechanisms. Furthermore, potential areas of research will also be examined, including inflammatory and systemic maladies, COVID-19 and cancer. Finally, the adverse effects and contraindications associated with this therapy and future directions of research will be considered. Overall, we encourage further research in this field to extend the possible uses of this procedure. The inclusion of HBOT in future clinical research could be an additional support in the clinical management of multiple pathologies.

Global occupational health research methods education.

Occupational and Public Health Research has been developed gradually over the last century, unfortunately not to the same levels in all continental parts of the globe. The aim is to supply an open modular educational program in Occupational- and Public Health research methodology for research of the risk indicators for the prevention of workers' health and safety globally. The modular educational program in research methodology is based on the Humboldtian university model with unity of research and teaching. Research data for the students comes from the research part of the "Maritime Education and Research Network" for all types of industries. The modules constitute the basic education in occupational health science research methodology. The proposal for Master of Science for medical doctor's specialization in occupational medicine with an emphasis on research includes 3 theoretical and a clinical module. The huge difference in research methodology globally indicates inequity in relation to the UN17 goals that need to be taken hand on. Global collaboration in teaching health research methodology is needed to reach the goals of equity in health science education. The aim is to reduce the inequity in global health by strengthening the education in health science research methodology.•Open access educational program for health science research methodology to reach the UN17 goals.•The modules constitute the education in research methodology for Public- and Occupational health.•Global education in health research methodology is needed to eliminate the inequity in global health.

Acute occupational phosphine intoxications in the maritime shipping sector: Belgian and French reported cases.

BACKGROUND: During ship transport of organic cargo e.g. soybeans in bulk or textiles in containers, there is a risk of pests damaging the cargo during transport as well as of unwanted global spread of organisms. Consequently, fumigation of the shipped goods is recommended. While aiming to protect the cargo from being damaged by pests during the transport time, fumigation constitutes a risk to the health of seafarers and port workers and even fatal cases are seen. Phosphine gas is increasingly applied for fumigation. Based on former experiences this article aims to describe the risk and to provide recommendations for prevention. MATERIALS AND METHODS: All reports of acute occupational exposures to phosphine in the maritime shipping industry to the Belgian Poison Centre were analysed and compared to reports in a study by ANSES (Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail), which collected data from the French Poison Centres. Data were registered and analysed between the 1st of January 1999 and the 31 of December 2018. RESULTS: The reported incidents have so far been rather few but seem to have increased over the last years. Symptoms are gastro-intestinal, neurologic and respiratory and often seem "vague" and non-specific and are often difficult to recognise for first responders. In the cases where the aetiology of the incident is known, there often seems to be a lack of clear information about the risk and options for mitigation in workplaces and among the workers. Twelve publications of case reports were included from the literature review that showed the same patterns as found in the registered incident reports. CONCLUSIONS: There seems to be an increase in incidents of acute poisoning from phosphine worldwide. This increase could be linked to the phasing out of methyl bromide in the Montreal Protocol but may also have other explanations. Strict precautions are needed when using phosphine for fumigation of ship cargoes and containers. Since symptoms are often vague, first-responders need to pay attention to the possible occurrence of acute phosphine intoxication as it may be life threatening. Phosphine intoxication remains a diagnosis nor to underestimate not to miss. Further monitoring and research is needed. Preventive actions are mandatory. It is essential to implement in a strict way the existing legislation of an in-transit fumigation with phosphine. Training of the crew and good communication between the different actors during an in-transit fumigation (ship-owner, captain, fumigator, crew, longshoremen) is the key of a good prevention of accidents.

Wellbeing of a selection of seafarers in Eastern Adriatic Sea during the COVID-19 pandemic 2020.

BACKGROUND: Work-related stress among seafarers is well known but a suspected excess of work-related stress due to the COVID-19 so far has not been published. The aim of the study was to evaluate the well- -being of the seafarers during the outbreak of COVID-19 pandemic and their evaluation of the precautions taken by the shipping companies. MATERIALS AND METHODS: Seventy-two seafarers completed the General Health Questionnaire (GHQ12) with three extra questions on how the COVID-19 precautions were taken on board. RESULTS: The mean Likert score was 13.9 for the whole sample, corresponding to "no problems" while a subgroup of 40% had mean Likert sum scores of 16.1 (level 15-23) corresponding to "starting problems." In response to the extra items, 50% of the seafarers did not feel safe doing their job in relation to the epidemic and 60% did not think everything has been done to ensure their health at work in relation to the epidemic. Thirty per cent suffered of insomnia to the extent of becoming concerned and 26% had been unhappy and depressed during the latest tours of duty. CONCLUSIONS: The hypothesis that excess work-related stress has been put on the seafarers in this specific situation was confirmed and calls for prevention. A combination of person-focused and organisation-focused prevention approaches has been advocated as the most promising for alleviation of job stress in the workplaces at sea.

Fatal accident involving a welder employed by a shipping container company, associated with the use of tramadol and antidepressant agents.

The widespread use of opioids for the treatment of moderate or severe acute and chronic pain has become a public health problem due to the physical and psychological dependence and tolerance they produce. The increasingly higher doses that patients require may reach toxic levels or lead to accidents, including fatalities. We present the case of a welder who, while working for a shipping container company, fell from height without a safety harness and subsequently died as a result of a traumatic brain injury. Post-mortem examination revealed a cardiac blood tramadol concentration of 2.83 mg/L, which is 3-4 times higher than the maximum therapeutic dose. The combined use of synthetic opioids and antidepressants may heighten the adverse neurological and psychiatric effects. A review of the literature, identified studies, including previous reports of fatalities, supported our causal hypothesis of a serotonin syndrome. This syndrome can lead to a loss of cognitive and sensory capacity, interfere with decision-making ability, and produce mental confusion and dizziness, among other symptoms. In order to prevent harm to themselves and others, all persons who are currently taking these kinds of drugs should avoid dangerous tasks at work and must be advised by a physician regarding the type of activities that are safe for them to perform.

Occupational disease due to Anisakis simplex in fish handlers.

BACKGROUND: Anisakis is a marine nematode. Its larvae can be found encysted in several species, both in the abdominal cavity and in the adjacent musculature. The most commonly affected commercial species are hake, whiting, cod, and mackerel. The prevalence in fish varies according to the fishing area and the size of the host. MATERIALS AND METHODS: Until now only three species have been confirmed to be involved in human anisakiasis, the most common ones being A. simplex sensu stricto (s.s.) and A. pegreffii, and anecdotally, A. physeteris. Infestation in humans occurs when they eat raw or undercooked parasitized fish or cephalopods (pickled, cold-smoked, salted, semi-preserved, prepared in certain Asian styles like sushi or sashimi, ceviche). RESULTS: The majority of anisakiasis cases have been described by Japanese authors. However, over the last few years there has been an increase in the number of cases reported in other countries including Italy and Spain. It is estimated that its incidence in the European Union is 0.32/100,000, and in the Basque Country (Spain), this parasite is responsible for 10% of anaphylaxis cases and 32% of urticaria cases in adults aged 40-60 years, around 300 cases/year. Anisakis-related disease in the work environment (occupational disease) is less common. CONCLUSIONS: We present three cases of the occupational disease in Spain due to a type I hypersensitivity to Anisakis simplex in individuals who handle fish (one fishmonger, one supermarket employee, and one chef).

Evaluation of the educational impact of a special study module on maritime medicine for medical undergraduate students.

BACKGROUND: The hazardous occupation of seafaring brings many unique medical challenges. Despite its international nature, maritime medicine does not typically form a part of undergraduate medical studies. A unique and innovative, optional student-selected module (SSM) 'maritime medicine' was offered to medical students. A key objective was to develop students' attitudes to maritime medicine and increase their awareness of the discipline and its specialised nature. AIM: The aim of this study was to assess qualitatively and quantitatively the educational impact of the maritime medicine SSM and to improve the module content and design for future academic years. MATERIALS AND METHODS: Students' perceived relevance and knowledge before and after the module was assessed using a Likert-based questionnaire. Comparison was made with controls in the post module100 multiple choice question (MCQ) paper. Qualitative feedback was obtained from semi-structured focus student discussion groups and the questionnaire's free comments section. RESULTS: A significant increase in perceived knowledge was seen between pre and post module p < 3.45 × 10-10, matched with the module students performing significantly better than controls in the end-of-module MCQ paper (p < 8.99 × 10-20). Qualitative analysis revealed 5 main themes: teaching methods, appreciation of non-academic instructors, appreciation of maritime medicine unique requirements, timetabling and enjoyment. CONCLUSIONS: This unique and innovative maritime medicine module harnessed local expertise and raised the awareness and profile of maritime medicine among undergraduate medical students. It was very well received and had a significant educational impact. Practical teaching methods were highly valued by students, with these areas also performing best in quantitative analysis.