Assessment of mental health and psychosocial factors in French merchant officer cadets.

BACKGROUND: Several studies have demonstrated the existence of psychological pathologies and psychosocial risks among seafarers, particularly merchant navy officers. To date, there is no study of merchant navy officer cadets. First aims are to assess anxiety and depression disorders, framework, work strain and social support in this population. MATERIALS AND METHODS: A questionnaire including demographic and sailing data to which we added the Hospital Anxiety and Depression Scale (HAD) and Karasek questionnaire was developed. All students were approached and completed the questionnaire anonymously by electronic means. RESULTS: One hundred and seventy questionnaires could be included. The population was predominantly male (76.4%), and the average age of the students was 21.7 years. The means of the HAD anxiety and HAD depression were 6.9 and 5.37, respectively. According to Karasek classification, we noted that the "active" class was the most represented with 29.4% of students, followed by the "high strain" and "low strain" classes with 27.6%. The "passive" class was the least represented with 15.3%. CONCLUSIONS: We found a predominance of anxiety disorders but few signs of depression. Signs of "high strain" according to Karasek were found in 27.6% of the population of these young officers. Job demand was linked to mean of anxiety and depression disorders declared in HAD questionnaire. Being a woman was associated with anxiety but not depression symptoms. Prevention programme to decrease the level of job demand and increase decision latitude and social support seems relevant for mental health disorders in merchant officers.

Hearing Impairment in French Merchant Seafarers: Retrospective Study on Data from 8308 Audiometric Tests.

Background: A high level of occupational noise exposure has been noted in the fishing sector. Yet, less is known regarding other navigation groups, such as merchant seafarers, since a French study in the 1980s. This study assesses hearing impairment (HI) in a French merchant seafarers' population. Methods: We collected data of all audiograms performed in 2018 and 2019 for French merchant seafarers. For each seafarer, hearing ability was measured in both ears using pure-tone audiometry at the following frequencies: 0.5, 1, 2, 3, 4, 6, and 8 kHz. Hearing threshold levels (HTLs), or the intensity of sound below which no sound is detected, were measured in decibels Sound Pressure Level (dB SPL) at each frequency and recorded in 5 dB increments. For HI, we used the validated definition of the American Speech−Language−Hearing Association (ASHA). Results: We were able to include statistical analysis results of 8308 audiograms. In a multiple logistic regression adjusted for age, experience, and class of navigation, we found that experience of more than 14 years Odds Ratio OR 1.28 (CI 95% 1.07−1.53), age 31−40 OR 2.2 (CI 95% 1.4−3.4), and >40 years OR 14, 3 (IC 95% 9.7−21) and marine engineers OR 1.26 (IC 95% 1.01−1.57) were still risk factors for HI. Conclusion: In 2018, Marine engineers were still the workers' group with a higher risk of HI in merchant seafarers but, notch at 4 Hz, specific of noise-induced hearing loss, has improved. They have an HI close to the definition of socioacousis and mean deficit differences with deck and services' merchant seafarers improved. Our results could be interpreted as a limitation of occupational noise exposure impact in a merchant seafarers' population, needing an improvement in prevention measures and also encouraged to continue to improve onboard working conditions.

Seafarers' mental health in the COVID-19 era: lost at sea?

Seafarers are exposed to several physical and psychosocial stressors. Recent studies highlighted specific disorders as fatigue, boredom and diseases as depression. Seafarers are also commonly exposed to post-traumatic stress disorder (piracy, accidents, threats). Coronavirus disease 2019 (COVID-19) impacts seafarers with an estimated 400,000 of whom are stranded on vessels around the world, with extended time on board, repatriation's difficulties and the financial concerns of the unexpectedly unemployed. International Maritime Organization has established the Seafarer Crisis Action Team to help them. In France, in last 10 months a dedicated call centre received 142 calls from 32 seafarers for psychological phone consultations mostly linked to this era. With the increase of duration of the COVID-19 crisis, psychological health care, repatriations and financial solutions are needed for seafarers.

Seasickness and its impact on researchers' work on board French oceanographic vessels.

BACKGROUND: Seasickness (SS) is an often hidden pathology, but one that can significantly disrupt work on board. The aim of the study is to evaluate the influence of SS on the workability of workers on board vessels. MATERIALS AND METHODS: We performed a cross-sectional questionnaire study conducted on 250 oceanographers in 2015 during 3 months. Based on the "Bos seasickness susceptibility questionnaire", we created a specific questionnaire with 49 questions. RESULTS: 151 men and 72 women responded to the survey. 188 of them (91.7% of women and 80.8% of men) report being seasick, either occasionally (69%) or at each boarding where there is female predominance (23.6% vs. 11.3% for men). The major symptoms are nausea (82%) and vomiting (56%). 60% of the workers think that SS has an influence on the success of their mission, by first affecting their mood (50%), relationship (23%), and increased risk of accidents such as falls, accidents on machines or in laboratories (40%). Antinaupathic treatments also produce deleterious effects on their workstation. Women have higher risk of developing SS (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.03-6.6; p = 0.04), more frequently taking medicines when ill (OR 4.1; 95% CI 1.27-13.2; p = 0.004) and coming with her own tablets (OR 2.3; 95% CI 1.3-4.1; p = 0.04). CONCLUSIONS: Gender is a trending factor of SS. Information on SS clinical signs, impact and therapeutics could be prone to prevent sickness and impact of it on workability.

Comment on Oldenburg, M., Jensen, H.J. Stress and Strain among Seafarers Related to the Occupational Groups. Int. J. Environ. Res. Public Health 2019, doi:10.3390/ijerph16071153.

Recently, Oldenburg M published an article in the journal "Communication" titled "Stress and Strain among Seafarers Related to the Occupational Groups" [...].

About the relationship between ship noise and the occurrence of arterial hypertension in seafarers.

No abstract because letter to editor.

Don't forget about seafarer's boredom.

BACKGROUND: The question we asked was whether it is worthwhile screening for seafarers who are prone to boredom, and whose mental health might deteriorate on board because of the particular character of life at sea. MATERIALS AND METHODS: We used the Farmer and Sundberg Boredom Proneness Scale (BPS), validated in French, as well as the Zigmond and Snaith Hospital Anxiety and Depression Scale (HADS). The survey was voluntary and responses were collected by means of questionnaires which were returned by post. RESULTS: Eighty seafarers (40 officers and 40 crew) as well as 63 office staff from the same shipping company were included in the survey. We found a significant difference between officers and operational personnel: average score of 8.4 ± 5 (median = 7) for officers and 10.2 ± 4.8 (median = 10) for operational personnel. 21% of the officers have scores greater than or equal to 12 compared with 41% of the crew. There is a significant correlation between the BPS and HADS test scores, in terms of depression, for the office staff and the seafarers taken as a whole; this correlation being highly significant among officers (r = +0.85), but only marginally significant among crew members (r = +0.54). CONCLUSIONS: The BPS may be useful in screening for seafarers prone to boredom and depression for their fitness for embarkation.

Respiratory assessment of refractory ceramic fibers in a heating technician population.

Refractory ceramic fibers (RCF) have been extensively used for insulation in condensing boilers. The aim of this study was to evaluate the respiratory exposure to these fibers among maintenance heating technicians. We first created a working group (Carsat Brittany and Finistère Occupational Health Services) and carried out a sampling strategy. Atmospheric measurements were done during work tasks, and filters were analyzed by phase contrast microscopy (PCM) and scanning electron microscopy (SEM) in French approved laboratories. Four companies were included for a total of 15 days of work. During those 15 workdays, 12 SEM and 21 PCM samples were taken and analyzed. The phase contrast microscopy and SEM average results were 0.04 and 0.004 fibers/cm3, respectively. In conclusion, the study confirms heating technician RCF respiratory exposure during maintenance work for both condensation gas boilers and atmospheric boilers. Collective and individual prevention measures should be implemented along with appropriate medical follow-up.

Exposure to phosphine in maritime transport: a real and important occupational risk: a report of three cases.

In maritime transport, to assess the risks of insect pests spreading, fumigation is recommended by the Food and Agriculture Organisation. Fumigant mostly used for foodstuffs is the phosphine gas generated by the reaction of aluminium phosphide and moisture in the atmosphere. In this article, we first discuss phosphine toxicity to humans and then we describe three cases of occupational exposure in maritime transport of cereals. We found phosphine level higher than 20 ppm in tank atmosphere of bulk carriers and levels from 2 to 3.5 ppm in port silos and port warehouses where cereals were unloaded. Two weeks later, atmospheric measurements in a silo were still at 0.8 ppm. In this case, 3 workers described symptoms which could be linked with phosphine. Exposures to phosphine and cases in maritime transport are surely underestimated. Exposure could occur at sea, in harbour but also in port warehouses, trucks and silos or warehouses along logistic chain. All workers in the chain could be exposed. We can recommend research aiming at the development of alternative techniques using a less harmful gas for humans. At individual level, we propose that, along with the training for employees, workers potentially exposed should wear a test strip (phosphine detector strips) or a personal gas badge with appropriate maintenance.

Occupational asthma in maritime environments: an update.

In 2006 we published our first review based on the available literature on occupational asthma in maritime environments in the "International Maritime Health" journal. Since then, we have obtained a great deal of new knowledge on asthma in seafood workers and fishermen and on the impact of exposures from sulphites preservatives, container fumigants etc. in maritime workers. This review aims to provide an update of the current knowledge base about occupational asthma in a maritime context and to provide recommendations regarding medical surveillance of workers at risk.

Skin Diseases Affecting High-Level Competition Sailors: Descriptive Study Carried Out During the 2012 AG2R Transatlantic Boat Race.

OBJECTIVES: The primary objective of this study was to identify skin disorders encountered in a population of sport sailors. Unlike merchant mariners and fishermen, there is sparse literature on this maritime population. Secondary objectives were to uncover on-board conditions that may contribute to dermatological problems in this population. METHODS: We conducted a prospective study during the 2012 AG2R transatlantic race. Sixteen two-man crews participated in this race, all using the same model of sailboat (Bénéteau Figaro 2). Clinical examinations were conducted, photographs taken, and questionnaires containing 34 questions were handed out before departure and on arrival, 22 to 24 days later. RESULTS: Twenty-eight of 32 skippers (88%) participated in departure data collection, and 18 (56%) completed data collection on arrival. The average age of sailors was 34 years (SD = 8). Compared with skin diseases documented on departure, there was an increased amount of folliculitis on the buttocks, fungal infections, and hyperkeratosis of the hands on arrival. Furthermore, several new skin problems were found postrace: skin scaling, skin erosions on the buttocks, dyshidrosis, thermal burns, and sunburns. The use of protective gear and sunscreen was common, but on-board hygiene was poor with infrequent bathing and clothing changes. CONCLUSIONS: Skin conditions are nearly universal in this maritime population. Further assessments are needed to know if long-term use of protective gear; improved hygiene; use of barrier creams; and proper on-board care of fungal infections, wounds, and burns could reduce the number and severity of skin problems encountered in sport sailors.

Acute phosphine poisoning on board a bulk carrier: analysis of factors leading to a fatal case.

OBJECTIVES: To determine accidental factors, clinical presentation and medical care in cases of seafarers presenting phosphine poisoning symptoms on board a bulk carrier. To consider primary prevention of this pathology, which can have extremely severe consequences. METHODS: To analyse circumstances resulting in toxic exposure to phosphine in the sea transport sector. To obtain information from medical reports regarding the seafarer's rescue. To identify the causes of this accidental poisoning and how to establish an early, appropriate diagnosis thus avoiding other cases. RESULTS: In February 2008, on board a bulk carrier with a cargo of peas, a 56-year-old seafarer with intense abdominal and chest pains, associated with dizziness, was rescued by helicopter 80 miles away from the coast. Despite being admitted rapidly to hospital, his heart rate decreased associated with respiratory distress. He lost consciousness and convulsed. He finally died of pulmonary oedema, major metabolic acidosis and acute multi organ failure. The following day, the captain issued a rescue call from the same vessel for a 41-year-old man also with abdominal pain, vomiting and dizziness. The ECG only revealed type 1 Brugada syndrome. Then 11 other seafarers were evacuated for observation. 3 showed clinical abnormalities. Collective poisoning was suspected. Medical team found out that aluminium phosphide pellets had been put in the ship's hold for pest control before the vessel's departure. Seafarers were poisoned by phosphine gas spreading through cabins above the hold. It was found that the compartments and ducts were not airtight. CONCLUSION: Unfortunately, a seafarer on board a bulk carrier died in 2008 because of acute phosphine poisoning. Fumigation performed using this gas needs to be done with extreme care. Systematic checks need to be carried out before sailing to ensure that the vessel's compartments are airtight.

Cardiovascular risk factors in seamen and fishermen: review of literature.

BACKGROUND AND AIM: The aim of this study was to evaluate the prevalence of risk factors for cardiovascular disease among sailors and their evolution over time. MATERIALS AND METHODS: This study is a review of the literature from Medline® database and the Medicina Maritima journal. With prevalence studies, the overall prevalence was calculated; 2 groups were created according to the study period (1990s vs. 2000s) and compared by c2 test with Mantel-Haenszel correction. RESULTS: Eighteen articles were selected (total: 57,473 European sailors and 327 non-European sailors). Smoking prevalence varied between 37.3 and 72.3%; overweight prevalence between 27.9 and 66.5%; hypertension was between 8.2 and 49.7%; hypercholesterolaemia ("high blood level of cholesterol") variedbetween 25.1 and 42% of the populations studied; between 3.3 and 9.3% of the populations studied suffered from diabetes. Two studies showed a 10-year cardiovascular risk comparable to that of the general population. After calculating with similar studies, the prevalences were 61.4% for smoking, 60.9% for overweight, 30.1% for hypertension, 34.6% for high cholesterol, and 3.6% for diabetes. Smoking prevalence was significantly lower in 2000s (45.4% vs. 61.3%, p < 0.01), those of overweight, hypertension and hypercholesterolaemia were higher (64.1% vs. 47.1%, p < 0.01, and 42.1% vs. 14.8%, p < 0.01, 42.0%vs. 33.9%, p = 0.02). CONCLUSIONS: Modifiable risk factors are the most studied. Smoking tended to decrease in the 2000s.

Skin infection by Staphylococcus aureus in a fisherman: difficulty in continuing work on board.

BACKGROUND AND AIM: The aim of this study was to understand why an infectious skin disease due to colonisation by Staphylococcus aureus methi-S led to disembarkation of a fisherman for treatment and follow-up. MATERIALS AND METHODS: While discussing this case we have analysed different reasons why the studied fisherman could not be successfully treated on board. RESULTS: A 42-year-old fisherman was first presented with skin lesions while fishing for hake. When the fisherman had developed a fever and exfoliative skin lesions on both hands, the ship's captain called the radio-medical centre for the maritime consultation in Toulouse and for the advice on treatment. After 3 days on penicillin, the fever decreased, but the dermatitis became incapacitating. On his return to shore, the fisherman was hospitalised. Bacteriological swabs of the skin lesion showed colonisation with Staphylococcus aureus methi-S with presence of Panton Valentine leukocidin. Seven-day treatment witha follow-up of antibioticotherapy was necessary to resolve the skin eruption and obtain definitive apyrexia. Treatment ashore was advised because of difficulty in continuing manual work on board whilst suffering from significant skin lesions and also due to fear of contagion. CONCLUSIONS: Skin infection with Staphylococcus aureus methi-S with presence of Panton Valentine leukocidinis difficult to treat on board because of difficulty in carrying out manual work when hands are affected, and also due to slow improvement of dermatitis even when appropriate treatment is undergone. The maritime environment is also a risk factor for skin abrasion, which can lead to secondary colonisation of pathogenic bacteria.

Evaluation of the sensitisation to grains and its pulmonary impact in employees of the port of Brest silos.

BACKGROUND: Evaluation of the sensitisation and levels of exposure to grains and its pulmonary impact ina population of Brest port silo employees. MATERIALS AND METHODS: We included exposed workers. The study consisted of clinical examination witha standardised questionnaire, blood samples, prick-tests, and spirometry tests. The atmospheric concentrationof total dust in the workplace was also associated. RESULTS: Eight workers were included in the study. No case of occupational asthma was found, but 3 casesof occupational rhinitis were noted and occupational prick-tests were positive in 4 cases. The mean totaldust concentration in the three atmospheric samples was 4.87 mg/m3 for 8 hours but it was under thedetection limits for alveolar fractions. CONCLUSIONS: Port silo workers are exposed to total dust concentrations below the French legal limit (10 mg/m3) but higher than Canadian and American recommendations. Levels of exposure in our studyare similar to other studies developed in port silos. Symptoms developed by workers may be due to highexposure to dust with an irritant effect rather than an allergic effect. Despite this fact, a specific medicalsurvey is needed, and ventilation and respiratory masks have to be promoted for prevention.

Cardiovascular risk factors and cardiovascular risk assessment in professional divers.

BACKGROUND: The professional diver's activity implies body cardiovascular stress. Little data on cardiovascular risk factors is available. Some studies report a high prevalence of tobacco consumption. The purpose of this study is to investigate the cardiovascular risk factors of professional divers and calculate the predicted 5-year risk and the predicted 10-year risk of an acute coronary event. MATERIALS AND METHODS: In one medical centre, data on dives and cardiovascular risk factors were analysed on Epidata(®) software, by Pearson χ(2) test or by Fisher's exact test, by analysis of variance test or by Kruskal-Wallis test, and by Spearman correlation coefficient. Cardiovascular risk scores at 5 and 10 years were calculated using SCORE. RESULTS: A total 200 professional divers were included. Of these, 31% were smokers or had stopped smoking for less than 3 years; 40% had an abnormal body mass index; 50% had raised total cholesterol levels; 11% had an advanced age; 6.5% had high blood pressure; 81% had at least one risk factor; 66% had an alterable risk factor; 25.5% had a 5-year risk greater than that of the general population of the same age; 2.5% had a high cardiovascular risk at 10 years; and 34% were at intermediate risk. CONCLUSIONS: The majority of divers had at least one cardiovascular risk factor. Cardiovascular risk scores were lower than that of the general population. However, some of this population is at high risk. One third of the divers had an intermediate risk, which should lead to the consideration of conducting additional biological examinations to better assess their risk.

Occupational poisoning by carbon monoxide aboard a gas carrier. Report on 8 cases.

OBJECTIVES: - To determine the accidental factors and the clinical symptoms in eight cases of occupational poisoning of port workers by carbon monoxide. - To consider the primary prevention of this serious pathology occurring at work. METHODS: - To analyze the circumstances of the exposure to carbon monoxide in the employees in the naval repair sector. - To indicate the systemic failures causing this accidental poisoning, the means for early diagnosis and appropriate treatment, and to discuss the prevention of such accidents. RESULTS: The poisoning occurred in eight mechanics and electricians working without any protective means in a gas carrier tank in dry dock. The employees, unaware of carbon monoxide exposure, stayed for 45 minutes in an atmosphere polluted with carbon monoxide concentrations of over 500 ppm. The main complaints were of headache, muscular weakness, and drowsiness. No post-interval syndrome was found three weeks after poisoning. The levels of carboxyhaemoglobin varied from 1.8 to 31.2%. Early normal pressure oxygen therapy reduced the symptoms. No delayed syndrome was found three weeks after poisoning. CONCLUSIONS: The inclusion of poisonous gas in gas-free certification, adherence to maritime harbour regulations, greater respect for working instructions in hazardous environments, and the use of detectors appropriate to the conditions for each ship would avoid exposure and decrease the risk of poisoning.

A case of occupational asthma from metabisulphite in a fisherman.

BACKGROUND: The objective was to describe a case of occupational asthma in a fisherman linked to the inhalation of metabisulphites, then to discuss the history and actions for prevention. MATERIAL AND METHODS: We report the case of a fisherman fishing for Dublin bay prawn (Nephrops), who suffered from asthma after being exposed to metabisulphites. This case is compared with other cases in the occupational medical literature. He was a 53-year-old male and a former smoker, who presented with dyspnoea and a very productive cough, due to both chronic exposure to metabisulphites and acute exposure to contamination due to the breakdown of the ventilation system in the trawler on which he was fishing. The symptoms appeared to be occupational. Tests carried out in the following months revealed reversible airway obstruction with non-specific bronchial hyperreactivity, while allergy tests were negative. A visit to the trawler allowed us to determine the unusual cause of exposure in the case. Other reported cases concern normal working processes causing reversible airway obstruction. DISCUSSION: Metabisulphites are antioxidants and preservatives used in the food industry which have been identified as the causative agent in occupational asthma since the 1980s. Only two other cases have been previously reported in fishermen, however. The clinical presentation of our subject was notable for the productive nature of his cough. The appearance of symptoms after combined acute and chronic exposure made us consider an irritative pathophysiology in this asthma, as opposed to sensitization. The negative allergy testing in this subject was similar to other cases reported in the literature. Our subject alone was submitted to patch testing, which was also negative. CONCLUSIONS: Our case represents occupational asthma caused by metabisulphites with clinical signs notable for the productive nature of the cough. Few cases have been reported amongst fishermen despite the significant use of this substance with irritant and sensitizing characteristics in the workplace.

Occupational asthma in the commercial fishing industry: a case series and review of the literature.

We present a case series of snow crab-induced occupational asthma (OA) from a fishing and processing vessel, followed by a review of OA in the commercial fishing industry. OA is typically caused from an IgE-mediated hypersensitivity reaction after respiratory exposure to aerosolized fish and shellfish proteins. It more commonly occurs due to crustaceans, but molluscs and fin fish are implicated as well. Standard medical therapy for asthma may be used acutely; however, steps to reduce atmospheric allergen concentrations in the workplace have proven to be preventive for this disease.

Deaths on board: medical and legal implications for the maritime physician.

When death at sea occurs many people are implicated. The assignees of victims often look for detailed circumstances of deaths at sea, and the doctor, besides his preventative role, has to certify the death on board and try to determine the circumstances with a view to a legal investigation if it proves necessary. In this work are presented the main causes, facts, and characteristics of human deaths at sea, and the responsibility of the ship's doctor in case of death on board.