Occupational allergic diseases among harvesting fishermen on the open sea: A systematic review.

BACKGROUND: Nearly 60 million people work in the fishing and aquaculture sectors worldwide and are exposed to specific allergens. Some reviews have been published in occupational allergic diseases in seafood workers but none in fishermen. OBJECTIVE: To describe the morbidity and main causal agents of allergic diseases among harvesting fishermen. METHODS: A protocol with predefined objectives and inclusion criteria was used in accord with the Preferred Items for Reporting Systematic Reviews and Meta-analyses-Protocols statement. Population was defined as harvesting fishermen, and the conditions of interest were allergic pulmonary diseases, occupational allergic rhinitis, and allergic dermatologic disease. A literature search was carried out in EMBASE, MEDLINE, Web of Science, and PASCAL databases. After the title-abstract and full-text selection of eligible studies, data were extracted and synthesized qualitatively. RESULTS: A total of 25 studies were selected, 15 articles on occupational asthma (OA) and 10 on dermatologic diseases. Most studies were case reports and case series from European countries. Most OAs were sensitizer induced, with common crab, Anisakis simplex, red soft coral, and cuttlefish as causal agents. Irritant-induced OA because of metabisulfites was also described. Occupational eczema caused by bryozoans was the most common of the cases among fishermen working in the North Sea and the Channel. CONCLUSION: Occupational allergic diseases in harvesting fishermen are described in well-resourced countries, but there are few studies from countries with a high number of fishermen, such as in Asia, and these mostly include immunoglobulin E-mediated diseases. The presence of the healthy worker effect is probable. Atmospheric allergen concentration is a major risk factor for OA. Specific conditions, including cold air, fish-juice contact, and salt-water contact, are other risk factors. There is a need to investigate occupational allergic disease in all countries and develop specific studies in fishermen.

Port Workers' Use of Medical Services in a Maritime Container Terminal in Costa Rica.

Supervised by three or four medical doctors and one nurse in rotating shifts, the medical clinic in Costa Rica's Moín Container Terminal is open 24/7 for visits from port workers. In our study, we aimed to identify the sociodemographic and clinical characteristics of a consecutive series of patients who attended the medical clinic for outpatient services during an 8-month period. Our descriptive study involved collecting patient records from the medical clinic during the first 8 months of 2021 (i.e., 1 January-31 August 2021), during which 3050 visits from 1301 port workers were registered. Terminal tractor drivers, crane operators, and stevedores were the most frequent job categories among the patients. Doping (i.e., ICD-10 Z03.6) was observed in 64% of the visits. The top ICD-10 codes among all other patients not observed to have engaged in doping (n = 469) were diseases of the musculoskeletal system (7.2%) and abnormal clinical and laboratory symptoms (6.2%). Problems with the musculoskeletal system were primarily back pain (36.0%), muscle contracture (30.1%), and secondary headache (25.2%). Two-thirds of the visits were due to screening for alcohol and drugs or doping; however, inconsistency in the coding system complicates the analysis of data, and a dropdown menu in the registration is therefore needed to prevent errors. Relative risk calculations are impossible due to a lack of data about the at-risk population but should be pursued under different circumstances in future studies. In the support chain of goods, the medical clinic in the port plays a key role in saving time in shipping, which means that the injured or sick employees in most cases can continue working. For the shipping industry, quick un- and offloading is very important to stay competitive in the market for transport.

Rethinking the use of urine dipstick for early diagnosis of Type 2 diabetes mellitus.

Transport workers, seafarers and fishers have biannual mandatory fit-for duty medical examinations. Urinedipstick is used for early diagnosis of Type 2 diabetes mellitus. Due to low sensitivity with more than 80% false negatives the method should be replaced by highly sensitive blood tests, Hb1Ac or similar for diagnosis of Type 2 diabetes mellitus to pursue the UN Global Sustainable Goals, especially Goal 3: Good health and well-being for all workers and Goal 8: Decent Work and Economic Growth.

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).

Risk Assessment in Artisanal Fisheries in Developing Countries: A Systematic Review.

INTRODUCTION: Artisanal fisheries generally do not have injury prevention plans and safety or quality management systems on board, thus making them prone to more fatal and nonfatal injuries. The objective of the study is to systematically review and synthesize the literature to identify the risks of injuries (fatal and nonfatal) and health problems in artisanal fisheries in developing countries. METHODS: A systematic literature search was carried out from December 2019 to March 2020. Articles were included with at least 1 outcome of interest (fatal injuries, nonfatal injuries, health problems, causal factors). In all, 18 articles on occupational safety and health aspects in artisanal fisheries from developing countries were kept for final analysis. RESULTS: Of the 4 studies on fatal injuries, only 1 reported fatal incidence rates (14 per 1,000 person-years). Vessel disasters were the most common cause of fatal injuries, with 14.3%-81% drownings. The prevalence of nonfatal injuries was between 55% and 61%. The most common causes were falls on the deck or into the sea/river, blows from objects/tools, punctures and cuts by fishhooks/fish rays and fishing equipment, and animal attacks or bites. Health problems included eye, ear, cardiovascular (hypertension), respiratory (decompression sickness), dermatological, and musculoskeletal problems. DISCUSSION: There is a serious gap of health and safety information in artisanal fishery, which is more extensive in developing countries. Epidemiological studies are needed with comparable incidence and prevalence rates. For adequate prevention and compliance with the UN sustainable goals, there is an urgent need to establish a health information system in the countries to register the relevant demographic and epidemiologic characteristics of the population.

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.

The costs of repatriating an ill seafarer: a micro-costing approach.

Seafarers sail the high seas around the globe. In case of illness, they are protected by international regulations stating that the employers must pay all expenses in relation to repatriation, but very little is known about the cost of these repatriations. The objective of this study was to estimate the financial burden of repatriations in case of illness. We applied a local approach, a micro-costing method, with an employer perspective using four case vignettes: I) Acute myocardial infarction (AMI), II) Malignant hypertension, III) Appendicitis and IV) Malaria. Direct cost data were derived from the Danish Maritime Authority while for indirect costs estimations were applied using the friction cost approach. The average total costs of repatriation varied for the four case vignettes; AMI (98,823 EUR), Malignant hypertension (47,597 EUR), Appendicitis (58,639 EUR) and Malaria (23,792 EUR) mainly due to large variations in the average direct costs which ranged between 9560 euro in the malaria case and 77,255 in the AMI case. Repatriating an ill seafarer is a costly operation and employers have a financial interest in promoting the health of seafarers by introducing or further strengthen cost-effective prevention programs and hereby reducing the number of repatriations.

Pattern of some risk factors of cardiovascular diseases and liver enzymes among Iranian seafarers.

Background: Little information is available on the trend in cardiovascular risk factors and hepatic enzymes in Iranian seafarers. The present study aimed at assessing the pattern of obesity, hypertension, diabetes, elevated serum glutamic oxaloacetate transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) in Iranian seafarers during 2010 to 2014. Methods: Data on cardiovascular risk factors and hepatic enzymes were extracted from seafarers' annual health examination of National Iranian Tanker Company (NITC) of 2010, 2012, and 2014. The repeated measure ANOVA was used to compare continuous variables across 3 years. Categorical data were analyzed using Chi-square test. Over weight was defined as BMI (Body Mass Index) >25 kg/m2; obesity was defined as BMI>=30 kg/m2; hypertension was defined as systolic blood pressure (SBP)> 140 mmHg, and diastolic blood pressure (DBP)> 90 mmHg, or a history of antihypertensive drug use. Diabetes (DM) was defined as fasting blood sugar (FBS) > 110 mg/dl, or having a history of oral hypoglycemic agents; and elevated SGOT and SGPT were defined as SGOT > 40 U/L and SGPT > 40 U/L, respectively. Results: The BMI mean±SD values of Iranian seafarers were 24.81±3.07 kg/m2, 25.51±2.96 kg/m2, and 25.96 ± 3.02 kg/m2 in 2010, 2012, and 2014, respectively. A significant difference was observed in BMI over the study period. The mean of systolic and diastolic blood pressure did not significantly increase over time. The SGOT and SGPT means were not significantly different from 2010 to 2014. The prevalence of overweight increased significantly from 46.7% to 60.9% over the study period; however, the prevalence of obesity, hypertension, elevated SGOT, and elevated SGPT did not change significantly. Conclusion: The current survey showed that the obesity problem has increased among Iranian seafarers working on tankers, which is a concerning problem because obesity has negative effects on seafarers' health.

Prevalence and associated factors of cardio-metabolic risk factors in Iranian seafarers.

BACKGROUND: Since Iran's economy is based on the sale of petroleum products, seafaring is considered a crucial job. Little research has been done on issues related to seafarers' health in Iranian maritime industry. The present study investigated the prevalence and associated factors of cardio-metabolic risk factors in seafarers of National Iranian Tanker Company (NITC). MATERIALS AND METHODS: A cross-sectional study was performed on 234 Iranian male seafarers of NITC in 2015. Metabolic syndrome (MetS) was diagnosed according to the reports of National Committee of Obesity. Three main blood parameters (of elevated total cholesterol, elevated low-density lipoprotein cholesterol, and elevated very low-density lipoprotein cholesterol) and general obesity were included as additional cardio-metabolic risk factors. RESULTS: The mean age of the participants was 36.0 ± 10.3 years. The prevalence of MetS was 14.9%. The common cardio-metabolic risk factors were excess weight (51.1%), abdominal obesity (38.5%), and smoking (27.8%) among Iranian seafarers. In multivariate analysis, age (OR: 1.05, 95% CI: 1.01-1.09) and body mass index (OR: 1.14, 95% CI: 1.01-1.27) were associated with the increase in hypertension risk. CONCLUSIONS: Our finding showed that the current prevalence of MetS among Iranian male seafarers working on tankers can affect negatively their health and career at sea.

Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997-2012.

BACKGROUND: Telemedical Maritime Assistance Service (TMAS) for seafarers and traveling passengers is important and can be crucial for the optimal medical treatment on board ships. The aim of this study was to analyse and to compare the data from consultations and evacuations from merchant ships and passenger ferries for possible improvements. MATERIALS AND METHODS: Data for seafarers from 1997, 2002 and 2007 and for passengers on Swedish ferries for the years 2007, 2009, 2011 and 2012 from the Swedish Radio Medical were studied. Symptoms and diseases were classified according to the International Classification for Primary Care (ICPC-2). The distribution of symptoms, accidents and diseases, treatments/actions taken, evacuations and the communication forms were analysed. RESULTS: One thousand ninety-five contacts for seafarers from merchant ships and 651 passenger patients from Swedish ferries were analysed. While the evacuations for the seafarers gradually decreased over the years from 18% in 1997 to 14% in 2007, still 39.5% of the passenger patient contacts were evacuated mainly by helicopters and 70 patients were picked up by an ambulance on the quay. Accidents were 20% for seafarers and 25% for passengers of the contacts. Evacuations for passengers were mainly in the diagnostic groups: unspecific (A), digestive (D), cardiology (K), musculoskeletal (L) and neurology (N). The use of VHF, radio communications and fax machines have been greatly reduced while the use of e-mail and satellite phone increased. CONCLUSIONS: No significant differences in reasons for contact or actions over the years have been identified. The evacuations of seafarers decreased over the years but was stable among the passenger patients (39%). The circumstances and reasons behind the evacuations should be analysed for prevention. Standard forms and digital images for documentation can facilitate knowledge exchange and further studies.

A review of fatigue in fishermen: a complicated and underprioritised area of research.

BACKGROUND: Fatigue in fishing has been a highly underprioritised area of research, even though fatigue has been found to be the largest single contributing factor in accidents. AIM: The aim of this article/paper is to provide an overview of the research conducted on fatigue in fishermen up to date, in order to establish a starting point for further research in this area. MATERIALS AND METHODS: The review is mainly based on journal articles from PubMed, Google Scholar, International Maritime Health, Science Direct and some relevant articles links were also followed. RESULTS: The research revealed that only 5 articles have been published concerning fatigue in fishermen.The articles all confirmed that fatigue is a serious health and safety issue among fishermen, and that further research therefore is warranted. CONCLUSIONS: Only 2 of the 5 studies of fishermen's fatigue used objective measures and in one of these, the sample size was small (n = 19), effectively limiting the statistical analysis and its application. Further research using larger samples is needed, preferably with a mix of objective and subjective measures, where of some of the questions should be scenario based and some should be from standardised questionnaires. Greater understanding is also needed to assess how much of the variance in fatigue is attributable to e.g. length of trip, hours of work without rest, and type of job and specific tasks. A greater understanding of the similarities and differences between acute and long-term fatigue is also needed.

A review of fatal accident incidence rate trends in fishing.

BACKGROUND: Injury prevention in fishing is one of the most important occupational health challenges. AIM: The aim was to describe and compare internationally the trends of the fatal injury incidence rates and to discuss the impact of the implemented safety programs. MATERIALS AND METHODS: The review is based on journal articles and reports from the maritime authorities in Poland, United Kingdom, Norway, Iceland, Denmark, United States and Alaska and Canada. The original incidence rates were recalculated as per 1,000 person-years for international comparison of the trends. RESULTS: The risk of fatal accidents in fishing in the northern countries has been reduced by around 50% to an average of about 1 per 1,000 person-years. Norway and Canada keep the lowest rates with around 0.5 and 0.25 per 1,000 person-years. About half of the fatal injuries are related to vessel disasters and drowning. The safety programs seem to have good effects, but the risk is still about 25 to 50 times higher than for onshore workers. CONCLUSIONS: The overall fatal injury rates in the European and North American studies decreased by around 50% most probably as result of the implemented safety programs. However the high risk in fishing compared to onshore workers calls for continued and intensified safety programs.

Social security for seafarers globally.

BACKGROUND: The social security protection is one of the essential elements of decent work. The issue is complexand no previous epidemiological studies of the coverage among the seafarers have yet been performed. AIM: The aim was to overcome the gap of knowledge to promote the further discussion and plan the implementationof the social security for all the seafarers. MATERIALS AND METHODS: The seafarers completed a short questionnaire concerning their knowledge abouttheir social security status. RESULTS: The significant disparities in the social security coverage were pointed out among the nationalities.Especially it is worth mentioning that more than half of the respondents believe they are economicallyuncovered for disability from an injury on board and from a work-related disease. CONCLUSIONS: The results confirm the ILO (Convention No. 143) statements that the significant part of theseafarers comes from the poorer countries without the substantial social security systems. The solutionssuggested are to implement the minimum requirements as recommended by the ILO 2006 Convention, tosurvey the implementation and - in the long term - to struggle for a global social equality.

Risk factors for fishermen's health and safety in Greece.

BACKGROUND: This is, to the best of our knowledge, the first occupational health study in Greek fishing. AIM: The aim of the study is to determine the risks for health and safety in Greek fisheries workers by exploring their health status and the health risk factors present in their occupational environment, thus providing a current baseline for further research in the future and for documentation of the needs for prevention. MATERIALS AND METHODS: A questionnaire pilot study was carried out in a random sample of 100 Greek fishermen. RESULTS: Twenty-eight per cent (28%) had experienced at least one injury, of which half caused more than one day absence, while 14% had a near drowning experience. The health risks factors studied include excessive weight, cardiovascular incidents and dermatological, musculoskeletal, respiratory, hearing, stress, and anxiety problems. The occupational health risk factors include alcohol, fatty food consumption, smoking, and lack of physical exercise. CONCLUSIONS: The health effects observed are causally related to diet, smoking, and exercise, which in turn relate to the specific working conditions and culture in small-scale fishing that need to be taken into consideration in prevention programmes. The results are comparable with international fisheries experience, mainly from Poland, Denmark, and Turkey.

Collaborative, cross-national studies on health and safety in seafaring for evidence-based Maritime policy and regulations.

BACKGROUND: Until recently, maritime health and safety policies and regulations were sparsely based on health and safety research, and only a small number of countries contributed to new research. OBJECTIVES: To strengthen maritime health and safety research activities by presenting a study example and discussing the possibilities and needs for more national and cross-national research. METHODS: In a cross-national epidemiological study example, the seafarers from eleven countries completed small, anonymous questionnaires concerning the working conditions on their latest tours at sea while waiting for their health examinations. RESULTS: Significant disparities were pointed out among the nationalities, e.g., the length of the tours at sea, the proportional distribution of officers and non-officers, the mean age structure, the injury incidence rates, and the differences of occupational safety standards. The analysis of all data together increased the statistical strength of the multivariate analyses and allowed for valid comparisons among the nationalities. CONCLUSIONS: The questionnaire data was used successfully in the collaborative study example, but other data sources and methods are useful for health and safety research in seafaring as well. More national and cross-national research on maritime health and safety is warranted.