Self-reported diabetes mellitus among seafarers: occupational and sociodemographic predictors.

BACKGROUND: Seafarers are at increased risk of diabetes due to their lifestyle and working conditions on board ships. There is, however, limited evidence regarding the magnitude of diabetes and its risk factors. In this study, we aimed to assess the prevalence of self-reported diabetes among seafarers on board ships and identify risk factors associated with it. MATERIALS AND METHODS: A cross-sectional epidemiological survey was conducted among seafarers aboard ships between November and December 2022. The study enrolled a total of 4,500 seafarers aged 18 and older. Data were collected using anonymous, standardized questionnaires. The association between the outcome variable and the independent variables was assessed using binary logistic regression models. RESULTS: In total, 2,986 participants were included in the study. The prevalence of self-reported diabetes among seafarers was found to be 8.2% (95% CI: 7.2-9.2). Self-reported diabetes prevalence among officers and non-officers was 7% and 9%, respectively. The mean age of study participants was 37.96 ± 10.22, while the mean age of participants with diabetes was 47.5 ± 9.46. Independent predictors of self-reported diabetes mellitus were age (51+ years) [adjusted odds ratio (AOR): 3.52, 95% confidence interval (CI): 1.46-8.95], rank (non-officer) [AOR: 1.65; 95% CI: 1.14-2.40], worksites (engine) (AOR: 2.08, 95% CI: 1.19-3.77), work experience (10-20 years) (AOR: 4.66, 95% CI: 2.33-10.05), work experience (21+ years) (AOR: 5.01, 95% CI: 2.32-11.55), working hours per week (57-70 hours) (AOR: 1.57, 95% CI: 1.08-2.31), working hours per week (71+ hours) (AOR: 1.80, 95% CI: 1.17-2.80), self-reported hypertension (AOR: 1.44, 95% CI: 1.03-1.99), overweight (AOR: 1.74; 95% CI: 1.24-2.47), and obesity (AOR: 2.93; 95% CI: 1.84-4.65). CONCLUSIONS: This study revealed that one in twelve seafarers between the ages of 19 and 70 have self-reported diabetes. The present study identified significant risk factors associated with diabetes. Risk factor mitigation strategies aimed at high-risk groups should be implemented on board ships.

Risk prediction model of self-reported hypertension for telemedicine based on the sociodemographic, occupational and health-related characteristics of seafarers: a cross-sectional epidemiological study.

OBJECTIVES: High blood pressure is a common health concern among seafarers. However, due to the remote nature of their work, it can be difficult for them to access regular monitoring of their blood pressure. Therefore, the development of a risk prediction model for hypertension in seafarers is important for early detection and prevention. This study developed a risk prediction model of self-reported hypertension for telemedicine. DESIGN: A cross-sectional epidemiological study was employed. SETTING: This study was conducted among seafarers aboard ships. Data on sociodemographic, occupational and health-related characteristics were collected using anonymous, standardised questionnaires. PARTICIPANTS: This study involved 8125 seafarers aged 18-70 aboard 400 vessels between November 2020 and December 2020. 4318 study subjects were included in the analysis. Seafarers over 18 years of age, active (on duty) during the study and willing to give informed consent were the inclusion criteria. OUTCOME MEASURES: We calculated the adjusted OR (AOR) with 95% CIs using multiple logistic regression models to estimate the associations between sociodemographic, occupational and health-related characteristics and self-reported hypertension. We also developed a risk prediction model for self-reported hypertension for telemedicine based on seafarers' characteristics. RESULTS: Among the 4318 participants, 55.3% and 44.7% were non-officers and officers, respectively. 20.8% (900) of the participants reported having hypertension. Multivariable analysis showed that age (AOR: 1.08, 95% CI 1.07 to 1.10), working long hours per week (AOR: 1.02, 95% CI 1.01 to 1.03), work experience at sea (10+ years) (AOR: 1.79, 95% CI 1.33 to 2.42), being a non-officer (AOR: 1.75, 95% CI 1.44 to 2.13), snoring (AOR: 3.58, 95% CI 2.96 to 4.34) and other health-related variables were independent predictors of self-reported hypertension, which were included in the final risk prediction model. The sensitivity, specificity and accuracy of the predictive model were 56.4%, 94.4% and 86.5%, respectively. CONCLUSION: A risk prediction model developed in the present study is accurate in predicting self-reported hypertension in seafarers' onboard ships.

The Magnitude of Cardiovascular Disease Risk Factors in Seafarers from 1994 to 2021: A Systematic Review and Meta-Analysis.

OBJECTIVES: The incidence of acute cardiac events is one of the main reasons for medical consultation, disembarkation, repatriation, and death among seafarers at sea. Managing cardiovascular risk factors, particularly those that can be modified, is the key to preventing cardiovascular disease. Therefore, this review estimates the pooled prevalence of major CVD risk factors among seafarers. METHODS: We conducted a comprehensive search of studies published between 1994 and December 2021 in four international databases, namely PubMed/Medline, Scopus, Google Scholar, and Web of Science (WOS). Each study was evaluated for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. The DerSimonian-Laird random-effects model with logit transformations was used to estimate the pooled prevalence of major CVD risk factors. The results were reported in accordance with the Preferred Items for Systematic Review and Meta-analysis (PRISMA) guidelines. RESULTS: Out of all 1484 studies reviewed, 21 studies with 145,913 study participants met the eligibility criteria and were included in the meta-analysis. In the pooled analysis, the prevalence of smoking was found to be 40.14% (95% CI: 34.29 to 46.29%) with heterogeneity between studies (I2 = 98%, p < 0.01). The prevalence of hypertension, overweight, obesity, diabetes mellitus, and alcohol consumption was 45.32%, 41.67%, 18.60%, 12.70%, and 38.58%, respectively. However, the sensitivity analysis after excluding studies showed a pooled prevalence of hypertension, overweight, obesity, and diabetes mellitus of 44.86%, 41.87%, 15.99%, and 16.84%, respectively. The subgroup analysis demonstrated that smoking prevalence among seafarers had decreased significantly after 2013. CONCLUSION: This study demonstrated that CVD risk factors, particularly hypertension, overweight, smoking, alcohol consumption, and obesity, are prevalent among seafarers. These findings may serve as a guide for shipping companies and other responsible bodies in order to prevent CVD risk factors among seafarers. PROSPERO Registration: CRD42022300993.

Choline-Containing Phospholipids in Stroke Treatment: A Systematic Review and Meta-Analysis.

BACKGROUND: Globally, stroke is the second leading cause of death and disability. In different studies conducted previously, the choline-containing phospholipids citicoline and choline alphoscerate have been proposed as adjuvants in the treatment of acute strokes. A systematic review was conducted to provide updated information on the effects of citicoline and choline alphoscerate in patients with acute and hemorrhagic strokes. METHODS: PubMed/Medline, Scopus, and Web of Science were searched to identify relevant materials. Data were pooled, and odds ratios (OR) were reported for binary outcomes. Using mean differences (MD), we evaluated continuous outcomes. RESULTS: A total of 1460 studies were reviewed; 15 studies with 8357 subjects met the eligibility criteria and were included in the analysis. In our study, citicoline treatment did not result in improved neurological function (NIHSS < 1, OR = 1.05; 95% confidence interval (CI): 0.87-1.27) or functional recovery (mRS < 1, OR = 1.36; 95% CI: 0.99-1.87) in patients with acute stroke. Choline alphoscerate improved neurological function and functional recovery in stroke patients based on the Mathew's scale and the Mini-Mental State Examination (MMSE). CONCLUSION: Citicoline did not improve the neurological or functional outcomes in acute stroke patients. In contrast, choline alphoscerate improved neurological function and functional recovery and reduced dependency in stroke patients.

Activity of Choline Alphoscerate on Adult-Onset Cognitive Dysfunctions: A Systematic Review and Meta-Analysis.

BACKGROUND: Choline alphoscerate (alpha glyceryl phosphorylcholine, α-GPC) is a choline-containing phospholipid used as a medicine or nutraceutical to improve cognitive function impairment occurring in neurological conditions including adult-onset dementia disorders. Despite its 1985 marketing authorization, there are still discrepancies between countries regarding its approval as a prescription medicine and discussions about its effectiveness. OBJECTIVE: This study aimed to evaluate the efficacy of the α-GPC compound for treating cognitive impairment in patients with adult-onset neurological disorders. METHODS: Relevant studies were identified by searching PubMed, Web of Science, and Embase. Studies that evaluated the effects of α-GPC alone or in combination with other compounds on adult-onset cognitive impairment reporting cognition, function, and behavior were considered. We assessed the risk of bias of selected studies using the Cochrane risk of bias tool. RESULTS: A total of 1,326 studies and 300 full-text articles were screened. We included seven randomized controlled trials (RCTs) and one prospective cohort study that met our eligibility criteria. We found significant effects of α-GPC in combination with donepezil on cognition [4 RCTs, mean difference (MD):1.72, 95% confidence interval (CI): 0.20 to 3.25], functional outcomes [3 RCTs, MD:0.79, 95% CI: 0.34 to 1.23], and behavioral outcomes [4 RCTs; MD: -7.61, 95% CI: -10.31 to -4.91]. We also observed that patients who received α-GPC had significantly better cognition than those who received either placebo or other medications [MD: 3.50, 95% CI: 0.36 to 6.63]. CONCLUSION: α-GPC alone or in combination with donepezil improved cognition, behavior, and functional outcomes among patients with neurological conditions associated with cerebrovascular injury.

Artificial Intelligence Models in the Diagnosis of Adult-Onset Dementia Disorders: A Review.

Background: The progressive aging of populations, primarily in the industrialized western world, is accompanied by the increased incidence of several non-transmittable diseases, including neurodegenerative diseases and adult-onset dementia disorders. To stimulate adequate interventions, including treatment and preventive measures, an early, accurate diagnosis is necessary. Conventional magnetic resonance imaging (MRI) represents a technique quite common for the diagnosis of neurological disorders. Increasing evidence indicates that the association of artificial intelligence (AI) approaches with MRI is particularly useful for improving the diagnostic accuracy of different dementia types. Objectives: In this work, we have systematically reviewed the characteristics of AI algorithms in the early detection of adult-onset dementia disorders, and also discussed its performance metrics. Methods: A document search was conducted with three databases, namely PubMed (Medline), Web of Science, and Scopus. The search was limited to the articles published after 2006 and in English only. The screening of the articles was performed using quality criteria based on the Newcastle-Ottawa Scale (NOS) rating. Only papers with an NOS score ≥ 7 were considered for further review. Results: The document search produced a count of 1876 articles and, because of duplication, 1195 papers were not considered. Multiple screenings were performed to assess quality criteria, which yielded 29 studies. All the selected articles were further grouped based on different attributes, including study type, type of AI model used in the identification of dementia, performance metrics, and data type. Conclusions: The most common adult-onset dementia disorders occurring were Alzheimer's disease and vascular dementia. AI techniques associated with MRI resulted in increased diagnostic accuracy ranging from 73.3% to 99%. These findings suggest that AI should be associated with conventional MRI techniques to obtain a precise and early diagnosis of dementia disorders occurring in old age.

LASSO Regression Modeling on Prediction of Medical Terms among Seafarers' Health Documents Using Tidy Text Mining.

Generally, seafarers face a higher risk of illnesses and accidents than land workers. In most cases, there are no medical professionals on board seagoing vessels, which makes disease diagnosis even more difficult. When this occurs, onshore doctors may be able to provide medical advice through telemedicine by receiving better symptomatic and clinical details in the health abstracts of seafarers. The adoption of text mining techniques can assist in extracting diagnostic information from clinical texts. We applied lexicon sentimental analysis to explore the automatic labeling of positive and negative healthcare terms to seafarers' text healthcare documents. This was due to the lack of experimental evaluations using computational techniques. In order to classify diseases and their associated symptoms, the LASSO regression algorithm is applied to analyze these text documents. A visualization of symptomatic data frequency for each disease can be achieved by analyzing TF-IDF values. The proposed approach allows for the classification of text documents with 93.8% accuracy by using a machine learning model called LASSO regression. It is possible to classify text documents effectively with tidy text mining libraries. In addition to delivering health assistance, this method can be used to classify diseases and establish health observatories. Knowledge developed in the present work will be applied to establish an Epidemiological Observatory of Seafarers' Pathologies and Injuries. This Observatory will be a collaborative initiative of the Italian Ministry of Health, University of Camerino, and International Radio Medical Centre (C.I.R.M.), the Italian TMAS.

The Benefits of Telemedicine in Personalized Prevention of Cardiovascular Diseases (CVD): A Systematic Review.

INTRODUCTION: Adverse effects on personalized care and outcomes of cardiovascular diseases (CVD) could occur if health systems do not work in an efficient manner. The pandemic caused by COVID-19 has opened new perspectives for the execution and advancement of cardiovascular tests through telemedicine platforms. OBJECTIVE: This study aimed to analyze the usefulness of telemedical systems for providing personal care in the prevention of CVD. METHODS: A systematic review analysis was conducted on the literature available from libraries such as PubMed (Medline), Scopus (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Data available in the last 10 years (2011-2020) were also examined by PRISMA guidelines. The selected studies were divided into two categories: (1) benefits of telemedicine in CVD prevention, and (2) recent progress in telemedical services for personalized care of CVD. RESULTS: The literature search produced 587 documents, and 19 articles were considered in this review. Results highlighted that the timely delivery of preventive care for CVD which can be implemented virtually can benefit and modify morbidity and mortality. This could also reduce the pressure on hospitals by decreasing acute CVD occurrence among the general population. The use of these technologies can also help to reduce access to hospitals and other medical devices when not necessary. CONCLUSIONS: Telemedicine platforms can be used for regular checkups for CVD and contribute to preventing the occurrence of acute events and more in general the progression of CVD.

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Seafarers: A Cross-Sectional Study of Prevalence and Clustering.

BACKGROUND: Cardiovascular diseases (CVD) are the major cause of work-related mortality from diseases onboard ships in seafarers. CVD burden derives mainly from modifiable risk factors. To reduce the risk factors and the burden of CVD onboard ships in seafarers, it is important to understand the up-to-date prevalence of modifiable risk factors. The primary purpose of this study was to assess the prevalence and clustering of self-reported modifiable CVD risk factors among seafarers. We have also explored the association between socio-demographic and occupational characteristics and reported modifiable CVD risk factor clustering. MATERIALS AND METHODS: A cross-sectional study was conducted among seafarers from November to December 2020 on board ships. In total, 8125 seafarers aged 18 to 70 were selected from 400 ships. Data were collected using a standardized and anonymous self-reported questionnaire. The prevalence value for categorical variables and mean differences for continuous variables were compared using chi-square and independent sample t-tests. Multinomial logistic regression models were performed to identify independent predictors for modifiable CVD risk factor clustering. RESULTS: Out of a total of 8125 seafarers aged ≥18 years on selected vessels, 4648 seafarers volunteered to participate in the survey, with a response rate of 57.2%. Out of 4318 participants included in analysis, 44.7% and 55.3% were officers and non-officers, respectively. The prevalence of reported hypertension, diabetes, current smoking and overweight or obesity were 20.8%, 8.5%, 32.5%, and 44.7%, respectively. Overall, 40%, 20.9%, 6% and 1.3% of the study participants respectively had one, two, three and four modifiable CVD risk factors. Older age (51+ years) (odds ratio (OR): 3.92, 95% confidence interval (CI): 2.44-6.29), being non-officers (OR: 1.36, 95% CI: 1.09-1.70), job duration (10-20 years) (OR: 2.73, 95% CI: 2.09-3.57), job duration (21+ years) (OR: 2.60, 95% CI: 1.79-3.78), working 57-70 h per week (OR: 2.03, 95% CI: 1.65-2.49) and working 71+ h per week (OR: 3.08, 95% CI: 2.42-3.92) were independent predictors for at least two self-reported modifiable CVD risk factor clustering. CONCLUSION: The results of our study demonstrate that more than four in six (68.5%) seafarers aged between 19 and 70 years have at least one of the modifiable CVD risk factors. Therefore, CVD prevention and modifiable risk factors reduction strategies targeting high-risk groups should be designed and implemented on board ships.

Impact of Obesity-Induced Inflammation on Cardiovascular Diseases (CVD).

Overweight and obesity are key risk factors of cardiovascular disease (CVD). Obesity is currently presented as a pro-inflammatory state with an expansion in the outflow of inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), alongside the expanded emission of leptin. The present review aimed to evaluate the relationship between obesity and inflammation and their impacts on the development of cardiovascular disease. A literature search was conducted by employing three academic databases, namely PubMed (Medline), Scopus (EMBASE), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The search presented 786 items, and by inclusion and exclusion filterers, 59 works were considered for final review. The Newcastle-Ottawa Scale (NOS) method was adopted to conduct quality assessment; 19 papers were further selected based on the quality score. Obesity-related inflammation leads to a low-grade inflammatory state in organisms by upregulating pro-inflammatory markers and downregulating anti-inflammatory cytokines, thereby contributing to cardiovascular disease pathogenesis. Because of inflammatory and infectious symptoms, adipocytes appear to instigate articulation and discharge a few intense stage reactants and carriers of inflammation. Obesity and inflammatory markers are strongly associated, and are important factors in the development of CVD. Hence, weight management can help prevent cardiovascular risks and poor outcomes by inhibiting inflammatory mechanisms.

A Descriptive Study on the Applications of Plasma Exeresis in Dermatology.

BACKGROUND: Plasma exeresis is an aesthetic procedure used for the non-surgical treatment of a variety of skin problems. This technology allows for the improvement of skin imperfections and wrinkles and can be used to treat certain dermatological disorders. OBJECTIVE: The purpose of this descriptive study was to describe the demographics and postprocedural recovery experiences of patients who underwent plasma exeresis at a single clinic over a period of eight months. Additionally, data on patient satisfaction with the treatment was recorded. Methods: A descriptive, cross-sectional study was conducted. Participants in the study included all individuals who underwent plasma exeresis at the Tsioumas Clinic in Greece over a period of eight months from September 2018 to April 2019. Frequency distribution tables were used to describe the types of cases and the number of patients who underwent plasma exeresis treatment each month. RESULTS: A total of 710 patients underwent plasma exeresis within 124 actual working days during the study period. Of these, 73.4% (n=528) were women, and 25.6% (n=182) were men. The most cases were recorded in January, March, November, and February, representing 15.5 percent, 15.4 percent, 15 percent, and 14 percent of the total cases, respectively. Over 33 percent and 18 percent of patients were treated in the upper and lower eyelids, respectively. With regard to patient satisfaction, more than 52.9 percent of the patients reported being extremely satisfied with the plasma exeresis treatment. CONCLUSION: The results from our study demonstrate that plasma exeresis is most popular in our clinic from November to March, and the upper and lower eyelids were the most frequently treated areas during the eight-month study period. While not all patients who were originally treated were able to be reached to report their level of satisfaction, the majority of the proportion of patients that were able to be contacted reported being satisfied with the treatment. Future research with more objective efficacy measurements are needed to support our findings.

First Surveillance of Violence against Women during COVID-19 Lockdown: Experience from "Niguarda" Hospital in Milan, Italy.

Violence against women emerges with tragic regularity in the daily news. It is now an evident trace of a dramatic social problem, the characteristics of which are not attributable to certain economic, cultural, or religious conditions of the people involved but affect indiscriminately, in a unanimous way, our society. The study is a survey about the number of hospital admissions due to episodes attributable to violence against women, recorded by the Niguarda Hospital in Milan in the period 1 March-30 May from 2017 to 2020. This period, in 2020, corresponds to the coronavirus Lockdown in Italy. All the medical records of the Emergency department were reviewed, and the extracted data classified in order to identify the episodes of violence against women and the features of the reported injuries and the characteristics of the victims. The data did not show an increase in the number of cases in 2020 compared to previous years, but we did find a notable increase in the severity of injuries.

Incidence of occupational injuries and diseases among seafarers: a descriptive epidemiological study based on contacts from onboard ships to the Italian Telemedical Maritime Assistance Service in Rome, Italy.

OBJECTIVES: Workers at sea have high mortality, injuries and illnesses and work in a hazardous environment compared to ashore workers. The present study was designed to measure the incidence of occupational injuries and diseases among seafarers and quantify the contribution of differences in rank and job onboard on seafarers' diseases and injuries rates. DESIGN: Descriptive epidemiological study. SETTING AND PARTICIPANTS: This study's data were based on contacts (n=423) for medical requests from Compagnie Maritime d'Affrètement/Compagnie Générale Maritime (CMA-CGM) container ships to the Italian Telemedical Maritime Assistance Service in Rome from 2016 to 2019, supplemented by data on the estimated total at-risk seafarer population on container ships (n=13 475) over the study period. OUTCOME MEASURES: Distribution of injuries by anatomic location and types of diseases across seafarers' ranks and worksites. We determined the incidence rate and incidence rate ratio (IRR) with a 95% CI. RESULTS: The total disease rate was 25 per 1000 seafarer-years, and the overall injury rate was 6.31 per 1000 seafarer-years over the 4 years study period. Non-officers were more likely than officers to have reported gastrointestinal (IRR 2.12, 95% CI 1.13 to 4.26), dermatological (IRR 3.66, 95% CI 1.27 to 14.42) and musculoskeletal (IRR 2.25, 95% CI 1.11 to 5.05) disorders onboard container ships. Deck workers were more likely than engine workers to be injured in the wrist and hand (IRR 3.25, 95% CI 1.19 to 10.23). CONCLUSIONS: Rates of reported injury and disease were significantly higher among non- officers than officers; thus, this study suggests the need for rank-specific preventative measures. Future studies should consider risk factors for injury and disease among seafarers in order to propose further preventive measures.

Assessment of Awareness and Knowledge on Novel Coronavirus (COVID-19) Pandemic among Seafarers.

Background: The ongoing pandemic due to the novel coronavirus (COVID-19) is becoming a serious global threat. Experts suggest that the infection can be controlled by immediate prevention measures. Sailing is one of the occupational categories more vulnerable to this virus outbreak due to the proximity of the working conditions. Objective: Awareness and knowledge assessments of seafarers towards the current epidemic is mandatory to understand the effectiveness and success of the infection control measures adopted by shipping companies. Methods: In this study, we presented an online questionnaire survey to determine the knowledge levels of COVID-19 among seafarers. The data were collected by self-reported survey, and analysis was done by the analysis of variance (ANOVA). The t-test was used to understand the knowledge attitude differences to COVID-19 among different occupational groups of seafarers, and the p-value ≤ of 0.05 was considered statistically significant. Results: Among 1,458 responses received, 92.82% had a college or university degree. The results reported that the mean COVID-19 knowledge score was 5.82 (standard deviation = 0.51, range 0-6), and the overall correct percentage was 97%. There was a statistically significant difference between age groups (F (4, 1453) = 5.44, p < 0.001) and educational groups (F (4, 1453) = 1.52, p < 0.001). The knowledge score was not significantly different across the educational status of the participants (F (2, 1455) = 1.52, p = 0.220). Conclusions: The present study highlighted good knowledge and behaviours among sailors about COVID-19. However, shipping companies need to come up with new campaigns to hold optimistic practices and suitable guidelines on ships, including cruise boats, to keep sea workers always alert and collaborative in mitigating the spread of COVID-19.

Telemedicine for Pre-Employment Medical Examinations and Follow-Up Visits on Board Ships: A Narrative Review on the Feasibility.

BACKGROUND: Telemedicine has already been applied to various medical specialties for diagnosis, treatment, and follow-up visits for the general population. Telemedicine has also proven effective by providing advice, diagnosis, and treatment to seafarers during emergency medical events onboard ships. However, it has not yet been applied for pre-employment medical examinations and follow-up visits on board ships. OBJECTIVE: This review aimed to assess the possibility of using telemedicine during periodic visits between one pre-employment medical examination and others on board ships, and to recommend necessary medical examination tests with screening intervals for seafarers. METHODS: Various databases including PubMed, EMBASE, Scopus, CINAHL, and Cochrane Library were explored using different keywords, titles, and abstracts. Studies published between 1999 and 2019, in English, in peer-reviewed journal articles, and that are conference proceedings were considered. Finally, the studies included in this review were chosen on the basis of the eligibility criteria. RESULTS: Out of a total of 168 studies, 85 studies were kept for further analysis after removing the duplicates. A further independent screening based on the inclusion and exclusion criteria resulted in the withdrawal of 51 studies that were not further considered for our analysis. Finally, 32 studies were left, which were critically reviewed. Out of 32 accepted studies, 10 studies demonstrated the effectiveness of the electrocardiogram (ECG) in monitoring and managing remote patients with heart failure, early diagnosis, and postoperative screening. In 15 studies, telespirometry was found to be effective in diagnosing and ruling out diseases, detecting lung abnormalities, and managing patients with chronic obstructive pulmonary disease (COPD) and asthma. Seven studies reported that telenephrology was effective, precise, accurate, and usable by non-medical personnel and that it reduced sample analysis times and procedures in laboratories. CONCLUSION: using new technologies such as high-speed internet, video conferencing, and digital examination, personnel are able to make the necessary tests and perform virtual medical examination on board ships with necessary training.

A descriptive epidemiological study of cardiovascular diseases among seafarers.

BACKGROUND: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality among seafarers. This study aimed to evaluate CVDs distribution and differences, considering seafarers' rank and worksite groups. MATERIALS AND METHODS: A descriptive epidemiological study was employed, and the analysis was based on the telemedical assistance data of the International Radio Medical Centre (C.I.R.M.) from 2010 to 2018. The age, gender, rank, and worksite variables were considered for the analysis. Chi-square or Fisher test was used to assess differences in CVD distribution between rank and worksite groups. RESULTS: Cardiovascular diseases were the sixth leading cause of medical advice requests to C.I.R.M. Distribution of CVD significantly differed between officers and non-officers [x2 (5) = 17.308, p = 0.004]. Officers were often diagnosed with hypertensive CVD (46%), whereas non-officers were frequently diagnosed with ischaemic heart diseases (41%). There were no significant differences in the distribution of CVD diagnoses between worksite groups [x2 (10) = 12.863, p = 0.231]. CONCLUSIONS: The frequency of CVD is higher among non-officers and older seafarers who have been more often diagnosed with CVD. Specific interventions such as early diagnosis, regular monitoring, and physical training to reduce cardiovascular risk should be considered on board ships. Future studies should take into account the incidence rate of CVD between rank and worksite groups.

Correlation between body mass index and blood pressure in seafarers.

BACKGROUND: High blood pressure is a serious medical condition that significantly increases the risk of cardiovascular disease. Although overweight and high blood pressure are frequent consequences for the health of life at sea, there is a paucity of information on the contribution of body mass index (BMI) to high blood pressure (HBP) in seafarers. OBJECTIVE: The present study was aimed to examine the relationship between BMI and blood pressure and to analyze further BMI as a risk factor for high blood pressure through a modeling approach. MATERIALS AND METHODS: A retrospective analysis was performed on 603 seafarers' medical examination records. The seafarer's blood pressure and BMI were recorded and interpreted according to the WHO criteria. Pearson product-moment correlation was examined to determine the association between BMI and blood pressure. Multinomial logistic regression models were performed to estimate the strength of association between the BMI and the HBP. RESULTS: Out of a total of 603 seafarers under study, 44.4% and 55.6% were officers and non-officers, respectively. Mean SBP, DBP, and BMI were significantly higher among non-officers than officers. BMI was positively correlated (p < .01) with both SBP (r = 0.336) and DBP (r = 0.344). About 39% and 16.6% of the study subjects were prehypertension and hypertensive, respectively. The risk of prehypertension and hypertension was higher in individuals who were overweight and obese. CONCLUSIONS: Mean blood pressure levels increase parallel to the rise of BMI. Thus, emphasis should be given on a weight management program in relation to the prevention and control of high blood pressure.

Conceptual Framework and Designing for a Seafarers' Health Observatory (SHO) Based on the Centro Internazionale Radio Medico (C.I.R.M.) Data Repository.

BACKGROUND: Health observatory (HO) models are helpful in gathering, analyzing, interpreting, and circulating reliable and quality information on population health and health service delivery. In this study, we proposed an HO conceptual model to enhance seafarer's health, which subjects to disease trends. METHODS: Three methods were followed during the study: a systematic collection of seafarer's health data from the Centro Internazionale Radio Medico (C.I.R.M.) repository, an integrative review of existing seafarer's policy, and both open and closed questionnaires were distributed to stakeholders to develop clinical knowledge. C.I.R.M. is the Italian Telemedical Maritime Assistance Service (TMAS). Results and Discussion. A three-layer HO framework was developed, and each layer had its components and functionalities. The proposed HO model integrated with the outcomes of the mentioned methods was working as the origin of the framework. In this way, we can design a standard infrastructure in ships and risk assessment conduction.

Diabetes and technology: A pilot study on the management of patients with insulin pumps during the COVID-19 pandemic.

BACKGROUND: The recent COVID-19 pandemic has accelerated the treatment process through IT/technological supports, useful in the management of chronic patients such as those affected by type 1 Diabetes Mellitus (T1DM). Specific routes for fragile patients such as those with micro-infusers have been created thanks to the application of "Diabetes Technology," which allows patients to monitor blood glucose quickly and easily. The present pilot study aimed to assess the quality of care provided to patients with micro-infusers in a delicate phase such as a pandemic lockdown. MATERIALS AND METHODS: A mixed-methods approach was used. In the first part, with prior written consent, patients with insulin pumps enrolled voluntarily. In the second part, the focus group discussion (FGD) was carried out with the voluntarily enrolled participants. The FGD data were organized and analyzed by the thematic areas. RESULTS: The number of patients with afferent insulin pumps at the center was 50 individuals. Among them, 20 patients voluntarily joined the first part of the study by completing the PACIC questionnaire, which gave an average result of 3.34 (min. 2.2 and max. 4.2). In the second part, the application of the focus group technique demonstrated that technology is decisive in the management of diabetic pathology, not only in the emergency phase. CONCLUSIONS: At the time of public health crises, alternative strategies such as Tele-Nursing or Telemedicine could be crucial for the management of patients with micro-infuser not only in critical moments, such as lockdown, but also in ordinary health management.

Factors affecting the quality and reliability of online health information.

BACKGROUND: Internet represents a relevant source of information, but reliability of data that can be obtained by the web is still an unsolved issue. Non-reliable online information may have a relevance, especially in taking decisions related to health problems. Uncertainties on the quality of online health data may have a negative impact on health-related choices of citizens. OBJECTIVE: This work consisted in a cross-sectional literature review of published papers on online health information. The two main research objectives consisted in the analysis of trends in the use of health web sites and in the quality assessment and reliability levels of web medical sites. METHODS: Literature research was made using four digital reference databases, namely PubMed, British Medical Journal, Biomed, and CINAHL. Entries used were "trustworthy of medical information online," "survey to evaluate medical information online," "medical information online," and "habits of web-based health information users". Analysis included only papers published in English. The Newcastle Ottawa Scale was used to conduct quality checks of selected works. RESULTS: Literature analysis using the above entries resulted in 212 studies. Twenty-four articles in line with study objectives, and user characteristics were selected. People more prone to use the internet for obtaining health information were females, younger people, scholars, and employees. Reliability of different online health sites is an issue taken into account by the majority of people using the internet for obtaining health information and physician assistance could help people to surf more safe health web sites. CONCLUSIONS: Limited health information and/or web literacy can cause misunderstandings in evaluating medical data found in the web. An appropriate education plan and evaluation tools could enhance user skills and bring to a more cautious analysis of health information found in the web.