Does seafarers' limited access to health care increase risk for community-acquired pneumonia requiring hospital care? A longitudinal register-based analysis.

BACKGROUND: Limited access to medical care can be considered as an occupational risk of seafaring and it may predispose to developing community-acquired pneumonia (CAP) requiring hospital care. We sought to investigate the risk for CAP and other lower respiratory tract infections (LRTI) requiring hospital care among seafarers. We examined the length of hospital stay (LOS) as a proxy for severity of illness. METHODS: The study population in this panel data analysis were all seafarers and a 20% random sample of economically active individuals aged 18-65 years who were residing in Denmark in 1997-2016, constituting more than 11 million person-years of follow-up. Annually-registered socio-demographic and work characteristics were linked to data on cause of hospital admissions. We used fixed-effects and zero-truncated Poisson regression to estimate the rate ratios of hospitalization for CAP and other LRTI, and compared LOS across the two populations. RESULTS: The adjusted incident rate ratio (IRR) for CAP in seafarers compared to the economically active population was 1.42 (95% confidence interval [CI]: 1.15-1.77), whereas the IRR was 0.73 (95% CI: 0.38-1.42) for other LRTI. For LOS, the IRRs for CAP and other LRTI in seafarers were 1.08 (95% CI: 1.04-1.12) and 0.92 (95% CI: 0.83-1.01), respectively. CONCLUSIONS: Our findings indicate that seafaring was associated with an increased risk for CAP requiring hospital care. Limited access to health care may be an important contributing factor.

Age and nationality in relation to injuries at sea among officers and non-officers: a study based on contacts from ships to Telemedical Assistance Service in Denmark.

OBJECTIVES: Characterisation of worker injuries on board merchant ships is modest. Using telemedical service contacts in Denmark, we describe the worker injuries patterns and factors related to injury incidence. METHODS: The data for this study were based on contacts (n=1401) from ships to Telemedical Assistance Service (TMAS) in Denmark in 2004-2014, which were supplemented with data on the annual estimation of all seafarers from the Danish Maritime Authority (n=73 336). The final data included information on broad age groups, occupation and nationality. The outcomes were injuries from any cause and six broad categories of injuries characterised by anatomic location or type of injury. RESULTS: During the observation period of 11 years, there were 1401 contacts to TMAS due to injuries, of which 36% were in upper limb, 18% in lower limb and 13% in the head. Age-adjusted incidence rates for all injuries varied between 13.6 and 26.8 incidences per 1000 person-years in 2004-2014. In most types of injuries, younger and older seafarers had higher risk for injuries than seafarers aged 30-49 years. Depending on the type of injury, non-officers had threefold to fivefold increased odds of injuries compared with officers, the risk being highest for head injuries with an OR of 5.00 (95% CI 3.19 to 7.83). Non-officers from the European Union (EU) had higher risk in most types of injuries than non-officers from outside the EU, whereas the pattern of this risk was inverse among officers. CONCLUSIONS: These findings suggest that non-officers and European seafarers have an increased risk for several types of injuries on board Danish-flagged merchant ships. Additionally, age affected risk with the younger (<30 years) and older (>50 years) seafarers having increased risk.

A medical admission unit reduces duration of hospital stay and number of readmissions.

INTRODUCTION: Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. We present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure. MATERIAL AND METHODS: We retrospectively extracted data from the hospital databases on two periods: one year before and the first year after establishment of the MAU. RESULTS: After establishment of the MAU, the overall average length of hospital stay was reduced from 4.1 to 3.8 days (p < 0.01). No increase in mortality either in-house or within 30 days after discharge was seen. A substantial reduction (26%) in the overall number of readmissions within 30 days after discharge was observed. CONCLUSION: The establishment of the MAU improved efficacy at the hospital owing to reduction in the length of hospital stay and the number of readmissions. As judged from mortality rates and indicated by readmission rates, neither the quality of treatment nor patient safety was compromised in a setup, where patients with suspected cardiac diseases are admitted along with patients suspected to suffer from other internal medical diseases. The dynamics between multidisciplinary physicians and nurses seems to improve when they are working close to each other in a setting where team spirit evolves. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Meckel's diverticulum and intestinal obstruction--report of a fatal case.

Meckel's diverticulum is an uncommon cause of intestinal obstruction in adult life. Rarely Meckel's diverticulum is complicated by a mesodiverticular band, which is believed to be a remnant of a vitelline artery. When this abnormality occurs it is associated with high mortality. We present a case of a 48-year-old man with increasing abdominal pain and vomiting for 3 days. Meckel's diverticulum was not taken into diagnostic consideration, and the man died. Autopsy revealed a Meckel's diverticulum with a mesodiverticular band and intestinal obstruction. Histological examination of cross sections of the mesodiverticular band showed the presence of an artery. Because of the high mortality of this rare anatomic anomaly in adults, we find the case of interest.