International Maritime Health最新文献

Background: Seafarers are exposed to a variety of job-specific physical and psychosocial stressors. Health promotion on board is of great importance for the salutogenesis of this occupational group. Due to the difficult accessibility of seafarers, electronically supported health management can be highly valuable. However, surveys on the needs and interests of seafarers in health promotion regarding e-health applications have not yet been carried out.

Material and methods: This pilot study uses a cross-sectional design to assess the need for digital health promotion for seafarers on board. This need was derived from the individual responses of 73 crew members on 3 merchant ships on health as well as addictive behavior, sports, coping strategies, and the level of knowledge regarding health-related issues. Conspicuous parameters on mental health and fatigue were compared to the general population.

Results: It was found that 31.9% of seafarers were smokers and 80.6% were alcohol consumers. 82.4% of the seafarers practiced sport. The most common coping strategies for stress were calming down (44.6%), listening to music (32.1%), resting and sleeping (25.0%) and sports (25.0%). The evaluation of the PHQ-9 mental health questionnaires indicated that 85.4% of respondents had moderate to severe symptoms of a depressive mood. The average WHO-5 Well-Being Index resulted in level of 69.7% of the maximum possible score. Knowledge questions on health-related issues were answered correctly in less than 60% of cases. With regard to fatigue, there was an increased score for the Epworth Sleepiness Scale (ESS) in 33.8% and the Pupillary Unrest Index (PUI) was elevated in 47.7%.

Conclusions: Nicotine and alcohol consumption is higher among the participating seafarers compared to a reference population living on land. Various coping strategies for managing stress are already used in the daily live. However, there is a demand and interest in acquiring more knowledge about health-promoting behavior. The risk of daytime sleepiness and depression is elevated among seafarers. This leads to key issues that should be taken into account for preventive medicine, health promotion and possible digitally supported health management on board.

Background: The aim of this study was to screen for musculoskeletal disorders (MSD) complaints, to analyse the activity and to identify their risk factors.

Materials and methods: This cross-sectional epidemiological study involved 903 men aged > 20 years and with a seniority > 2 years. It included a questionnaire and an ergonomic analysis of the activity. The questionnaire included: socio-demographic and occupational characteristics, health status and life habits, stress and items from the Nordic questionnaire. The observation of work situations required video recordings and the use of three methods: Occupational Safety and Health Administration (OSHA), Rapid Upper Limb Assessment (RULA) and the Gesture Tracking and Assessment Tool (Outil de Repérage et d'Évaluation des Gestes: OREGE).

Results: The prevalence of MSDs was 61.9%. It was significantly higher among deckhands than among other professionals (65.6% vs 27.4%; p < 0.001) and in seasonal workers than in permanent workers (67.8% vs 43.1%; p < 0.001). A positive correlation was noted between MSDs and daily work duration. Stress was an aggravating factor, whereas leisure activities were protective. The prevalence of MSDs was 40.5% (lower back), 40.4% (wrist/hand joints), 34.6% (neck) and 31.7% (shoulders). The ergonomic analysis of the workstation was performed on a deckhand who unloaded the fish crates out of the hold of a trawler. OSHA score = 12 (normal < 5); significant risk of upper limb MSD. RULA total score = 7 (acceptable between 1 and 2); immediate modification. OREGE scores evaluating effort, repetitiveness and joint positions indicate that the actions were not recommended or to be avoided.

Conclusions: The analysis made it possible to evaluate the difficulty of the job and to note a high risk of MSDs requiring ergonomic and organizational improvements.

Background: Indonesia, with its expansive territorial waters, hosts numerous fishing communities residing on various islands. Many of these communities rely on diving activities, predominantly free diving without standardized safety equipment. This practice poses risks, including the potential for hypoxia-induced oxidative stress, which plays a role in disease pathogenesis. This study aimed to investigate the levels of malondialdehyde (MDA) in freediving fishermen and explore potential influencing factors.

Materials and methods: The research involved 30 freediving fishermen, aged 20-60, who engaged in diving at least twice weekly over the last 3 months. Blood plasma MDA levels were assessed using the Will method.

Results: Results revealed a median age of 40.5 years (range: 20-59), a body mass index of 23.1 ± 2.8, and a mean blood pressure of 132/85 mmHg. A significant portion of the subjects exhibited smoking habits (90%) and alcohol consumption (76.7%). The median MDA level among subjects was measured at 0.42 nmol/mL (range: 0.34-0.70). However, no discernible relationship was found between smoking habits, alcohol consumption, and MDA level categories, as determined by the Fisher exact test (p > 0.05).

Conclusions: While these findings shed light on the MDA levels in freediving fishermen, further research is warranted to explore additional factors that may influence these levels. This comprehensive understanding is crucial for addressing the health risks associated with free diving practices in this unique population.

Background: Cellulitis is an acute bacterial infection of the skin and subcutaneous tissue. The characteristic symptoms of the disease are an area of skin that is swollen, warmth, redness, pain, unknown borderline, tends to expand, and can lead to tissue necrosis. Hyperbaric Oxygen (HBO) is a non-drug treatment, which has the effect of relieving pain, reducing edema, and accelerating the wound healing process for patients with cellulitis. This study aims to evaluate the results of treating patients with cellulitis by HBO.

Materials and methods: A case-control study was conducted. 89 patients were diagnosed with cellulitis and treated at VINIMAM from January 2022 to December 2023. The study group included 48 patients treated with HBO combined with intravenous antibiotics, wound care. The reference group included 41 patients who were not treated with HBO but were treated with intravenous antibiotics, wound care.

Results: The pain relief level of the study group was better than that of the reference group (VAS score after one day of treatment: 4.34 and 5.78, after 2 days: 2.46 and 4.17, after 3 days: 1.28 and 3.35). The time for edema to subside in the study group was shorter than in the reference group. The circumference of the cellulitis area in the study group shrunk better than in the reference group. The average days of treatment in the study group were less than the reference group (8.33 ± 2.67 days and 13.17 ± 4.78 days).

Conclusion: Hyperbaric Oxygen was a good method to treat cellulitis, helped to reduce pain, was anti-inflammatory, reduced edema, and shortened treatment time.

Background: Dental problems are common among seafarers due to unique environmental, occupational, and lifestyle factors that may impact their dental health. This study aims to assess the prevalence of dental and periodontal problems among Thai seafarers.

Material and methods: A cross-sectional study was conducted among 602 Thai seafarers who received oral health assessments and were subsequently categorized based on dental readiness classification (DRC) from dentists at Somdech Phra Pinklao Hospital from November 2021 to October 2023.

Results: The prevalence of dental caries among seafarers was 43.5% with significant differences in the number of dental caries between officers and non-officers (p < 0.0001). The mean (SD) of decayed, missing, and filled teeth were 1.2 (± 2.0), 2.9 (± 3.3), and 1.6 ± (2.8), respectively. About fifty percent of the seafarers were categorized as DRC 1, 44.9% as DRC 2, and 5.3% as DRC 3. Dental findings of non-officers were significantly more likely to be not dentally fit compared to officers (AOR = 2.179, 95% CI: 1.396-3.402). Dental scaling was the most required treatment, needed by 53.7% of the study population.

Conclusions: High rates of dental caries and periodontal disease are found among seafarers. Incorporating comprehensive dental assessments into pre-boarding fitness evaluations for seafarers can help reduce the likelihood of dental emergencies while at sea.

Background: The Philippines is the global maritime industry's single biggest source of seafarers. This article examines how the Philippines protects the welfare of its seafarers working on board ocean-going vessels.

Materials and methods: We employed a multi-method approach to better understand the POEA-SEC as a regulatory instrument. First, we analysed Philippine legislation and regulations that are shaping the employment, welfare, and working conditions of Filipino seafarers. Second, we examined the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC) which requires that minimum standards of employment for seafarers are met. We use legal analysis to examine three specific provisions that pertain to their well-being: duration of employment, monetary considerations, and working conditions in terms of hours of work and rest periods. Third, we analysed interview and focus group data on the experiences of Filipino seafarers on board ships in respect of the POEA-SEC's efficacy in protecting their well-being.

Results: Analysis of the policy environment for Filipino seafarers shows how the interests of powerful actors have taken precedence over those of Filipino seafarers. Seafarers' experiences suggest that they cannot be reached by the contract, whether symbolic or otherwise. The contract fails to address seafarer issues, such as security of tenure, excessive working hours resulting in fatigue, stress and anxiety.

Conclusions: The POEA-SEC falls short as a legal document to address occupational, health and safety issues, which contribute to the detriment of seafarers' health and well-being. This indicates that the Philippine government cannot fully protect its seafarers.

Purpose: Working on a ship is challenging for maritime workers. Ship movements and high physical workload on board are straining their musculoskeletal system, which can particularly lead to lower back pain (LBP). The purpose of this study is to review recent studies about the impact of moving environments on the lower back both of seafarers and fishermen and the frequency of related health complaints.

Methods: Using a systematic review in the PubMed database, 384 studies about musculoskeletal issues among maritime workers were identified in the period 2000 to 2021. Evaluation of studies was done according to the PRISMA statement.

Results: The review revealed 13 studies focusing on musculoskeletal issues of the lower back among maritime workers. Four studies used biomechanical modeling to examine the physical load on board. They all described high physical strain when performing heavy working tasks in moving environments and 2 described the need for compensational efforts due to ship movements. Ten studies examined the musculoskeletal health of seafarers or fishermen and pointed out that particularly fishermen suffer from increased rate of LBP. A comparison of the data of four studies, which comprise prevalence of LBP, depict higher prevalences on fishermen (between 60.95; 95% CI 51.62-70.28 and 82.13; 95% CI 77.23-87.03) than data from land-based population (48.63; 95% CI 46.62-50.64), while the study concerning seafarers showed lower prevalence (28.42; 95% CI 24.74-32.10).

Conclusions: The high prevalence of LBP among fishermen suggests that heavy physical work (e.g., operating of fishing nets, filleting process) during ship motions is a strong risk factor. Further studies should evaluate effects of ship movements on the lower back among maritime workers, considering the different activities on board of vessels. As in most physically challenging jobs with repetitive activities, consequent prevention might be a key to lower the morbidity.

This paper delves into the unexplored area of Advance Directives (ADs) in maritime surroundings, diving into the moral and legal quandaries that crop up when these directives are used at sea. ADs, which include durable powers of attorney and living wills, are essential documents that indicate a person's wishes for healthcare in the event of incapacitation. Global variations in legal recognition pose ethical questions, particularly in non-regulated jurisdictions. The maritime context introduces unique challenges, questioning the ethical applicability and binding of ADs at sea. Despite international and European laws ensuring medical assistance, the absence of specific provisions for ADs raises uncertainties. The paper advocates for a balanced approach respecting autonomy while addressing practical challenges, proposing solutions and a standardized international framework. This exploration seeks to uphold individual healthcare preferences, whether on solid ground or navigating the open sea.

Background: Commercial fishermen represent a particularly vulnerable group within the Blue Economy (BE), enduring hazardous working conditions, strenuous labor, prolonged exposure to extreme weather, and irregular sleep and nutritional patterns. The health of these invisible workers holds significant implications for the social, economic, and environmental dimensions of fisheries, as it directly influences productivity. Despite their importance, no public data are available on fishermen's cardiometabolic health and health behaviors in Rhode Island. However, sound evidence suggests elevated cardiometabolic risks, altered sleep patterns, and chronic stress in similar fishermen populations globally. This paper establishes a comprehensive research framework to examine commercial fishermen's cardiometabolic health, protective and risk factors, quality of life (QoL), lifestyle behaviors, and productivity. The overarching goal is to identify potential targets for intervention to improve commercial fishermen's health behaviors, QoL, and cardiovascular health.

Materials and methods: Following the STROBE guidelines, this framework includes methodological, societal, environmental, and economic aspects to guide the development of an exploratory study protocol. A two-phase mixed-methods study will be conducted. Phase 1 (qualitative) will hold two focus groups (n = 6-10 participants per group) and will inform Phase 2 (quantitative), where biomarkers, health factors and behaviors, QoL, and productivity of commercial fishermen (n = 59) will be gathered.

Results: Recruitment began in January 2024, and data collection will end in August 2024. The results of this study are expected to be published in 2025.

Conclusions: A framework was developed considering the impact and implications of commercial fishermen's health-related behaviors on BE-based states, sustainable communities, and marine ecosystems. This protocol established a guideline-based, two-phase mixed-methods study to explore the cardiometabolic health, QoL, and productivity of commercial fishermen. Since better cardiovascular health is associated with lower risks of cardiovascular disease death and all-cause mortality, the findings will provide a situational screening and inform the development of tailored theory-based preventive behavioral interventions.