Bulletin of the Institute of Maritime and Tropical Medicine in Gdynia最新文献

The aim of the present study was to investigate the occurrence of cholelithiasis in the occupationally active population of seamen and deep-sea fishermen aged 20-60, to assess the impact of environmental and dietary factors upon its course and to evaluate the fitness for work at sea of persons with biliary stones. The study group comprised 36 seamen and fishermen who received surgical treatment because of symptoms and complications of cholelithiasis, and 1000 seamen and fishermen periodically examined among whom 34 cases of asymptomatic cholelithiasis were diagnosed. The diagnosis was based on the anamnesis, physical examination and usg examination of the gallbladder and biliary ducts, in selected cases supplemented by other examinations. It was demonstrated that the factors which are concomitant and stimulate the development of biliary stones in seamen and fishermen were obesity and alcoholism. No role of hyperlipidemia and the type of diet in the formation of biliary stones was confirmed. In the group of 36 patients, the indications for the surgical treatment were complications of choletithiasis, i.e. biliary duct stones, mechanical jaundice, acute hydrops or empyema of the gallbladder. They resulted in temporary unfitness for work at sea. Asymptomatic cholelithiasis in seamen and fishermen does not result in unfitness for work at sea and is not an indication for surgical treatment.

A survey was conducted among Polish seafarers on work-related accidents and injuries. Their average incidence rate in 1990-1995 was 22.07 per 1000 men per year (fatal accidents: 0.85/1000). Out of 960 accidents recorded including 37 fatal ones, 768 caused work incapacity, and in 307 major injuries the duration of it was 29 or more days. The causes of death of seafarers were: drowning 24, violence 2, suffocation 4, contusion 2, and disappearance from ship during voyage 5. The incidence rate of accidents in the surveyed population varied from year to year and there was no tendency of lowering it. Prevention of accidents on ships should be improved.

A questionnaire survey was conducted in 1994-1996 among Polish seafarers employed on foreign-flag ships, in order to collect their opinions and experiences on work and life on these ships, and to estimate the morbidity and injuries incidence. The majority of 1103 respondents were satisfied with the conditions of work and life on these ships: their food, accommodation, the health and safety of work, standard of health care on board were good or satisfactory; they had no problems with living and working together on the same ship with seamen of other nationalities. But about 7.8% of respondents complained that the safety and health of work on their ship was unsatisfactory, or conditions of work "endangered their health and life". The self-reported morbidity (calculated rate 176.8 per 1000 men per year) and accidents (rate 114.5 per 1000 per year) was recorded.

181 fatal cases of diseases and work-related accidents recorded in the years 1985-1994 among seamen and fishermen were analyzed. The highest mortality rate and fatal accident rate were noted in seamen. They were higher than those pertaining to workers employed on land. The respective rates for Polish fishermen were lower than those reported in other countries. The main causes of death at sea were sea catastrophes, injuries, drowning, poisoning and circulatory system diseases. The most frequent were deaths during the day and not on the watch, being alone in the cabin. Limited access to qualified medical assistance during the voyage and frequent occurrence of sudden deaths reduce substantially the efficacy of help. Therefore, prevention of diseases and accidents is of crucial importance.

The surveyed group consisted of 338 port workers including 136 stevedores, 128 operators of mechanized equipment and 74 hoistmen. 233 people (68.9%) complained of cervical and back pain. In relation to the size of the groups examined, the pain was reported by 84.6% stevedores, 60.8% hoistmen and 57.0% operators. On the basis of the clinical course, the types of the pains were determined in stevedores to be: skeletogenic--in 41.8% of them, neurogenic--25.4%, angiogenic--4.5% and mixed within the cervical segment of the spine--28.3%. The back pain in the group of stevedores was classified as high ischialgia--in 65.7%, low ischialgia--in 24.6% and lumbar pain and sacralgia--in 9.7% of cases. In hoistmen and operators, lumbagia and sacralgia were two times more frequent than in stevedores. Sick leave in the subjects examined in the course of the seven-year observation totalled 18,452 days, in that number 7646 days in connection with diseases of the muscular-skeletal system, and 5150 days by problem in the spine. In operators and hoistmen the absence caused by these diseases was proportionally two times lower than in stevedores.

Oral diseases seem to be the most common health problem of seafarers world-wide. Seafaring as an occupation may create a risk for the dental health of crews of ships. Sitting in messrooms and eating snacks in between regular meals is a popular way of spending free time during the ships voyage. This means not only high caloric intake which contributes to overweight but also to high dental caries incidence among crews. During long sea voyages, the access of seamen to dental services is very limited and making regular check ups and treatment of caries is difficult. The best solution to the problem of poor teeth is a preventive one. Conventional methods for preventing caries are health education, restrictions the use of sugar-containing products, good oral hygiene and use of fluorides. A newer method to prevent caries is systematic use of xylitol. Scientific evidence shows that the addition of small quantities of xylitol, a natural carbohydrate sweetener, to the diet causes a significant reduction in the incidence of dental caries.

This cohort study investigated mortality patterns in Danish commercial fishermen between 1970 and 1985, compared to all economically active men. The population census in 1970 in Denmark was the source of information on individual occupation, age and economic status. Computerised linkage with the Danish Mortality Register gave information about deceased persons' date and cause of death. Standarised mortality ratio (SMR) for all causes among crew members was 1.50; 95% confidence intervals (95% CI) 1.34-1.65) highest in the age group 20-34 years (SMR = 2.09, 95% CI 1.68-2.58). The increased SMR among fishermen was primarity due to deaths by accident other than road accidents (SMR = 5.76, 95% CI = 3.09-7.46), ischemic heart disease (SMR = 1.27, 95% CI, 1.01-1.57) and causes without information (SMR = 6.44 95% CI 4.31-9.27). SMR due to bronchitis and emphysema among 35-64 years old crew members was 1.96, 95% CI 1.01-3.45. Among skippers, the SMR for all causes was 1.12, 95% CI 1.03-1.20). The study confirms earlier findings of a high mortality among fishermen, especially due to accidents, and a slightly increased risk of dying from cancer, respiratory and cardiovascular diseases.

The present evaluation of reasons for loss of fitness to perform heavy and very heavy loading operations in dockers was based on a prospective study comprising a selected population of 508 men, carried out in 1989. A follow-up of their health and ability to perform loading operations continued until 1995. In this period change of the working post caused by health problems was observed in 185 (36.4%) men, 67 (13.2%) people either quitted work or got a disciplinary dismissal, 24 (4.7%) subjects got a promotion and 80 retired. 12 dockers deceased (2.45%); noteworthy, no death was associated with the work performed. They were 140 dockers (27.6%) that remained on their posts after 7 years of observation. In the group of 185 dockers the main reason for the medical disqualification for work were the diseases of the nervous peripheral and musculoskeletal system and of the connective tissue in 71 men (38.4%), chronic diseases of the upper respiratory tracts in 36 men (19.4%), circulatory system diseases in 24 cases (13.0%) and posttraumatic states of the musculoskeletal system in 16 cases (8.6%). A proper health qualification is crucial for a long-lasting fitness to work.