Fatal accidents and injuries among merchant seafarers worldwide.

BACKGROUND: The British merchant fleet has expanded in recent years but it is not known whether this expansion has led to proportionate changes in mortality. AIMS: To investigate mortality from accidents and injuries in British merchant shipping, to determine whether this has increased in recent years, to compare fatal accident rates across British industries and to review fatal accident rates in merchant shipping worldwide over the last 70 years. METHODS: Examinations of marine accident investigation files, death registers and death inquiry files, national mortality statistics, worldwide surveys and review methodology. The main outcome measure was the fatal accident rate per 100 000 worker-years. RESULTS: Of 66 deaths in British shipping from 2003 to 2012, 49 were caused by accidents, which largely affected deck ratings. The fatal accident rate in British shipping increased by 4.7% per annum from 2003, although this was not significant (95% confidence interval: -5.1 to 15.6%). During 2003-12, the fatal accident rate in shipping (14.5 per 100 000) was 21 times that in the general British workforce, 4.7 times that in the construction industry and 13 times that in manufacturing. Of 20 merchant fleets worldwide with population-based fatal accident rates, most have shown large reductions over time. CONCLUSIONS: The expansion of the British merchant fleet in recent years does not appear to have had a major impact on fatal accidents. Further preventive measures should target fatalities during mooring and towing operations. Internationally, most shipping fleets have over time experienced large decreases in fatal accident rates.

High-risk occupations for suicide.

BACKGROUND: High occupational suicide rates are often linked to easy occupational access to a method of suicide. This study aimed to compare suicide rates across all occupations in Britain, how they have changed over the past 30 years, and how they may vary by occupational socio-economic group. Method We used national occupational mortality statistics, census-based occupational populations and death inquiry files (for the years 1979-1980, 1982-1983 and 2001-2005). The main outcome measures were suicide rates per 100 000 population, percentage changes over time in suicide rates, standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs). RESULTS: Several occupations with the highest suicide rates (per 100 000 population) during 1979-1980 and 1982-1983, including veterinarians (ranked first), pharmacists (fourth), dentists (sixth), doctors (tenth) and farmers (thirteenth), have easy occupational access to a method of suicide (pharmaceuticals or guns). By 2001-2005, there had been large significant reductions in suicide rates for each of these occupations, so that none ranked in the top 30 occupations. Occupations with significant increases over time in suicide rates were all manual occupations whereas occupations with suicide rates that decreased were mainly professional or non-manual. Variation in suicide rates that was explained by socio-economic group almost doubled over time from 11.4% in 1979-1980 and 1982-1983 to 20.7% in 2001-2005. CONCLUSIONS: Socio-economic forces now seem to be a major determinant of high occupational suicide rates in Britain. As the increases in suicide rates among manual occupations occurred during a period of economic prosperity, carefully targeted suicide prevention initiatives could be beneficial.

Concentration of microelements in blood and urine following intravenous chelation test in workers occupationally exposed to lead.

Microelements such as zinc, copper or magnesium play an important role in the regulation of metabolism on cellular level. The aim of the present work was to establish whether and to what extent the routine employment of diagnostic chelation test affects physiological concentration of microelements in blood and diurnal urine in workers occupationally exposed to lead. Based on the examinations carried out it has been found that intravenous administration of 1 g of Chelation essentially increases the urinary excretion of lead and zinc, thus lowering their content in blood.

[Criteria and problems related to the diagnosis of malaria, amebiasis and leishmaniasis as occupational disease in Polish citizens]. / Zasady i problemy orzekania o malarii, amebozie i leiszmaniozie jako chorobach zawodowych u obywateli polskich.

The general criteria and rules of the current and retrospective diagnosis of malaria, amebosis and leishmaniosis were analysed. According to the list of occupational diseases the above mentioned infectious diseases are considered as occupationally related if they concern Polish citizens who work abroad. The risk of infection, the permanent sequelae, the resulting incapacity and the evaluation of the claims for health damages are examined. The significance of the problem is to be indicated due to the increasing number of Polish citizens exposed professionally to the risk.

[The influence of exertion on the incidence and course of diabetes mellitus]. / Wplyw wysilku fizycznego na wystepowanie i przebieg cukrzycy.

Regular physical activity brings some benefits for patients with diabetes: it decreases insulin resistance, improves glycaemic tolerance and the state of the cardiovascular system, regulates blood lipid profiles and increases the fibrinolytic activity of plasma. All these factors improves the quality of life and professional rehabilitation of diabetic patients. Taking into consideration all contraindications kinesis therapy, together with diet and pharmacological treatment should be recommended as an important factor in the management of diabetes mellitus, especially NIDDM.

[The significance of diagnosing microalbuminuria and microglobulinuria in diabetes mellitus and arterial hypertension]. / Znaczenie wykrywania mikroalbuminurii i mikroglobulinurii w cukrzycy i nadcisnieniu tetniczym.

The detection of urinary low-molecular weight proteins is significant in the management of persons with serious diseases which can lead to renal insufficiency. The measurement of urinary albumin excretion rate (microalbuminuria) is a routine diagnostic tool in screening for diabetic nephropathy. The detection of other proteins allows the monitoring of treatment efficiency among patients with arterial hypertension or diabetes mellitus.

Comparative study of the death during sea voyages among Polish seamen and deep-sea and boat fishermen.

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.

Cholelithiasis and fitness for work at sea.

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.

Death at sea: certain factors responsible for occupational hazard in Polish seamen and deep-sea fishermen.

Deaths at sea, namely work-related fatal cases, are registered in all fleets throughout the world. Considering the medical and legal aspects, they are subject to notification, inquest, and possible indemnity. The aim of the study was to identify causes, circumstances, and mortality rates among Polish seamen and deep-see fishermen. The group studied comprised 113,260 employees of one shipping company and two fishing enterprises. Out of this number 148 fatal cases (109 seamen and 39 fishermen) registered during the years 1985-94 were investigated thoroughly. Mean annual rates of mortality (130.6) and fatal accidents (67.8) were calculated per 100,000 employees. They occurred to be higher than those among fishermen and the male population of the same age group (20-59 years) employed in various branches of the land economy, yet remaining lower compared to data on British and American seamen and fishermen. The risk of death was particularly high in persons above 40 years of age. It was demonstrated that unlike in the general population, 52% of deaths were due to external causes; primarily sea catastrophes, injuries, poisoning and missing. Among internal causes, circulatory diseases accounted for over 80% of deaths, including one fifth of cases due to acute myocardial infarction. In one third of these cases, cardiac failure had been already diagnosed before the voyage. The following circumstances were specific to deaths occurring during the voyage: deaths at open sea, frequently in the state of being alone in the cabin, no possibility of evacuating sick person to land medical institution, limited access to qualified medical assistance and effective rescue from outside, poor life-saving facilities and difficult communication. It was indicated that in a substantial percentage of fatal cases an adverse effect of the work performed, navigation and weather conditions proved to be hazardous, life-threatening and responsible for the fatal outcome. Sixty per cent of deaths were acknowledged by the shipowners as work-related or equivalent accidents with legal and economic consequences. The countermeasures proposed by the authors to minimize health hazards and life-threat at sea are of rather limited value for both organizational and economic reasons. The ship is still considered as one of the most dangerous workplaces.

Causes and Circumstances of Deaths of Polish Seafarers During Sea Voyages.

Background: The safety of life and work at sea depends, among other things, on the state of health of the members of the crew. Despite preliminary fitness selection, death at sea is still frequent. In the present paper, causes and circumstances of fatal cases at sea in the years 1985-1994 were analyzed for one Polish shipping company. Methods: Analysis was based on medical documentation and reports of accidents prepared by health centers, the employer and the marine judiciary. The effects of work conditions, as well as disease, on the resulting death were taken into account. The data obtained were compared to the mortality in nonseafaring men of productive age. Results: The most frequent causes of deaths were sea catastrophes, circulatory system diseases, injuries, and poisonings (a total of 85%). Next were suicides, "missings," and cerebral apoplexies. Seamen of 50 to 59 years of age died most often, primarily of myocardial infarction. Fatal events occurred in different places (mostly at sea, less frequently in port). Certain onboard occupations were identified as most dangerous for fatal accidents. The shipowner acknowledged 60% of the deaths as accidents at work. The effects of weather conditions, stress, overstrain, and lack of access to qualified medical assistance were analyzed. A relationship between diagnosed disease and death was found only in the case of myocardial infarction and cerebral apoplexy. In scarcely 15% of these cases were preliminary symptoms noticed, while behavioral and personality disturbances were earlier observed in the majority of suicides. Conclusions: The ship has remained one of the most dangerous workplaces, and fatal cases are to a large extent related to specific labor conditions at sea.

Malaria as an Occupational Disease in Polish Citizens.

Background: Since 1963, malaria has been exclusively recognized in Poland as an imported disease, which has become increasingly frequent in recent years. When associated with performing duties in malaria-endemic areas, malaria is acknowledged as an occupational disease. Methods: Ninety five cases of malaria recognized as an occupational disease in Polish citizens in the years 1984-1993 were studied retrospectively in terms of working conditions, epidemiologic and clinical features, and permanent disability sequelae. Results: Among patients examined, young and professionally active persons who called at tropical ports or who worked in rural areas or in the regions of military conflict were predominant. Most infections were contracted in Africa during the first few months of the stay. The observed morbidity and recrudescence rates were mainly attributable to Plasmodium falciparum. Disregard of prevention and chemoprophylaxis of malaria were key risk factors. In 33% of the patients, severe symptoms and complications occurred and these required long-term therapy. In seven cases, disturbances of the central nervous system, hepatic, renal, or cardiac system occurred 6 months after termination of treatment, and these occurrences resulted in permanent disability and an inability to work. Conclusions: The disability and inability to work and its legal consequences, such as indemnity, demonstrate that malaria may present a serious socioeconomic problem, even in the country where it is an imported disease.

Long-term monitoring and prevention of occupational lead exposure in a production plant.

During 19 years of monitoring and prevention of occupational lead exposure in a production plant the authors studied lead emission sources and exposure intensity encountered in the work place, the indices of current and long-term lead exposure, and markers of toxic effects of lead in 132 persons examined together 935 times. Lead poisoning was confirmed in 20 persons, i.e. about 2 per cent of examinations, whereas in 12 per cent signs of enhanced lead absorption were found. Based on a complex simultaneous assessment of many parameters, appropriate prophylaxis and therapy were applied to lessen the toxic effects of lead exposure. It is pointed out that technical improvements are fundamental for limiting lead emission and absorption in the work place. As it has been demonstrated, the proper cooperation between the physician, the toxicological laboratory, occupational safety service and the plant administration effectively contribute to the limitation or even elimination of lead exposure, thus reducing the possible future health effects of long-term lead exposure.

Guided fine needle absorption biopsy in the diagnosis of cysts in maritime workers.

Cysts in the organs of the abdominal cavity revealed in ultrasonographic examinations in patients with none or with unclear clinical symptoms cause diagnostic and fitness for work assessment problems. The aim of the study was to evaluate the usefulness of ultrasonography of cysts, combined with biochemical, bacteriological, cytological examinations and analysis of markers CEA and AFP of the fluid collected with fine needle aspiration biopsy (FAB). The study material examined were maritime workers who were submitted to these examinations for diagnostic purposes and/or previous to issue of certificate of health for work at sea. Examinations results provided support for usefulness of the method discussed in diagnosis and differentiation of inflammatory and neoplastic processes with simple cysts. This was crucial for final diagnosis, for decision about treatment and recognizing fitness for work at sea. It was concluded that the method FAB is safe both in hospital as well as in ambulatory conditions.

Malaria as an occupational disease.

In Poland, cases of imported malaria are noted at present. In Polish citizens who work abroad, malaria is considered as an occupational disease. 95 cases of malaria in Polish citizens treated at the Clinic of the Institute of Maritime and Tropical Medicine in 1984-1993 were subjected to retrospective analysis, considering their occupational, epidemiological and clinical aspects as well as permanent sequelae of the disease. The most numerous groups among the patients examined were seafarers, fishermen, priests and missionaries. They were infected mostly in West Africa, during the first year of work. The majority of patients neglected chemoprophylaxis of malaria. In about 1/3 of patients, the resulting incapacity for work exceeded 1 month and more. In 7% of patients, 6 months after the treatment, permanent sequelae of the disease were observed: damage to the central nervous system, liver, kidneys and heart. The social and material costs of this invasive occupational disease were high. Malaria is an important health problem in Poles who work in endemic areas. Malaria prevention should be intensified.

[Evaluation of cellular and humoral immunity in men after occupational exposure]. / Ocena odpornosci komórkowej i humoralnej u mezczyzn zawodowo narazonych na olów.

Hundred twenty seven adult men have been examined to determine an effect of the occupational exposure to lead on the immunity. A group of 77 men occupationally exposed to lead absorbed by respiratory has been selected on the basis of the determination of exposure to lead in their working places, detection of lead deposits and its metabolites in the body. Fifty men constituted a control group. They were exposed to lead corresponding to an exposure of general population. Immunological studies have shown that high lead levels in the occupational environment produced significant disorders in all stages of both types of immunological response--a decrease in the cellular and humoral immunity.

Immunological humoral responsiveness in men occupationally exposed to lead.

On the basis of literature the hypothesis of the effect of lead upon humoral, immunological responsiveness in the adult men was examined. The examinations comprised 77 men occupationally exposed to lead of high concentration and 50 persons not exposed to this metal in their work. In the group of many years' occupational lead exposure, especially with lead-poisoning traits, an immunosuppressive effect of lead on humoral responsiveness was found. It was pronounced in peripheral B lymphocytes pool reduction and IgG and IgM serum immunoglobulins titres decrease as well as in the decrease of the specific antibodies (IgG) production--after antityphoid immunisation.

[Electroencephalographic studies and endoscopy in peptic ulcer. Correlation of EEG changes and the endoscopic image]. / Badania elektroencefalograficzne a endoskopia w chorobie wrzodowej. Próba korelacji pomiedzy zmianami EEG a obrazem endoskopowym.

In the Institute of Maritime Medicine EEG, endoscopic and psychiatric-neurological examinations were carried out in 169 cases of peptic ulcer of the stomach or duodenum. Low-voltage and abnormal records were associated usually with larger ulcers of the stomach or duodenum. These abnormalities were significantly more frequent in cases of duodenal ulcer than in stomach ulcer, and were characteristic fora cases with symptoms of neurosis. EEG changes are due, according to the authors, to coexistent emotional disturbances or neurosis.