Musculoskeletal disorders of fishermen in the artisanal and coastal sector.

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.

Health status, sleeping habits and dyssomnia of coastal fishermen.

BACKGROUND: The aim of this survey was to assess the health status, sleep habits and dyssomnia of coastal fishermen. MATERIALS AND METHODS: This cross-sectional survey involved a representative sample of 948 coastal fishermen. All participants were men and had a regular activity for at least 2 years. We used an individual questionnaire inspired by those of Morphée network, the National Institute for Research and Security of France, and of the Karasek's Job Content Questionnaire. RESULTS: The prevalence of sociodemographic and individual parameters was similar in rotating shiftwork (RW) and in nocturnal work (NW). The average age of the total population was 38.8 ± 8.1 years. The prevalence of sleep habits and alertness disorders was similar in RW and in NW. The average daily sleep time of the total population was 5.5 ± 0.9 hours during the week, and 8.7 ± 0.8 hours during the holidays, Fridays and recovery days. Upon waking, 49.7% of the subjects felt tired and sleepy, 43.2% fit and 7.1% had a headache. 47.2% reported being chronic insomniac. The index of severity of insomnia was moderate to severe in 29.6%. The prevalence of excessive daytime sleepiness (Epworth > 10) was 16.2%. Fatigue, iso-strain and socio-economic concerns were associated with a higher risk of chronic insomnia. CONCLUSIONS: Coastal fishermen were at a high risk of chronic dyssomnia and alertness disorders. Education initiatives should be conducted to raise fishermen's awareness on their health and safety consequences.

Prevalence of consumption of psychoactive substances among construction workers.

INTRODUCTION: The prevalence of psychoactive substance is constantly increasing in developing countries, and all occupational sectors are concerned. Construction sector is a particular target because of the heavy workload as well as family and social isolation. However, few studies have investigated toxic habits in this population in Morocco. The aim of this study was to determine the prevalence of addictive substances consumption, use, and misuse amongst construction workers and to appreciate the poly-consumption according to socio-demographic and occupational parameters. METHODS: This cross-sectional study was conducted amongst 1,128 construction workers. The interview with each person took place at occupational health service during his medical examination. The questions were formulated orally in French and /or in Arabic. The questionnaire covered socio-demographic and occupational parameters, toxic habits (tobacco, alcohol, cannabis and others psychotropic substances). The misuse was assessed by specific tests: dependence on smoking tobacco (Fagerstrom), Cannabis Abuse Screening Test (CAST) and Alcohol Use Disorders Identification Test (AUDIT). RESULTS: The prevalence of consumption was 47.9% for smoking tobacco, 12.7% for cannabis, and 20.1% for alcohol. Amongst consumers, the prevalence of dependence or misuse was 68% for smoking tobacco, 70.6% for cannabis and 63% for alcohol. 42.7% of construction workers had no toxic habit, 36.1% one toxic habit, 16.3% two toxic habits, 4.8% three toxic habits and 0.1% four toxic habits. The most frequent associations were tobacco-alcohol (8.1%) and tobacco-cannabis (3.7%). CONCLUSIONS: Occupational health physicians have to play a key role in raising awareness and fighting against toxic habits. The prevention approach needs a cooperative spirit. It will be more accepted and applied if all construction workers and their representatives are involved in its elaboration.

Occupational risk perception, stressors and stress of fishermen.

BACKGROUND: The aim of this survey was to assess the stress in fishermen by analysing its relationship with sociodemographic and professional characteristics, by evaluating work stressors, and by estimating psychosomatic symptoms. MATERIALS AND METHODS: This cross-sectional survey involved representative sample of 828 artisanal and coastal fishermen. All participants were men and had a regular activity for at least 2 years. We used an individual questionnaire inspired by those of the National Institute for Research and Security of France and of the Karasek's Job Content Questionnaire. RESULTS: The prevalence of self-reported stress was 53.9%. The average age was 36.7 ± 8.7 years, it was higher among stressed than non-stressed. The prevalence of stress was higher in subjects with dependents (69.1%) versus 30.9% without dependents, and among those living alone (61%) versus 47.5% among those living in couple. The prevalence of harmful habits was 68.5% for tobacco smoking or snuff, 36.8% for cannabis smoking, 35.4% for alcohol consumption, 8.6% for other psychotropic substances and medications, and 21.4% for antalgic drugs. These toxic habits were significantly higher in stressed individuals. Thirty-three point seven per cent had self-reported chronic pathologies (40.5% among stressed vs. 25.7% non-stressed). Thirty-four per cent were overweight (38.3% among stressed vs. 28.8% non-stressed), and 14% obese (19.3% among stressed vs. 7.6% non-stressed). The average daily working hours were 11.2 h (12.8 h among stressed subjects vs. 10.5 h non-stressed). Psychological demand was higher in stressed subjects, while decisional latitude and social support were lower. Psychosomatic symptoms were higher among stressed than non-stressed. The main suggestions of the fishermen were to improve income, social welfare, health insurance, safety on board, quality of lifestyle, sport and leisure activities, information and awareness campaigns of occupational stress, and fight against addictive behaviours. CONCLUSIONS: Fishermen were at a high risk of chronic stress with its health consequences. Health promotion and education initiatives should be conducted to raise fishermen's awareness of the dangers of occupational stressors.

Prevalence of consumption of psychoactive substances amongst Moroccan taxi drivers.

BACKGROUND: The prevalence of psychoactive substances is constantly increasing in developing countries, and all professional sectors are concerned. Taxi drivers are a particular target because of the dangerousness and complexity of their work. However, few studies have investigated toxic habits in this population. OBJECTIVES: The aim of the study was to determine the prevalence of the use and misuse of addictive substances in taxi drivers and to appreciate poly-consumptions according to socio-demographic and occupational characteristics. METHODS: This cross-sectional study took place in five big cities during the second quarter of 2014, and was conducted amongst 2,927 taxi drivers who went through official, obligatory control areas on a daily basis. The questionnaire covered socio-demographic and occupational characteristics, toxic habits (tobacco, alcohol, cannabis and others psychotropic substances). The misuse was assessed by specific tests: Fagerström test for tobacco smoking, Cannabis Abuse Screening Test (CAST) and DETA (Diminuer, Entourage, Trop, Alcool) test for alcohol. RESULTS: The prevalence of consumption was 36.6% for smoking tobacco, 18.4% for cannabis, and 10.5% for alcohol. Amongst consumers, the prevalence of dependence or misuse was 36.6% for smoking tobacco, 37.2% for cannabis and 56.5% for alcohol. Fifty point three percent had no toxic habit, 35 % had one toxic habit, 11.5% had two toxic habits, 2.7% had three toxic habits and 0.6% had four toxic habits. The most frequent associations were tobacco-alcohol (6.8%) and tobacco-cannabis (4.1%). CONCLUSIONS: The elaboration of the prevention approach needs a cooperative spirit. It will be more accepted and applied if all taxi drivers, their representatives and road safety officers are involved in its preparation.

Occupational safety and health in maritime sector in Morocco 60 years after independence: current state, constraints and prospects.

BACKGROUND: The aim of this study was to evaluate the situation 60 years after independence, to assess the current state, to highlight the constraints and to propose recommendations for improving occupational health in the maritime sector. MATERIALS AND METHODS: This study was based on collecting data of: 1) Legislative texts on occupational health and safety; 2) Statistics from administrations (Ministry of Health and Ministry of Marine Fisheries), general medical council of Morocco, scientific societies and associations of occupational health and maritime medicine; 3) Analysis of a self-questionnaire sent to 22 physicians working in fishermen's health services and listed in the yearbook 2017 of the Moroccan Society of Maritime Medicine. It included five sections: socio-demographic and professional characteristics, training, assessment of activities, constraints in their exercise and ten priority recommendations to improve the situation. RESULTS: Health and safety in maritime sector are progressing since the Labour Code of 2004 and the Convention of December 27, 1996 between the Ministry of Health and the Ministry of Marine Fisheries. It concerns the organisation of a fishermen's health prevention with the establishment of the fishermen's health office at central level and fishermen's health services at the main ports. However, medical coverage is still insufficient. Maritime medicine remains an unattractive specialty because the physicians are a poorly paid and have some difficult working conditions. CONCLUSIONS: The absence of up-to-date synthetic data on safety and health in maritime sectors led us to carry out this study, which showed some dysfunctions and deficiencies that hinder the promotion of workers' health in this sector. The recommendations proposed by the physicians should be the backbone of any improvement related to occupational health and safety. It is the practitioners themselves who, faced with their practice, are the best able to disseminate a reflection qualified as ethical, which cannot be dissociated from their everyday activities.

Prevalence of consumption of psychoactive substances amongst dockers.

BACKGROUND: Dockers in the port facilities are exposed to significant psychosocial risks (stress, suffering at work, etc.) related to heavy organisational, environmental, physical, chemical constraints, etc. These workers are particularly affected by the consumption of psychoactive substances because of the dangerousness and complexity of their work. To what extent can these numerous occupational risks be at the origin of behaviour favouring the consumption of psychoactive substances? However, in our country no study has investigated toxic habits in this population. The aim of this study was to determine the prevalence of the use and misuse of psychoactive substances amongst dockers, and to appreciate the poly-consumption according to socio-demographic and occupational characteristics. MATERIALS AND METHODS: This cross-sectional study was conducted amongst 665 dockers. The interview took place at the occupational health service and lasted between 15 and 20 minutes for each person respecting the confidentiality. The questionnaire covered socio-demographic characteristics, socio-professional characteristics, and toxic habits (tobacco, alcohol, cannabis and others psychotropic substances). The misuse was assessed by specific tests: Fagerström test for tobacco smoking, Cannabis Abuse Screening Test (CAST) and Alcohol Use Disorders Identification Test (AUDIT). RESULTS: The prevalence of use was 30.5% for tobacco smoking, 9.1% for cannabis smoking, and 16.5% for alcohol consumption. The prevalence of toxic habits was significantly higher in handlers than in machinery operators: tobacco smoking (39.7% vs. 27%; p = 0.002), snuff tobacco (12.5% vs. 4.6%; p = 0.001), hookah (7.6% vs. 2%; p = 0.001), cannabis smoking (20.6% vs. 4.5%; p = 0.001) and alcohol consumption (22.3% vs. 14.3%; p = 0.019). Amongst consumers, the prevalence of dependence or misuse was 45.3% for tobacco smoking, 56.7% for cannabis smoking and 44.5% for alcohol consumption. Fifty-two point five per cent had no toxic habit, 36.7% had one toxic habit, 9.9% two toxic habits, and 0.9% three toxic habits. The most frequent associations were tobacco-alcohol (6.5%), and tobacco-cannabis (3%). CONCLUSIONS: Occupational health professionals have to play a key role in raising awareness and fighting against consumption of psychoactive substances amongst dockers.

Prevalence of chronic obstructive respiratory diseases amongst fishermen.

BACKGROUND: The objective was to screen and evaluate the prevalence of respiratory diseases and obstructive ventilatory defects among fishermen in Morocco. MATERIALS AND METHODS: This observational and cross-sectional epidemiological study involved 924 men over 20 years old and with at least two years of seniority. It included a questionnaire and a spirometry. The questionnaire is composed of four sections: sociodemographic and occupational characteristics, toxic habits, medical history and respiratory clinical symptoms. RESULTS: The prevalence of symptoms of tracheobronchial irritation was 9.2% for cough, 8.2% for sputum 7.8% for dyspnoea and chest wheezing 8.1%. The frequency of rhinitis was 17.1%, asthma 6.8%, chronic bronchitis 5.6% and chronic obstructive pulmonary disease (COPD) 4.1% (5.4% for current and former smokers versus 1.1% for non-smokers). The prevalence was reaching 6.8% among those who smoked more than 10 pack-years and 17.9% among those who smoked more than 20 pack-years. Among subjects over 40 years old who had smoked more than 10 pack-years, the prevalence of COPD was 8.1%. The comorbidities were frequent. CONCLUSIONS: Smoking was very common among fishermen. Symptoms and respiratory diseases remain underdiagnosed and undertreated. Prevention and early detection must be a priority in this sector.

Prevalence of skin diseases amongst Moroccan fishermen.

BACKGROUND: The main objective was to evaluate the prevalence of skin diseases amongst fishermen, to specify the different clinical forms, associations and most frequent localisations, and to identify potential aetiological factors. The secondary objectives were to assess the knowledge, attitudes and practices of seafarers regarding occupational dermatoses to conduct information, awareness and education campaigns on risk factors and behaviours and to propose adapted prevention. MATERIALS AND METHODS: This cross-sectional survey involved 1102 artisanal fishermen who attended the annual legal medical consultation at the occupational health service. All participants were men and had a regular activity for at least 2 years. It included an individual questionnaire, a clinical examination and a technical visit to the workplace Results: The skin disorders were palmar hyperkeratosis in 67.1% of fishermen, plantar hyperkeratosis in 59.4%, scares in 52.2%, facial wrinkling in 32%, and marine stings in 11.2%. The skin infections were fungal (44.4%), bacterial (8.3%), viral (5.5%) and scabies (1%). Only 192 (17.4%) fishermen did not have any dermatologic disease, 43% had one type of dermatologic diseases, 27.2% two types, 9.5% three types and 2.5% four types. Concerning personal protective equipment, only 87.4% wore protective clothing, 12.8% high visibility clothing, 52.6% safety shoes, 30.1% protective gloves, and 63.5% protective caps or hats. Only, 12% knew that mycosis were infectious origin and were contagious. Eighty-two per cent ignored the mode of contamination, 78% the means of prevention and 91% the existence of a medical treatment. Ninety-five per cent thought that pityriasis versicolor was due to sunrays especially in summer and not to fungus. CONCLUSIONS: The elaboration of the prevention approach needs a cooperative spirit; it will be more accepted and applied by all fishermen, if their representatives are involved in its preparation. The realisation of information and sensitization campaigns about the skin health must be based on the results of prevalence surveys.

Risk-taking behaviours among fishermen in Morocco by the evaluation of "ordalique" functioning.

BACKGROUND: The aim was to investigate the potential fishermen's psychological functioning which induces risk-taking behaviours by evaluating the ordalique functioning. MATERIALS AND METHODS: This cross-sectional epidemiological study was conducted in three ports of northern Morocco in 2016 and concerned 1413 traditional fishermen working in small embarkations and 1049 administrative staff working in the maritime sector on land. Both groups were male, comparable for age and educational level. The survey support was an individual questionnaire covering socio-demographic characteristics, toxic habits and ordalique functioning questionnaire (le questionnaire de fonctionnement ordalique, QFO). It is composed of 42 items and four dimensions which are evaluated: risk-taking, transgression, positive representation of risk-taking and believes. RESULTS: The prevalence of the ordalique behaviour and its four dimensions was significantly higher among traditional fishermen than administrative staff on land; 66.4% vs. 33.6% (p < 0.0001) for risk-taking, 65.2% vs. 34.8% (p < 0.0001) for transgression, 60.4% vs. 39.6% (p < 0.0001) for positive representation, 59.8% vs. 51.2% (p < 0.0001) for believes. For all range ages, the prevalence of ordalique functioning was higher among fishermen than administrative staff on land. Among fishermen, the prevalence of the was significantly higher among the under 40 years old (69.1% vs. 54.7%, p < 0.0001). The prevalence of toxic habits among ordalique fishermen was significantly greater than no-ordalique ones: tobacco (54.5% vs. 48.6%, p < 0.035), alcohol (42.8% vs. 32.4%, p < 0.0001), cannabis (34.8% vs. 26.6%, p < 0.0001), psychotropic drugs (13.8% vs. 10.4%, p < 0.081) and a combination of toxic habits (27.7% vs. 19.6%, p < 0.0001). CONCLUSIONS: Ordalique behaviour among fishermen may explain the partial failure of preventive measures in this sector. Risk-taking behaviours into account in the safety system could reduce occupational hazards in the fishery.

Wellbeing and occupational risk perception among health care workers: a multicenter study in Morocco and France.

BACKGROUND: The study analyzes health care workers' (HCWs) occupational risk perception and compares exposure to occupational risk factors in Moroccan and French hospitals. METHOD: Across nine public hospitals from three Moroccan regions (north, center and south), a 49 item French questionnaire, based on the Job Content Questionnaire, and 4 occupational risks subscales, was distributed to 4746 HCWs. Internal consistency of the study was determined for each subscale. Confirmatory factor analysis was conducted on the Moroccan questionnaire. Psychosocial job demand, job decision latitude and social support scores analysis was used to isolate high strain jobs. Occupational risks and high strain perception correlation were analyzed by univariate and multivariate logistic regression. A comparative analysis between Moroccan and French (Nantes Hospitals) investigations data was performed. RESULTS: In Morocco, 2863 HCWs (60 %) answered the questionnaire (54 % women; mean age 40 years; mean work seniority 11 years; 24 % physicians; 45 % nurses). 44 % Moroccan HCWs are at high strain. Casablanca region (1.75 OR; CI: 1.34-2.28), north Morocco (1.66 OR; CI: 1.27-2.17), midwives (2.35 OR; 95 % CI 1.51-3.68), nursing aides (1.80 OR; 95 % CI: 1.09-2.95), full-time employment (1.34 OR; 95 % CI 1.06-1.68); hypnotics, sedatives use (1.48 OR; 95 % CI 1.19-1.83), analgesics use (1.40 OR; 95 % CI 1.18-1.65) were statistically associated to high strain. 44% Moroccan HCWs are at high strain versus 37 % French (Nantes) HCWs (p < 0.001). CONCLUSION: Moroccan HCWs have high strain activity. Moroccan HCWs and more Moroccan physicians are at high strain than Nantes HCWs. Moroccan and French's results showed that full time workers, midwives, workers using hypnotics, and analgesics are at high strain. Our findings underscore out the importance of implementing a risk prevention plan and even a hospital reform. Further research, with an enlarged study pool will provide more information on psychosocial risks (PSR) and HCWs' health.

Psychosocial and occupational risk perception among health care workers: a Moroccan multicenter study.

BACKGROUND: International studies on occupational risks in public hospitals are infrequent and only few researchers have focused on psychosocial stress in Moroccan Health Care Workers (HCWs). The aim of this study was to present and analyze Moroccan HCWs occupational risk perception. Across nine public hospitals from three Moroccan regions (northern, central and southern), a 49 item French questionnaire with 4 occupational risks subscales, was distributed to 4746 HCWs. This questionnaire was based on the Job Content Questionnaire. Psychosocial job demand, job decision latitude and social support scores analysis were used to isolate high strain jobs. Occupational risks and high strain perception correlation were analyzed by univariate and multivariate logistic regression. RESULTS: 2863 HCWs (60%) answered the questionnaire (54% women; mean age 40 years; mean work seniority 11 years; 24% physicians; 45% nurses). 44% of Moroccan HCWs were at high strain. High strain was strongly associated with two occupational categories: midwives (2.33 OR; CI 1.41-3.85), full-time employment (1.65 OR; CI 1.24-2.19), hypnotics and sedatives use (1.41 OR; CI 1.11-1.79), analgesics use (1.37 OR; CI 1.13-1.66). CONCLUSION: Moroccan HCWs, physicians included, perceive their job as high strain. Moroccan HCWs use of hypnotics, sedatives and analgesics is high. Risk prevention plan implementation is highly recommended.

[Prevalence and risk factors of attention disorders of professional drivers in Morocco]. / Prévalences et facteurs de risque des troubles de la vigilance chez les routiers professionnels au Maroc.

We aimed to evaluate the prevalence and risk factors of professional drivers' vigilance disorders in Morocco. This transversal epidemiological multicentric study concerned 5,566 professional drivers of taxis (2,134), buses (1,158) and trucks (2,274). We used an anonymous individual questionnaire of 4 sections: socioprofessional and sanitary characteristics of drivers, working conditions, sleeping habits, symptoms of sleep problems and favouring factors. Drivers were a population at risk: high body mass index (62.2%), toxic habits (smoking: 50.6%; alcohol: 12.9%; cannabis use: 11.7%), pathological antecedents (27%) and consumption of psychotropic drugs (4%). Their working conditions were difficult and sleeping problems were frequent. The mean daily hours of work was 10.6 ± 1.6, and mean sleep duration 6.5 ± 1.3 hr. Insomnia was 40.2%, abnormally high Epworth scores 36.3% and sleepiness when driving 53.4%. Information and education on the dangers of sleepiness while driving is necessary, as is respect for regulations on work duration. The extension of the occupational health system to this type of activity would help improve road security and protect the health of professional drivers and road users.

[Evaluation of knowledge, attitudes and practices in the health care setting in Morocco with regard to hepatitis B and C]. / Evaluation des connaissances, attitudes et pratiques sur les hépatites virales B et C en milieu de soins au Maroc.

The purpose of this study was to evaluate practices and knowledge on infectious hazards, to determine the prevalence of viral hepatitis B and C related to occupational blood exposures among health care workers, and to propose a prevention policy. This descriptive epidemiological survey, which is multicentric and cross-cutting, was carried out in 2005 in four Moroccan cities. 1562 health care workers were contacted and 1002 accepted to reply to the questionnaire (64.1%). The mean age was 39.5 +/- 6.8 years and length of service 12.6 +/- 8.3 years. Blood was identified as the product most handled by workers (91.3%), followed by dirty linen and hospital waste. The most frequently used instruments reported were hollow needles (77.9%), followed by lancets. Re-sheathing used needles was practiced by 47.3% of the personnel. Nurses, assistants and support staff have insufficient knowledge on how viral hepatitis B and C is transmitted. Only 47.4% of personnel were adequately vaccinated against hepatitis B. Post-vaccines serology was carried out on only 2.7% of the vaccinated staff. During the last twelve months, 62.8% of the persons were victim to at least one occupational blood exposures of which 8.3% were reported. Universal precautions are not widely known or applied: only 24.4% wore gloves for invasive acts and 63% correctly disinfected their hands. Viral hepatitis B and C hazards in healthcare facilities are not sufficiently taken account. The recent creation of occupational health services in hospital facilities should contribute to improve working conditions, provide for mandatory vaccination of hospital employees against viral hepatitis B, and improve and increase information and education on hazards related to occupational blood exposures for healthcare personnel.