Diseases, accidents and injuries among travelers in Poland.

A survey was conducted among a group of people who traveled from Poland abroad, and who were insured before leaving the country, and in case of illness or injury claimed the costs of treatment providing medical documentation. The risk of disease and injury among these travelers was estimated. Among 336,254 travelers, there were 2,411 cases of disease and 789 cases of injury, during their mean period of travels and stay abroad of about 3 weeks (20,63 days). In the surveyed group, there were 24 cases of fatal disease and 7 cases of fatal injuries recorded. The incidence per 100,000 was calculated.

The WHO intercountry training course on maritime occupational health, Gdynia, 1998.

Following the ILO/WHO Consultation on Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers (Geneva, 25-27 November 1987) held at the International Labour Office, this Course was conducted at the Institute of Maritime and Tropical Medicine and the WHO Collaborating Centre there on 14-28 June 1998. The Lecturers were scientists and experts in this field of medicine working at the Institute, and also invited Guest Lecturers from Belgium, Germany, Italy and Sweden. The WHO Representative from Geneva (Dr. M.I.Mikheev, Chief, Occupational Health, WHO HQ) participated during the last 3 days of the Course, lectured on the role of WHO in the health protection of maritime workers, took part in the field visits, and distributed Course Certificates to participants. The invited ILO Representative was not able to come, but ILO sent to Gdynia ILO publications for distribution to participants, and also a paper entitled "The International Labour Organization and the Health of Seafarers and Fishermen", text of which is published in this issue of the Bulletin.

Malaria in seafarers. 1. The magniture of the problem and the strategy of its control.

Malaria infections among seafarers have been regularly reported from Denmark, Germany, France, Belgium, Italy, Poland, The Netherlands, United Kingdom and other countries. No statistics are available on malaria infections among crews of ships flying "flags of convenience". The estimated number of malaria cases in international seafarers may be between 500 and 1000 each year; and fatalities among them are reported. This has been an important health problem for seafarers and preventive interventions are essential. In the strategy of malaria prevention in this occupational group the most important objective is to prevent death caused by severe Plasmodium falciparum infections, in which the clinical manifestations occurred during the ship's voyage, and the diagnosis and treatment were delayed. Protective measures against malaria on ships, benefits, risks and limitations of chemoprophylaxis are discussed.

Malaria in seafarers. 2. The status of malaria in large ports of the world. Protective measures against malaria in crews of ships.

In 1997, the information was collected in collaboration with WHO on the actual status of malaria in large ports of Africa, Asia, and America, on the level of endemicity, prevailing Plasmodium species and the resistance to antimalarial drugs. The factors determining the risk of infection in seafarers were discussed. The risk is different than it is for other groups of travellers. The strategy of malaria prevention in crews of ships should be based on balancing the actual risk of infection in the visited ports of the tropics with the risk of side effects of antimalarials used for prophylaxis. Five schemes for malaria prevention in seafarers may be recommended, depending on the geographical areas of the ship's voyage.

Diseases and work-related injuries in Polish seafarers and conditions of their work on foreign-flag ships.

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.

Accidents and injuries in Polish seafarers.

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.

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.

Work-related accidents and injuries in Baltic fishermen.

Data on the incidence of work-related accidents and injuries in Baltic fishermen employed on medium-size and small fishing vessels were collected during 9 years, and were compared with this incidence in the control group of shore workers, and in a group of deep-sea fishermen surveyed previously. The non-fatal and fatal injuries in Baltic fishermen occurred much more frequently, than in deep-sea fishermen employed on large ocean-going trawlers-factory ships. This may be related to the difference in the conditions of work on various types of fishing vessels.

Work-related lost time accidents in deep-sea fishermen.

To evaluate the problem of work-related accidents and injuries in fishermen, a survey was conducted among crews of deep-sea fishing trawlers-factory ships of 3 large fishing companies, covering the period of 10 years (1977-1986). In the surveyed population of 10,475 men and a control group of 4,073 workers employed on shore, there were altogether 1,688 work-related accidents recorded, including 33 fatal accidents. Their incidence was 16.54 per 1000 per year (0.32 fatal cases per 1000 men per year). In the control group (n = 4,073 workers), the incidence was 27.98 per 1000 men (0.03 fatal accidents per 1000). There were more accidents recorded in the control group, than in fishermen. But the incidence of fatal cases was about 10 times higher among fishermen than among workers employed on shore. Among 33 fatal cases in fishermen, there were 12 cases of drowning, 6--injuries, 2--intoxications, 1--burn, and 12 cases sudden death at sea considered as "work-related accidents".

Knowledge of seamen and fishermen on risk factors of diseases of the circulatory system.

A total of 1352 seafarers and deep-sea fishermen were interviewed with the use of a questionnaire regarding their knowledge on risk factors in cardiovascular diseases. A great majority of them knew about the harmful effect of tobacco smoking (88.4 per cent of persons interviewed), arterial hypertension (75.7 per cent), and diet rich in fats which contributes to increasing the level of serum cholesterol (75.2 per cent); only 43.2 per cent marked diabetes mellitus as a risk factor. The knowledge on the above risk factors was not enough to change their attitude and habits, with regard to smoking and diet. Preventive interventions should be intensified on ships in order to promote the health of crews. Maritime medicine staff should play more active role in this health promotion programme.