A risky occupation? (Un)healthy lifestyle behaviors among Danish seafarers.

Sedentary working conditions, smoking, unhealthy eating habits and lack of exercise are some of the lifestyle risk factors that form a potentially growing problem for seafarers within certain parts of the maritime sector creating a heightened risk for chronic diseases such as diabetes and cardiovascular disease. Health promotion initiatives to combat this negative development requires as a first step identifying the magnitude of the different risk factors. A survey was conducted in 2007-08 with two Danish shipping companies on seafarers' health, wellbeing, diet, smoking and physical activity. In addition, a health profile was offered to the respondents, consisting of physiological measurements, such as fitness rating, body mass index (BMI), cholesterol measurement and blood pressure. The response rate in the questionnaire study was 57% (n = 360) of which 76% (n = 272) of the respondents received a health profile. Results (males) showed 44% daily smokers compared with 32% in the general Danish adult male population. Twenty-five percent of the seafarers were obese with a BMI > 30 compared with 12% of the Danish adult male population. Fifty-one percent of the respondents were defined as having metabolic syndrome, compared with 20% of the Danish adult male population. Seafaring is a risky occupation when looking at the seafarers' health and wellbeing. The results of this survey confirm the need for health promotion interventions such as smoking cessation courses, healthy cooking courses and physical exercise programs, etc. that can enable healthier lifestyle. The challenge will be to take into account the special seafaring conditions when implementing the interventions.

Health promotion in the Danish maritime setting: challenges and possibilities for changing lifestyle behavior and health among seafarers.

BACKGROUND: Seafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. This trend is partly due to a higher number of accidents but also higher incidence of lifestyle-related diseases like cardiovascular disease and lung cancer. In Denmark, the proportion of smokers as well as of overweight and obese persons is higher among seafarers compared to the general population. This high burden of risk indicates that this occupational group might be a growing challenge at sea in regard to safety and health issues and there is a need to further our understanding of the health promotion approaches that work. METHODS: A single-group pre-post design was conducted in 2008-2009 in order to identify changes in lifestyle related behaviors and health risk factors among seafarers (N: 606) in two Danish shipping companies after implementing two structural health promotion interventions (healthy cooking courses for ship cooks and improvement of fitness facilities) as well as health education interventions (smoking cessation courses, individual exercise guidance and extra health check-ups) at the maritime workplace. Baseline and follow-up data were collected with a self-administrated standardized questionnaire and individual health profiling assessing parameters such as physical health and physical fitness. In addition, qualitative interviews with participants and non-participants were conducted in order to gain in-depth information on experiences with the intervention processes. RESULTS: Significant changes were identified for levels of fitness, daily sugar intake and metabolic syndrome. However, these results were not associated with participating in the health educational interventions. One possible explanation for the improved fitness rate could be the upgrading of fitness equipment onboard the ships provided by the management level. The decrease in daily sugar intake and prevalence of seafarers with metabolic syndrome might be associated with the cooking course intervention which aimed at providing healthier daily meals on board. CONCLUSION: The findings suggest that a multicomponent health promotion intervention program has the potential to achieve change in seafarers' health behavior and health parameters. In the future, studies with more rigorous designs, separately testing the contribution of different types of interventions are needed.

Evaluation of national pandemic management policies-A hazard analysis of critical control points approach.

Analyses of pandemic preparedness policies revealed weaknesses in control systems of European nations. This reinforces the need to support countries in their endeavours to prevent and contain pandemics. A Hazard Analysis and Critical Control Points (HACCP) was applied to a generic plan to identify weaknesses in pandemic management policies, in order to develop recommendations for improving national pandemic management systems. Policy components considered in our analysis are command and control, early case detection and disease surveillance, and community containment management. The main critical areas identified in national pandemic control were: communication systems among all institutions and levels involved in pandemic management, guidelines and regulations describing how key personal and institutions should operate during a pandemic, training and dissemination of information to health care personnel involved in outbreak management. The HACCP analysis highlighted the need for agreed communication structures, clear division of responsibilities and harmonised policy guidelines at all levels of pandemic management. Being prepared is the key to successfully coordinate and implement response measures when a pandemic emerges.

The costs of repatriating an ill seafarer: a micro-costing approach.

Seafarers sail the high seas around the globe. In case of illness, they are protected by international regulations stating that the employers must pay all expenses in relation to repatriation, but very little is known about the cost of these repatriations. The objective of this study was to estimate the financial burden of repatriations in case of illness. We applied a local approach, a micro-costing method, with an employer perspective using four case vignettes: I) Acute myocardial infarction (AMI), II) Malignant hypertension, III) Appendicitis and IV) Malaria. Direct cost data were derived from the Danish Maritime Authority while for indirect costs estimations were applied using the friction cost approach. The average total costs of repatriation varied for the four case vignettes; AMI (98,823 EUR), Malignant hypertension (47,597 EUR), Appendicitis (58,639 EUR) and Malaria (23,792 EUR) mainly due to large variations in the average direct costs which ranged between 9560 euro in the malaria case and 77,255 in the AMI case. Repatriating an ill seafarer is a costly operation and employers have a financial interest in promoting the health of seafarers by introducing or further strengthen cost-effective prevention programs and hereby reducing the number of repatriations.

What does it take to get a healthy diet at sea? A maritime study of the challenges of promoting a healthy lifestyle at the workplace at sea.

BACKGROUND AND AIM: Prevalence of obesity is high among Danish seafarers and appropriate health promotion interventions are required within the maritime setting. The aim of this study was to examine whether a training intervention for ship cooks could improve seafarers' diet on board and, in particular, to identify possible challenges in practice on board of vessels from 2 Danish shipping companies. MATERIALS AND METHODS: Interviews and participant observations were conducted during a 2-day cooking course. Interviews were repeated 1 year after (N:35) the course in order to assess self-perceived changes in preparing meals and ordering supplies, as well as perceived challenges in implementing changes and maintaining them. In addition, changes in self-reported eating behaviour before the cooking course and 1 year after were assessed based on a 1-year follow-up quantitative questionnaire survey (N:193). RESULTS: Participants reported positive opinions about the course and subsequent changes in promoting a nutritious and healthy diet at sea by way of health education. Also a significant change was found in these afarers' self-reported eating behaviour from T1 to T2. However several challenges were identified during the transfer and maintenance phase such as many cooks having received little or no prior training which limited their cooking abilities. Confined physical capacities on board, restricted space for storage and lack of proper equipment were other barriers and so were low frequency of supply options and high prices for fresh fruit and vegetables. CONCLUSIONS: To fully realise the benefits of the changes, these challenges related to the specific maritime workplace setting need to be acknowledged and addressed at management level.