Self-reported diabetes mellitus among seafarers: occupational and sociodemographic predictors.

BACKGROUND: Seafarers are at increased risk of diabetes due to their lifestyle and working conditions on board ships. There is, however, limited evidence regarding the magnitude of diabetes and its risk factors. In this study, we aimed to assess the prevalence of self-reported diabetes among seafarers on board ships and identify risk factors associated with it. MATERIALS AND METHODS: A cross-sectional epidemiological survey was conducted among seafarers aboard ships between November and December 2022. The study enrolled a total of 4,500 seafarers aged 18 and older. Data were collected using anonymous, standardized questionnaires. The association between the outcome variable and the independent variables was assessed using binary logistic regression models. RESULTS: In total, 2,986 participants were included in the study. The prevalence of self-reported diabetes among seafarers was found to be 8.2% (95% CI: 7.2-9.2). Self-reported diabetes prevalence among officers and non-officers was 7% and 9%, respectively. The mean age of study participants was 37.96 ± 10.22, while the mean age of participants with diabetes was 47.5 ± 9.46. Independent predictors of self-reported diabetes mellitus were age (51+ years) [adjusted odds ratio (AOR): 3.52, 95% confidence interval (CI): 1.46-8.95], rank (non-officer) [AOR: 1.65; 95% CI: 1.14-2.40], worksites (engine) (AOR: 2.08, 95% CI: 1.19-3.77), work experience (10-20 years) (AOR: 4.66, 95% CI: 2.33-10.05), work experience (21+ years) (AOR: 5.01, 95% CI: 2.32-11.55), working hours per week (57-70 hours) (AOR: 1.57, 95% CI: 1.08-2.31), working hours per week (71+ hours) (AOR: 1.80, 95% CI: 1.17-2.80), self-reported hypertension (AOR: 1.44, 95% CI: 1.03-1.99), overweight (AOR: 1.74; 95% CI: 1.24-2.47), and obesity (AOR: 2.93; 95% CI: 1.84-4.65). CONCLUSIONS: This study revealed that one in twelve seafarers between the ages of 19 and 70 have self-reported diabetes. The present study identified significant risk factors associated with diabetes. Risk factor mitigation strategies aimed at high-risk groups should be implemented on board ships.

The Magnitude of Cardiovascular Disease Risk Factors in Seafarers from 1994 to 2021: A Systematic Review and Meta-Analysis.

OBJECTIVES: The incidence of acute cardiac events is one of the main reasons for medical consultation, disembarkation, repatriation, and death among seafarers at sea. Managing cardiovascular risk factors, particularly those that can be modified, is the key to preventing cardiovascular disease. Therefore, this review estimates the pooled prevalence of major CVD risk factors among seafarers. METHODS: We conducted a comprehensive search of studies published between 1994 and December 2021 in four international databases, namely PubMed/Medline, Scopus, Google Scholar, and Web of Science (WOS). Each study was evaluated for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. The DerSimonian-Laird random-effects model with logit transformations was used to estimate the pooled prevalence of major CVD risk factors. The results were reported in accordance with the Preferred Items for Systematic Review and Meta-analysis (PRISMA) guidelines. RESULTS: Out of all 1484 studies reviewed, 21 studies with 145,913 study participants met the eligibility criteria and were included in the meta-analysis. In the pooled analysis, the prevalence of smoking was found to be 40.14% (95% CI: 34.29 to 46.29%) with heterogeneity between studies (I2 = 98%, p < 0.01). The prevalence of hypertension, overweight, obesity, diabetes mellitus, and alcohol consumption was 45.32%, 41.67%, 18.60%, 12.70%, and 38.58%, respectively. However, the sensitivity analysis after excluding studies showed a pooled prevalence of hypertension, overweight, obesity, and diabetes mellitus of 44.86%, 41.87%, 15.99%, and 16.84%, respectively. The subgroup analysis demonstrated that smoking prevalence among seafarers had decreased significantly after 2013. CONCLUSION: This study demonstrated that CVD risk factors, particularly hypertension, overweight, smoking, alcohol consumption, and obesity, are prevalent among seafarers. These findings may serve as a guide for shipping companies and other responsible bodies in order to prevent CVD risk factors among seafarers. PROSPERO Registration: CRD42022300993.

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Seafarers: A Cross-Sectional Study of Prevalence and Clustering.

BACKGROUND: Cardiovascular diseases (CVD) are the major cause of work-related mortality from diseases onboard ships in seafarers. CVD burden derives mainly from modifiable risk factors. To reduce the risk factors and the burden of CVD onboard ships in seafarers, it is important to understand the up-to-date prevalence of modifiable risk factors. The primary purpose of this study was to assess the prevalence and clustering of self-reported modifiable CVD risk factors among seafarers. We have also explored the association between socio-demographic and occupational characteristics and reported modifiable CVD risk factor clustering. MATERIALS AND METHODS: A cross-sectional study was conducted among seafarers from November to December 2020 on board ships. In total, 8125 seafarers aged 18 to 70 were selected from 400 ships. Data were collected using a standardized and anonymous self-reported questionnaire. The prevalence value for categorical variables and mean differences for continuous variables were compared using chi-square and independent sample t-tests. Multinomial logistic regression models were performed to identify independent predictors for modifiable CVD risk factor clustering. RESULTS: Out of a total of 8125 seafarers aged ≥18 years on selected vessels, 4648 seafarers volunteered to participate in the survey, with a response rate of 57.2%. Out of 4318 participants included in analysis, 44.7% and 55.3% were officers and non-officers, respectively. The prevalence of reported hypertension, diabetes, current smoking and overweight or obesity were 20.8%, 8.5%, 32.5%, and 44.7%, respectively. Overall, 40%, 20.9%, 6% and 1.3% of the study participants respectively had one, two, three and four modifiable CVD risk factors. Older age (51+ years) (odds ratio (OR): 3.92, 95% confidence interval (CI): 2.44-6.29), being non-officers (OR: 1.36, 95% CI: 1.09-1.70), job duration (10-20 years) (OR: 2.73, 95% CI: 2.09-3.57), job duration (21+ years) (OR: 2.60, 95% CI: 1.79-3.78), working 57-70 h per week (OR: 2.03, 95% CI: 1.65-2.49) and working 71+ h per week (OR: 3.08, 95% CI: 2.42-3.92) were independent predictors for at least two self-reported modifiable CVD risk factor clustering. CONCLUSION: The results of our study demonstrate that more than four in six (68.5%) seafarers aged between 19 and 70 years have at least one of the modifiable CVD risk factors. Therefore, CVD prevention and modifiable risk factors reduction strategies targeting high-risk groups should be designed and implemented on board ships.

Impact of Obesity-Induced Inflammation on Cardiovascular Diseases (CVD).

Overweight and obesity are key risk factors of cardiovascular disease (CVD). Obesity is currently presented as a pro-inflammatory state with an expansion in the outflow of inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), alongside the expanded emission of leptin. The present review aimed to evaluate the relationship between obesity and inflammation and their impacts on the development of cardiovascular disease. A literature search was conducted by employing three academic databases, namely PubMed (Medline), Scopus (EMBASE), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The search presented 786 items, and by inclusion and exclusion filterers, 59 works were considered for final review. The Newcastle-Ottawa Scale (NOS) method was adopted to conduct quality assessment; 19 papers were further selected based on the quality score. Obesity-related inflammation leads to a low-grade inflammatory state in organisms by upregulating pro-inflammatory markers and downregulating anti-inflammatory cytokines, thereby contributing to cardiovascular disease pathogenesis. Because of inflammatory and infectious symptoms, adipocytes appear to instigate articulation and discharge a few intense stage reactants and carriers of inflammation. Obesity and inflammatory markers are strongly associated, and are important factors in the development of CVD. Hence, weight management can help prevent cardiovascular risks and poor outcomes by inhibiting inflammatory mechanisms.

Incidence of occupational injuries and diseases among seafarers: a descriptive epidemiological study based on contacts from onboard ships to the Italian Telemedical Maritime Assistance Service in Rome, Italy.

OBJECTIVES: Workers at sea have high mortality, injuries and illnesses and work in a hazardous environment compared to ashore workers. The present study was designed to measure the incidence of occupational injuries and diseases among seafarers and quantify the contribution of differences in rank and job onboard on seafarers' diseases and injuries rates. DESIGN: Descriptive epidemiological study. SETTING AND PARTICIPANTS: This study's data were based on contacts (n=423) for medical requests from Compagnie Maritime d'Affrètement/Compagnie Générale Maritime (CMA-CGM) container ships to the Italian Telemedical Maritime Assistance Service in Rome from 2016 to 2019, supplemented by data on the estimated total at-risk seafarer population on container ships (n=13 475) over the study period. OUTCOME MEASURES: Distribution of injuries by anatomic location and types of diseases across seafarers' ranks and worksites. We determined the incidence rate and incidence rate ratio (IRR) with a 95% CI. RESULTS: The total disease rate was 25 per 1000 seafarer-years, and the overall injury rate was 6.31 per 1000 seafarer-years over the 4 years study period. Non-officers were more likely than officers to have reported gastrointestinal (IRR 2.12, 95% CI 1.13 to 4.26), dermatological (IRR 3.66, 95% CI 1.27 to 14.42) and musculoskeletal (IRR 2.25, 95% CI 1.11 to 5.05) disorders onboard container ships. Deck workers were more likely than engine workers to be injured in the wrist and hand (IRR 3.25, 95% CI 1.19 to 10.23). CONCLUSIONS: Rates of reported injury and disease were significantly higher among non- officers than officers; thus, this study suggests the need for rank-specific preventative measures. Future studies should consider risk factors for injury and disease among seafarers in order to propose further preventive measures.

Conceptual Framework and Designing for a Seafarers' Health Observatory (SHO) Based on the Centro Internazionale Radio Medico (C.I.R.M.) Data Repository.

BACKGROUND: Health observatory (HO) models are helpful in gathering, analyzing, interpreting, and circulating reliable and quality information on population health and health service delivery. In this study, we proposed an HO conceptual model to enhance seafarer's health, which subjects to disease trends. METHODS: Three methods were followed during the study: a systematic collection of seafarer's health data from the Centro Internazionale Radio Medico (C.I.R.M.) repository, an integrative review of existing seafarer's policy, and both open and closed questionnaires were distributed to stakeholders to develop clinical knowledge. C.I.R.M. is the Italian Telemedical Maritime Assistance Service (TMAS). Results and Discussion. A three-layer HO framework was developed, and each layer had its components and functionalities. The proposed HO model integrated with the outcomes of the mentioned methods was working as the origin of the framework. In this way, we can design a standard infrastructure in ships and risk assessment conduction.