Seafarers' well-being in the context of the COVID-19 pandemic: A qualitative study.

BACKGROUND: The public health strategies for prevention of SARS-CoV-2 infection have included closing the national borders and cancelling international flights, which has severely affected free crew changes. This caused prolonged stay on board or at home for seafarers, who should be recognized as 'key' workers regarding their essential role in maintaining the flow of vital goods. OBJECTIVE: Using a general inductive approach, this qualitative study aims to describe how the COVID-19 pandemic reflects on seafarers' well-being. The study focused on obtaining personal experiences from seafarers on board, and seafarers at home, relating to the current world pandemic. METHODS: A convenience sample consisting of 752 seafarers from the international seafarers' population participated in an online study in spring 2020. The questionnaire used included questions relating to basic sociodemographic and work characteristics, and one open question which addressed seafarers' personal experiences. The data obtained was analysed by thematic analysis. RESULTS: The emerged themes included mental, physical, social and economic well-being. Most of the answers of seafarers located on board related to threatened mental, physical and social well-being, while seafarers at home reported mostly on threats to their economic well-being. CONCLUSION: Seafarers' well-being is seriously threatened by preventive measures relating to the COVID-19 pandemic. Results are discussed in relation to earlier findings in the area of occupational stress in seafaring. Overall, the data obtained portrays existing underlying occupational structures in the seafaring sector, which are rendered more visible due to the COVID-19 pandemic. In short, seafarers describe their reality as far away from the concept of 'key' or 'essential' workers.

Mortality among seafarers: a register-based follow-up study.

BACKGROUND: Seafarers are exposed to many occupational risk factors. AIMS: To study whether there are differences in mortality between seafarers and other employees, whether there are variations in seafarers' mortality between different seafaring occupations and whether these differences can be explained by sociodemographic factors. METHODS: A register-based study of all seafarers aged 25-64 years, resident in Finland in 2000 with minimum 5 years of cumulative seafaring experience on Finnish vessels and other employees, followed for mortality 2001-13. Analysis methods included age standardized death rates, mortality ratios (SMR) and Cox proportional hazard model. RESULTS: During the follow-up period 2001-13, there were 81,035 person years and 382 deaths in the cohort of seafarers. Seafarers had 1.3 times higher risk of death (men SMR 132, 95% confidence intervals [CI] 118-147, women SMR 125, 95% CI 99-157) than other employees. Mortality was especially high in alcohol-related causes (men SMR 172, 95% CI 126-233, women SMR 262, 95% CI 131-525) and causes related to smoking. Controlling for sociodemographic characters strengthened the risk compared to other occupations. Mortality was high among male deck and engine crew and among male and female galley personnel. The mortality differences between different seafaring occupations were partly explained by adjustments of sociodemographic characters. CONCLUSIONS: Seafarers still have increased mortality among men after adjustment of sociodemographic characters. Results by causes of death suggest that changing practices to enable healthy behaviour are important.

Needs and possibilities for ship's crews at high seas to communicate with their home.

OBJECTIVES: Good communication between seafarers and their families at home is essential to compensate for the work-related strain experienced on board ships. This paper presents the needs and possibilities for communication with home in seafaring. MATERIAL AND METHODS: In total, 323 seafarers were interviewed during their work assignments on board (the participation rate of 88.5%). The results were stratified by cultural background, family ties, rank groups and shipping routes. RESULTS: The average stay of the officers on board the current vessels lasted 4 months and that of the ratings 9 months (p < 0.001). About a third of the officers and a half of the ratings evaluated these lengths of stay as too long. In the study, only 50 participants (15.5%) mentioned that the Internet on board their previous vessel was available for private use. Only 40.6% of these crew members stated that they had used it on a daily basis. Particularly the seafarers assigned to worldwide destinations and crew members without children experienced the insufficient possibilities for telecommunication as work-related strain (OR 1.87, 95% CI: 1.15-3.04 respective OR 2.00, 95% CI: 1.03-3.88). The average amount of time spent on telecommunication amounted to more than 2.5 h/week (which equals approximately 20 min/day). The average cost of about USD 30/week for telecommunication was considered by 24.7% of the seafarers as "much too high." CONCLUSIONS: The fact that several crew members considered the time spans of their assignments as too long should lead to certain adjustments. In view of the importance of good options for shipboard telecommunication, this study makes an essential contribution to understanding the crews' needs. Measures should be taken to improve communication by allowing an easier access to information and communication technology (ICT) (on board and ashore), by offering cheaper fees, and by providing Internet access in their cabins. The study results show a substantial need to improve the means of communication on board ships. Int J Occup Med Environ Health. 2019;32(6):805-15.

Dockworkers' health and safety. A cross-sectional study of self-perceived safety and psychosocial work environment amongst Danish dockworkers.

BACKGROUND: This study aimed to determine the characteristics and association between self-perceivedsafety and psychosocial work environment amongst dockworkers in Denmark. MATERIALS AND METHODS: A cross-sectional study was conducted among dockworkers in three harbours inDenmark, using a triangulation strategy approach, with a questionnaire survey and telephone interviews.Both collection methods included questions on workplace safety, accidents, work environment, colleaguesand management. The majority felt confident about the safety at the work place (88.8%) and agreed thatgood collaboration and teamwork among colleagues (95.4%) was the reason they felt safe. The majoritywere very satisfied with their job (76.1%). Moreover, the majority stated that they were thriving well in thechangeable working hours (85.1%) and did not find it stressful to be a part-time worker with no guaranteeof work (80.2%). 46.1% had never felt stressed, and only 7.9% had felt stressed often the last 2 weeks.The main source of feeling stressed was the combination of work and personal life (39.3%). The studypopulation was 88 and the response rate of the questionnaire was 41%. RESULTS AND CONCLUSIONS: Due to the small study population and the distribution of answers, it was notpossible to measure an association between self-perceived safety and psychosocial work environment;however, it was found that dockworkers were greatly satisfied with the working conditions, primarily becauseof good colleagues, flexible working hours and a satisfying pay cheque.

Comparative analysis of the medicinal compounds of the ship's "medicine chests" in European Union maritime countries. Need for improvement and harmonization.

BACKGROUND: The contents of the ship pharmacy, namely "medicine chest" and its compliance with therespective regulations concerning the type of drugs to be provided for merchant vessels involved in long distance voyages and without a doctor on board were analysed. The current existing disparity between regulations can make medical assistance more complicated, and more often of low quality, due to frequent off-label use of supplied drugs. This study may represent a starting point leading to a model high-quality medicine chest on board ships. MATERIALS AND METHODS: A comparative analysis between the medicine chest requirements of 12 European countries and the CEE Directive 31 March 1992 n.92/29 was made. Prescriptions of the aforementioned Directive were compared with the WHO Model List of Essential Medicines (third Edition). RESULTS: The investigation showed a lack of homogeneity of contents. It emerged that some medicinechests lack of several pharmaceutical categories required by the reference standards. The subsequentcomparison of the European Directive with the WHO Model List of Essential Medicines has highlightedthe absence of some therapeutic categories that in the ship environment can be of important to ensureadequate therapy in many situations. CONCLUSIONS: There are disparities regarding regulations concerning the ship medicine chests. It is crucial toharmonize these and create a single medicine chest for all the ships without a doctor on board, undergoingperiodic updates and revisions, based on epidemiological analysis that will ensure high-quality healthcareto seafarers around the world.

Navy Medicine Introduces Value-Based Health Care.

In 2016 the newly appointed surgeon general of the Navy launched a value-based health care pilot project at Naval Hospital Jacksonville to explore whether multidisciplinary care teams (known as integrated practice units, or IPUs) and measurement of outcomes could improve the readiness of active duty personnel and lower the cost of delivering care to them, their dependents, and local retirees. This article describes the formation of the project's leadership structure, the selection of four conditions to be treated (low back pain, osteoarthritis, diabetes, and high-risk pregnancy), the creation of the care team for each condition, outcomes and costs measured, and the near-term changes in outcomes during the twelve-month pilot period. Patient outcomes improved for three of the four conditions. We describe factors that contributed to the project's success. After the pilot concluded, the Navy combined the back pain and osteoarthritis IPUs into a single musculoskeletal clinical unit and established a similar IPU at another naval hospital and its clinics. The diabetes IPU was continued, but the high-risk pregnancy IPU was not. We offer several observations on the elements that were key to the success of the project, explore challenges and opportunities, and suggest that the pilot described here could be taken to greater scale in the Military Health System and elsewhere.

Rates and occupational characteristics of international seafarers with mental illness.

BACKGROUND: Seafarers enable 90% of global commerce, working in isolation from social support and medical care. While occupational conditions of isolation may suggest possible excess risk of mental illness and suicide, research on seafarer mental illness is limited. AIMS: To describe seafarers with mental illness and associated incidence rates in a large population of international seafarers. METHODS: We used mental illness claims data from a large international marine insurance provider arising from working seafarers during the years 2007-15. We used descriptive statistics and calculated mental illness incidence rates in this seafarer population. RESULTS: There were 278 seafarer mental illness claims in the study data. Claims were more often reported in deck workers (46%) and ratings (58%). The crude mental illness rate was 3.9 per 100 000 person-years. CONCLUSIONS: Using objective data on a large seafaring population, our analysis highlights the important issue of mental illness in this isolated and underserved international workforce. The low observed mental illness claims rate is likely due to the high threshold for claims reporting.

Occupational injuries and diseases in fish farming in Finland 1996-2015.

BACKGROUND: The agriculture, forestry and fishing industry sector has high rates of occupational injuries. Fishing has globally particularly high occupational fatality rates, but injuries and illnesses to people working in its sub-sectors, aquaculture and fish farming, are not well understood. MATERIALS AND METHODS: This study characterised injuries and occupational diseases to fish farmers and people employed on fish farms in Finland using national employment and accident insurance (workers' compensation) data. RESULTS: A total of 392 injuries and 18 occupational diseases were compensated during 1996 to 2015 to fish farmers and people employed on fish farms in Finland. The average injury rate was 3.2 injuries per 100 employed persons with no significant trend over time. Two of the injuries were fatal. Injured persons were primarily male (87.2%), in 45-54 year age group (39.1%), and working in coastal areas (49%). Com- mon injury characteristics included: incident type: slips, trips, and falls (37%); location: building, structure or ground level surface (28%); injured body part: hand or finger (25%); type of injury: dislocation, sprain, strain (35%); and lost worktime: 1 to 2 weeks (26.9%). Seven out of 18 occupational diseases occurred to women, most resulting in cumulative trauma from fish processing. CONCLUSIONS: The injury rate in fish farming corresponds to rate in all industries combined in Finland, and is higher than the rate in available Nordic statistics on fish farming. Fish farming injuries could be reduced further by slip resistant surfaces, protection of hands and fingers and ergonomics in processing.

Exposure to fumigants in containers: a questionnaire assessment on 125 French dockers.

BACKGROUND: Cases of intoxications to gas from container's atmosphere have been described. For diagnosis, Fum Ex 2 questionnaire has been developed by the European Society for Environmental and Occupational Medicine. The aim of this study was to enhance knowledge on health effects of toxic substances in containers and to validate this questionnaire in medical follow-up and diagnosis. MATERIALS AND METHODS: In 2014, 125 French dockers answered the questionnaire in a face-to-face interview. RESULTS: 83.5% declared no exposure to fumigants or pesticides. Most frequently declared symptoms were fatigue and neurological disorders for dockers and respiratory irritation for refrigeration technicians. Only 28 workers wore regularly individual protection equipment. CONCLUSIONS: A "healthy worker" effect could explain low level of symptoms. Fum Ex 2 questionnaire is relevant for diagnosis. Workers in all steps of the logistic transport chain and consumers are exposed to containers' atmosphere.

Longitudinal Analysis of CAD/CAM Restoration Incorporation Rates into Navy Dentistry.

INTRODUCTION: Computer-aided design/computer-aided manufacturing (CAD/CAM) has gained increasing popularity since the first commercially viable dental system was introduced in the mid-1980s. Digitally milled dental restorations can be fabricated chairside in the course of one dental appointment, reducing time, cost, and manpower when compared with traditional laboratory-fabricated analog restorations. Clinical performance, physical properties, and esthetics of digital restorations have been shown to be comparable to traditional analog restorations. The Navy has incorporated CAD/CAM systems into dental clinics on multiple platforms to include ships. The efficiency of this technology has the potential to positively impact dental health and mission readiness. The objective of the present study was to evaluate placement rates of CAD/CAM restorations by Navy dental providers. MATERIALS AND METHODS: Placement rates of CAD/CAM restorations from October 2011 to June 2017 (Department of Defense created codes specific to CAD/CAM restorations in 2011) and of laboratory-fabricated analog restorations from January 2008 to June 2017 were queried from the Dental Common Access System (DENCAS) and Corporate Dental Access system (CDA) and evaluated. Scatterplots for each dental restoration category were generated using monthly production data and overlaid with simple linear regression lines and 95% confidence intervals. Regression analysis was performed to determine whether changes in the monthly percentages of placements before and after CAD/CAM were increasing or decreasing and to determine whether the monthly percent change from before CAD/CAM implementation and after CAD/CAM implementation was significantly different from one another. RESULTS: A total of 20,512 CAD/CAM restorations were placed by Navy providers over the 68-month period. A year-over-year increase in digitally fabricated restorations was observed. As a percentage of total indirect restorations, CAD/CAM units surged from 13.8% in 2012 to 38.1% in 2017. All ceramic restorations fabricated by the classical analog method also increased significantly through the period. Traditional analog porcelain fused to metal (PFM) restorations and large amalgam restorations, which frequently serve a similar clinical purpose as indirect or direct full or partial tooth coverage restorations, both decreased significantly after CAD/CAM productivity tracking was initiated. CONCLUSIONS: Implementation of CAD/CAM digital restorations has led to a significant decline in specific traditional analog procedures since productivity tracking of CAD/CAM was initiated in 2011. Navy dentistry has embraced CAD/CAM as an efficient means to prepare sailors and marines for deployments, improve operational dental readiness, and potentially decrease dental emergencies by reducing the need for provisional restorations. The trend toward increased utilization of digital dentistry is expected to continue for the following reasons: (1) incorporation of CAD/CAM technology into dental school curricula, (2) advancement of CAD/CAM systems equipped with fast-evolving user interfaces, (3) increased accessibility to CAD/CAM technology in Navy clinics, and (4) training of a greater proportion of dentists in digital CAD/CAM technology. Future studies should investigate the survival rate of CAD/CAM restorations placed within military settings, cost, and manpower of maintaining CAD/CAM units, and impact on military dental laboratories associated with increased CAD/CAM usage.

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.

Seafarers' views on the impact of the Maritime Labour Convention 2006 on their living and working conditions: results from a pilot study.

BACKGROUND: The Maritime Labour Convention 2006 (MLC2006) entered into force in 2013 and is the first comprehensive set of standards for better living and working conditions covering aspects such as wages, contracts, food, medical care and social security. Currently, the Convention covers more than 90% of the world's shipping fleet. The aim of the study was to investigate the impact of the MLC2006 on the living and working conditions of seafarers and to test and adjust the methods for future use through a pilot study. This article presents the seafarers' perceived impact of MLC2006. MATERIALS AND METHODS: A mixed-method research approach was used (February to April 2018). The quantitative data of 55 seafarers were analysed using descriptive statistics. Qualitative data obtained through a focus group interview and thematic content analysis was applied. RESULTS: Remarkably, one third of the respondents pointed out a complete lack of improvement, while 43.6% stated that the MLC2006 had improved their working and living conditions "somewhat" and only 7.3% "to a great extend". The focus group participants agreed that the MLC2006 did not improve working conditions but mostly increased paperwork. Other issues of concern were the safety on board including safety training, long working hours connected to low manning, food and social difficulties. CONCLUSIONS: For Danish seafarers, the MLC2006 did not have a significant impact, as most standards were in place before. It must be further investigated what the MLC2006 achieved for other flag states, especially in the light of its 5-year anniversary. Both methods yielded valuable data. Focus groups are an ideal setting to study the views of seafarers.

Establishment of the International Maritime Health Foundation: the next step in scientific publishing in maritime health.

The Bulletin of the Institute of Maritime and Tropical Medicine (IMTM) was published first time in 1948 as a preliminary publication. Since then it has developed and from 1999 it is known as International Maritime Health (IMH). Initially it was published by the Institute of Maritime and Tropical Medicine (IMTM) in Gdynia. From 2009 it was published by the Polish Society of Maritime, Tropical and Travel Medicine (PSMTTM) in cooperation with the International Maritime Health Association (IMHA) and the Norwegian Centre for Maritime Medicine (NCMM), later the Norwegian Centre for Maritime and Diving Medicine (NCMDM) at the Department of Occupational Medicine, Haukeland University Hospital, Bergen. After a couple of years of planning and discussions on how to take the journal forward, the International Maritime Health Foundation (IMHF) was established under Polish Law, 21st June 2018. This article discusses the process from the very beginning of the journal, until the establishment of the IMHF as well as the foundation's objectives and way forward.

A historical review of the U.S. Navy's busiest recompression chamber in the Pacific theater with a current perspective on caring for civilian divers within its area of responsibility: short communication.

On the island Nation of Guam, the United States Department of Defense has stationed military personnel from every service branch. Guam is utilized as a strategic waypoint for the U.S. military in the Pacific theater. As the largest service branch in the region, the Navy has placed a few Diving Medical Officers in Guam to collectively manage and treat patients with recompression therapy. Guam is also a popular tourist destination, with multiple recreational diving companies certifying individuals who are looking to take advantage of the beautiful warm water and exotic marine life. Unfortunately, with an increase in training and certifying inexperienced divers, came an increase in the operational tempo of the U.S. Navy's recompression chamber on Guam. The recompression chamber on Naval Base Guam (NBG) has been treating patients since 1971. With the only multiplace chamber in the Mariana Islands, Diving Medical Officers, with the accompanying chamber staff, treat military personnel, active-duty sponsored patients and civilian patients. Treating civilian patients by military providers through military treatment facilities presents multiple issues that must be addressed in an effort to provide efficient quality medical care. This article reviews the records, documents, and activity of the NBG chamber over the last four decades. Through the obtained data the information provides projected financial reimbursement from civilian patients. The article also sheds light on areas of needed improvement with regard to data collection, third-party financial collection efforts and the necessity of an inclusive electronic health record (EHR) for military and civilian patients.

Ergonomic assessment of selected workstations on a merchant ship.

This study describes some key ergonomic factors within the engine room, navigation bridge and other locations of a merchant ship. Ergonomic assessments were carried out on a crew of a merchant ship. The study examines the importance of factors such as noise, vibration, heat radiation (in machinery areas), psychological stress and ergonomics of the physical arrangement of the navigation bridge. It also addresses the effect of working in confined areas for a long duration and the need to process large amounts of data, decision-making and the influence of specific operating conditions in different areas of a ship. This study includes analysis of workstations, working methods and the burden of environmental factors as well as a discussion of specific marine environmental conditions such as confined working and leisure spaces, long-term family and sociocultural separation, frequent changes in climate and time zones, and temporary physical overload and long-term psychological burdens.

The changing economic structure of the maritime industry and its adverse effects on seafarers' health care rights.

BACKGROUND: This review seeks to understand whether and how seafarers can exercise their human right to health care and the factors that facilitate or impede that exercise. The general focus is on a critical policy analysis of labour policies from the mid-twentieth century through today, with a specific focus on how Filipino seafarers access their health care rights. MATERIALS AND METHODS: The methodology includes a critical policy analysis of seafaring, focusing on mid-twentieth century political shifts in the recognition and regulation of health care rights. The analysis of international and United States policy provides the backbone for understanding the health care experiences of seafarers by laying the ideological, theoretical, and political foundations of labour rights and precarious employment. RESULTS: Policy analysis shows that there are numerous laws, regulations, and human rights norms that have been established to protect seafarers, but uncertain and limited recourse to lay claim to such laws, regulations, and norms while at sea. Lack of recourse to policies and regulations, taken together with the changed conditions of labour and worker protections through technology and neoliberal policies, create the conditions that may increase the health inequity among seafarers'. CONCLUSIONS: Health policy discussions in the United States and internationally must not solely focus on the health of seafarers as an interruption to travel and trade, but policy makers should consider that their decisions may contribute to how seafarers can exercise their rights to health care. In this context, health is more than disease and access to care - economic and governance structures come to not only matter, but play an integral role in the facilitation or impediment of health care and to the health arrangements/conditions of workers.

The assessment of seafarers' knowledge, attitudes and practices related to STI/HIV/AIDS in northern Morocco.

BACKGROUND: The purpose of this study was to assess the knowledge, attitudes and practices of seafarers in relation to sexually transmitted infections (STI) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). MATERIALS AND METHODS: This transversal, descriptive and behavioural study was conducted in 2014 on a representative sample of 1447 seafarers. RESULTS: The rate of participation was 95%. The mean age was 36.1 ± 8.2 years. Knowledge about transmission and prevention mode was satisfactory on HIV/AIDS; however, some misconceptions still persist. The level of stigmatisation and discrimination towards people living with the virus was considered high. The prevalence of sexual high-risk behaviour was significant: 32% had at least two sexual partners and 26.3% have had sex with sex workers, 60% of them were not protected; 42.8% have never used the condom and only 15.1% used it systematically. The sailors who had sexual intercourse under the influence of alcohol or drugs are less protected. As too HIV testing, only 10.2% did it. CONCLUSIONS: This study showed a gap in knowledge about transmission and prevention of HIV infection/AIDS and sexual risk behaviour. Increasing awareness and information among seafarers is of prime importance.