Medical training of seafarers: International Maritime Health Foundation (IMHF) Expert Panel Consensus Statement.

BACKGROUND: Medical emergencies and on-going medical conditions on board may seriously impair seafarers' health and safety, and also negatively impact on future work prospects for seafarers. When a seafarer gets ill or injured on a ship, medical treatment often relies on the competences on his colleagues on board. The aim of this project was to establish a consensus-based minimum standard for medical education for seafarers, in order to ensure competency for adequate management of ill-health on board. MATERIALS AND METHODS: International Maritime Health Foundation (IMHF) conducted a workshop on medical training of seafarers. A research-based approach to gain consensus on core learning outcomes/competences developed by the Tuning Project, has been used. This method was used by Tuning (Medicine) to gain consensus on core learning outcomes for primary medical degrees (Master of Medicine) across Europe. RESULTS: The result of the project is a set of learning outcomes/competences in medical training for merchant seafarers. CONCLUSIONS: The project resulted in a set of learning outcomes/competences on medical training of the seafarers that will be submitted to the relevant bodies of International Maritime Organization (IMO) in the process of the development of model courses 1.13, 1.14 and 1.15.

Healthcare to parents of young terrorism survivors: a registry-based study in Norway.

OBJECTIVES: To assess changes in parents' short-term and long-term primary and specialised healthcare consumption following a terrorist attack threatening the lives of their children. DESIGN: Registry-based study comparing parental healthcare service consumption in the 3 years before and the 3 years after a terrorist attack. SETTING: The aftermath of the Utøya terrorist attack. The regular, publicly funded, universal healthcare system in Norway. INTERVENTION: Parents learning of a terrorist attack on their adolescent and young adult children. PARTICIPANTS: Mothers (n=226) and fathers (n=141) of a total of 263 survivors of the Utøya terrorist attack (54.6% of all survivors 13-33 years, n=482). MAIN OUTCOME MEASURES: We report primary and specialised somatic and mental healthcare service consumption in the early (0-6 months) and delayed (>6-36 months) aftermath of the attack, both in terms of frequency of services consumed (assessed by age-adjusted negative binomial hurdle regression) and proportions of mothers and fathers provided for (mean semiannual values). The predisaster and postdisaster rates were compared by rate ratios (RRs), and 95% CI were generated through bootstrap replications. RESULTS: Frequency of primary healthcare service consumption increased significantly in both mothers and fathers in the early aftermath of the attack (mothers: RR=1.97, 95% CI 1.76 to 2.23; fathers: RR=1.73, 95% CI 1.36 to 2.29) and remained significantly elevated throughout the delayed aftermath. In the specialised mental healthcare services, a significant increase in the frequency of service consumption was observed in mothers only (early: RR=7.00, 95% CI 3.86 to 19.02; delayed: RR=3.20, 95% CI 1.49 to 9.49). In specialised somatic healthcare, no significant change was found. CONCLUSION: Following terrorist attacks, healthcare providers must prepare for increased healthcare needs in survivors and their close family members, such as parents. Needs may present shortly after the attack and require long-term follow-up.

Does posttraumatic stress predict frequency of general practitioner visits in parents of terrorism survivors? A longitudinal study.

Background: Life threat to children may induce severe posttraumatic stress reactions (PTSR) in parents. Troubled mothers and fathers may turn to their general practitioner (GP) for help. Objective: This study investigated frequency of GP visits in mothers and fathers of adolescent and young adult terrorism survivors related to their own PTSR and PTSR in their surviving children. Method: Self-reported early PTSR (4-5 months post-disaster) in 196 mothers, 113 fathers and 240 survivors of the 2011 Utøya terrorist attack were linked to parents' three years pre- and post-disaster primary healthcare data from a national reimbursement claims database. Frequency of parents' GP visits was regressed on parent and child PTSR, first separately, then in combination, and finally by including an interaction. Negative binominal regressions, adjusted for parents' pre-disaster GP visits and socio-demography, were performed separately for mothers and fathers and for the early (<6 months) and delayed (6-36 months) aftermath of the terrorist attack. Results: Parents' early PTSR were significantly associated with higher early frequency of GP visits in mothers (rate ratio, RR = 1.31, 95%CI 1.09-1.56) and fathers (RR = 1.40, 95%CI 1.03-1.91). In the delayed aftermath, early PTSR were significantly associated with higher frequency of GP visits in mothers only (RR = 1.21, 95%CI 1.04-1.41). Early PTSR in children were not significantly associated with an overall increase in GP visits. On the contrary, in mothers, child PTSR predicted significant decrease in GP visits the delayed aftermath (RR = 0.83, 95%CI 0.71-0.97). Conclusions: Our study suggests that GPs may play an important role in identifying and providing for parents' post-disaster healthcare needs. GPs need to be aware that distressed individuals are likely to approach them following disasters and must prepare for both short- and long-term healthcare needs.

Planteamiento: Las amenazas vitales a los niños puede inducir graves reacciones de estrés postraumático (PTSR, siglas en inglés de posttraumatic stress reactions) en los padres. Las madres y los padres preocupados pueden recurrir a su médico de cabecera (GP, siglas en inglés de general practitioner) en busca de ayuda. Objetivo: Este estudio investigó la frecuencia de visitas al GP por parte de madres y padres de adolescentes y adultos jóvenes supervivientes del terrorismo relacionados con las reacciones de estrés postraumático propias y de sus hijos supervivientes. Métodos: Los autoinformes de reacciones tempranas de estrés postraumático (4-5 meses después del desastre) en 196 madres, 113 padres y 240 supervivientes del ataque terrorista de Utøya de 2011 se enlazaron con los datos de atención primaria de salud de los padres (tres años antes y después del desastre) provenientes de una base de datos nacional de reclamaciones de reembolso. Se hizo una regresión de la frecuencia de las visitas al GP de los padres mediante regresiones binomiales negativas con las PTSR de los padres y el hijo, primero por separado, luego en combinación, y finalmente con la inclusión de una interacción. Los análisis se realizaron por separado para las madres y los padres con respecto a las consecuencias tempranas (<6 meses) y tardías (6-36 meses) después del ataque terrorista y se ajustaron para las visitas pre-desastre al GP de los padres y la sociodemografía. Resultados: Las PTSR tempranas de los padres se asociaron significativamente con una mayor frecuencia temprana de visitas al GP en las madres (RR = 1,31, IC del 95%: 1,09-1,56) y padres (RR = 1,40, IC del 95%: 1,03-1,91). En las consecuencias posteriores, las PTSR tempranas se asociaron significativamente con una mayor frecuencia de visitas al GP en madres solamente (RR = 1,21; IC del 95%: 1,04-1,41). Las PTSR tempranas en niños no se asociaron significativamente con un aumento general de las visitas al GP. De hecho, en las madres, las PTSR del hijo predijeron una disminución significativa en las consecuencias tardías (RR = 0,83; IC del 95%: 0,71-0,97). Conclusiones: Nuestro estudio sugiere que los médicos de cabecera pueden desempeñar un papel importante a la hora de identificar y la proporcionar las necesidades de atención médica de los padres después de un desastre. Los médicos de cabecera deben ser conscientes de que las personas angustiadas es probable que se acerquen a ellos después de los desastres y deben prepararse para las necesidades de salud a corto y largo plazo.

Early postdisaster health outreach to modern families: a cross-sectional study.

OBJECTIVES: This study investigated whether the early outreach programme following the Utøya massacre reached out to the parents of the young survivors. Additionally, we explored whether specialised mental healthcare services were provided to parents presenting elevated levels of PTSD and depression reactions. DESIGN: Cross-sectional survey, face-to-face interviews and questionnaires. SETTING: Norway, aftermath of the Utøya massacre, 4-7 months postdisaster. BACKGROUND: Following the Utøya massacre, proactive early outreach programmes were launched in all municipalities that were affected, facilitating access to appropriate healthcare services. PARTICIPANTS: A total of 453 parents of the Utøya survivors aged 13-33 years took part. Overall, 59.8% of the survivors were represented by one or more parent in our study. MAIN OUTCOME MEASURES: Engagement with the proactive early outreach programme (psychosocial crisis teams and contact persons in the municipalities), utilisation of healthcare services (general practitioner and specialised mental healthcare services) and mental distress (UCLA PTSD-RI and HSCL-8). RESULTS: A majority of the participants reported contact with the proactive early outreach programme (crisis team, 73.9%; and contact person, 73.0%). Failure of outreach to parents was significantly associated with non-intact family structure (crisis team: OR 1.69, 95% CI 1.05 to 2.72, p=0.032) and non-Norwegian origin (crisis team: OR 2.39, 95% CI 1.14 to 4.98, p=0.021). Gender of the parent was not significantly associated with failure of the outreach programme (p ≥ 0.075). Provision of specialised mental healthcare services was significantly associated with higher levels of PTSD (OR 2.08, 95% CI 1.55 to 2.79, p<0.001) and depression (OR 2.42, 95% CI 1.71 to 3.43, p<0.001) and not with the sociodemography (p ≥ 0.122). CONCLUSIONS: Proactive early outreach strategies may be helpful in identifying healthcare needs and facilitating access to the required services in a population struck by disaster. Our findings prompt increased attention to the complexity of family structures in reaching out universally to modern families following a disaster.