Overview of oral health status and associated risk factors in maritime settings: An updated systematic review.

OBJECTIVES: The aim of this study is to provide an updated overview of the oral health status and associated risk factors in maritime settings. METHODS: We systematically searched PubMed, Ovid Embase, Web of Science, CINAHL and SCOPUS from January 2010 to April 2023. Two independent reviewers extracted the data. The quality of included studies was assessed using relevant assessment tools. RESULTS: A total of 260 records were found in the initial search; 24 articles met the inclusion criteria. Most studies had descriptive design, and only two randomized controlled trials were found. The main oral health issues noted are oral cancer, dental caries, periodontal diseases, oral mucosal lesions, and dental emergency. Male seafarers have higher risk of oral cancers in the tongue, lips, and oral cavity while oral mucosal lesions are more prevalent among fishermen. CONCLUSIONS: Dental caries and periodontal diseases are prevalent in both seafarers and fishermen. The consumption of tobacco, alcohol, fermentable carbohydrate, and poor oral hygiene are risk factors that affect the oral health status at sea. The occurrence of oral diseases in maritime setting requires more attention of researchers and authorities to develop strategies to tackle these issues. TRIAL REGISTRATION: Systematic review registration number in PROSPERO: CRD42020168692.

Screening for type 2 diabetes and hypertension in seafarers' medical examinations.

BACKGROUND: The aims of the study are: 1) to replace the urine glucose test for diabetes with more than 50% false negatives, with an accurate screening for type 2 diabetes and hypertension in the mandatory biannual fit-for-duty medical examinations of seafarers; 2) to produce data driven "Green Ship" health pro-motion in the ships. A new health promotion and disease prevention public health intervention programme integrated in the fit-for-duty medical examinations for seafarers is being developed. MATERIALS AND METHODS: The lack of an accurate diagnosis of type 2 diabetes is replaced by accurate HbA1c and/or fasting glucose tests and the test for hypertension in various disease stages is based on the International Associations' Guidelines. A "Green Ship" health promotion programme is proposed for all on board, not only for diseased crew members. RESULTS: A protocol for an accurate biannual screening for diabetes and hypertension is presented. Educational programmes for medical doctors and seafarers on the management of hypertension and diabetes on board will be developed. Presuming that all crew members are potentially on their way to be pre-diseased or are diseased, the "Green Ship" health promotion programme is implemented for the whole crew. CONCLUSIONS: The International Labour Organization and the National Maritime Authorities are prompted to revise the International and the National Guidelines for Seafarers Medical Examinations, respectively. Con-certed actions are requested to implement public health promotion projects in shipping. Maritime medical doctors are prompted to use health dialogues and to report the clinical data in the Excel file. Sustainability is obtained by complying with the Sustainable Development Goals (3, 4, 8, 10, and 17).

Global overview of dietary outcomes and dietary intake assessment methods in maritime settings: a systematic review.

BACKGROUND: Seafaring is a risky occupation with high prevalence of risk factors for non-communicable diseases. Food intake and eating habits are important cornerstones regarding health and health promotion. The aim of this study was to provide an overview of dietary intake and dietary intake assessment methods of seafarers and suggestions for applicable assessment tools. METHODS: We systematically searched PubMed and NLM Gateway (for MEDLINE), Web of Science, and SCOPUS up to February 2020 using standard keywords including nutrition OR diet OR meal AND maritime settings. Two independent reviewers extracted the data. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal checklist. RESULTS: From 4449 studies initially identified, 26 articles were included in the final review. Qualitative data (e.g. on unhealthy eating) had been gathered using in-depth individual or group interviews, participant observations, and phone-based chats. Composition of menu analysis, 24 h dietary recall, food diaries/ diet records, dietary habits questionnaire, food stores and food waste of the ship were used to assess the quantitative outcomes (e.g. dietary intakes). Access to meat, processed meat and egg, frozen and canned food items, sugary drinks, alcohol, greasy and salty food was high. In contrast, consumption of fruit, vegetables, dairy products, and cereals was lower than recommended. CONCLUSIONS: Eating habits and dietary intakes in maritime settings are unhealthy. Subjective dietary assessment methods combining menu analysis with new technologies (e.g. mobile-based) might be an applicable method in this hard to reach setting which is the vessels.

Seafarers' mental health in the COVID-19 era: lost at sea?

Seafarers are exposed to several physical and psychosocial stressors. Recent studies highlighted specific disorders as fatigue, boredom and diseases as depression. Seafarers are also commonly exposed to post-traumatic stress disorder (piracy, accidents, threats). Coronavirus disease 2019 (COVID-19) impacts seafarers with an estimated 400,000 of whom are stranded on vessels around the world, with extended time on board, repatriation's difficulties and the financial concerns of the unexpectedly unemployed. International Maritime Organization has established the Seafarer Crisis Action Team to help them. In France, in last 10 months a dedicated call centre received 142 calls from 32 seafarers for psychological phone consultations mostly linked to this era. With the increase of duration of the COVID-19 crisis, psychological health care, repatriations and financial solutions are needed for seafarers.

The impact of the Maritime Labor Convention on seafarers' working and living conditions: an analysis of port state control statistics.

BACKGROUND: The Maritime Labour Convention, 2006 (MLC2006) entered into force in August 2013 and is a milestone for better working and living conditions (WLC) for seafarers. As of March 2020, 96 countries have ratified the MLC2006, covering more than 90% of the world's shipping fleet. A system of port state control (PSC) allows ratifying countries to inspect any foreign ship arriving in their ports for compliance with the convention. It is intended as a second safety measure for the identification of substandard ships that sail all over the world. Nine regional agreements, so-called Memoranda of Understanding (MoU), have been signed to coordinate and standardize PSC inspections and to increase efficiency by sharing inspections and information. This paper uses public PSC statistics to evaluate the impact of the MLC2006. METHODS: A preliminary analysis using registered tonnage and MLC2006 ratification was conducted and seven MoU were selected for the analysis. The annual reports of these MoU have been viewed in September 2019. Numbers on annual inspections, deficiencies and detentions and in particular data for deficiencies related to living and working conditions and certificates and documents, have been extracted and analyzed for the years 2010 to 2017. RESULTS: Across the eight-year period analyzed, inspection numbers remained stable among all MoU authorities. Deficiencies overall and deficiencies related to WLC declined, indicating an improvement in conditions overall and an increased focus on seafarers' conditions on board. After the MLC2006 entered into force, three MoU reported WLC-ratios above 14%, while the numbers didn't rise above 10% in the other four authorities. Deficiencies related to certificates and documents did not rise significantly between 2010 and 2017. Two European MoU showed the highest ratios for deficiencies in both categories analyzed. CONCLUSION: The analysis confirmed that an increasing attention is being paid to the inspection of working and living conditions, especially in European countries. However, a clear positive impact of the MLC2006 could not be determined from the PSC statistics in this analysis. A large variation still exists among the MoU, a fact that demands increased efforts for harmonization of PSC procedures.

Association of Serum Uric Acid with cardio-metabolic risk factors and metabolic syndrome in seafarers working on tankers.

BACKGROUND: There is still controversy over the clinical interpretation of the association between metabolic syndrome (MetS) and serum uric acid (SUA) levels. Therefore, the aim of this study was to investigate the association of SUA levels with MetS and other cardio-metabolic risk factors (CMRF) in seafarers working on tankers. METHODS: This cross-sectional study was conducted in 2015 and included 234 male seafarers working on tankers. The participants were divided into three groups based on the tertiles of SUA. The report from of the National Committee of Obesity was used to define the MetS. The relationship between SUA, CMRF and MetS adjusted for age, educational level, job history, shift work, smoking and BMI was assessed by logistic regression analysis. RESULTS: The subjects were aged 36.0 ± 10.3 years (mean ± SD). A notable upward trend was observed in mean weight, body mass index (BMI), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL) and very low-density lipoprotein (VLDL) as tertiles of SUA increased (P < 0.001). In all models of the logistic regression analyses, the odds ratio (OR) of high TG for participants in the 3rd tertile of SUA was four times higher than that for participants in the 1st tertile of SUA (P < 0.001). The odds ratio of high TC and the SUA levels increased, so that the odds ratio of high TC for participants in the 2nd tertile was 2.47 (95% CI: 1.10-5.53) (P < 0.05) as compared with that for participants in the 1st tertile. Significant association was observed between MetS and the levels of SUA; 6.10 (95% CI: 1.77-20.94) (P < 0.05). CONCLUSIONS: Findings revealed that SUA levels were associated with MetS, high TG and high TC. Therefore, it is recommended that clinical attention should be given to symptoms related to elevated SUA - being one of the most important remediable risk factors for MetS - in the annual medical examinations of seafarers.

Follow-up of citations of maritime epidemiological injury studies.

BACKGROUND: The article is based on a review and follow-up of the citations of 13 epidemiological studies that aimed to improve maritime health and safety. While it's well-recognised that epidemiology is needed in occupational health and safety, the main research question: "How can epidemiology help workers to return healthy from the sea" was unanswered. MATERIALS AND METHODS: The 13 articles were selected as a representative sample of different epidemiological design studies intended to contribute to improving safety management in fishing, merchant shipping and offshore industry. The PubMed, Research Gate, Cochrane-Library and Google Scholar were searched for authors that had cited our articles by using full bibliographic information and the results analysed. RESULTS: In all, 213 citation records were identified. After duplicates and records with insufficient information were removed, 123 full-text articles were eligible for evaluation with answers to the research questions: how did other authors use the studies, how has the injury epidemiology been developed, which recommendations are given for new policies and new studies and how can epidemiology help workers return safe and healthy from the sea? CONCLUSIONS: The answer to the main research question is yes, epidemiological studies are not only useful but a necessary component by providing the needed evidence for successful prevention programmes.

Comment on Oldenburg, M., Jensen, H.J. Stress and Strain among Seafarers Related to the Occupational Groups. Int. J. Environ. Res. Public Health 2019, doi:10.3390/ijerph16071153.

Recently, Oldenburg M published an article in the journal "Communication" titled "Stress and Strain among Seafarers Related to the Occupational Groups" [...].

Global prevalence of cardiometabolic risk factors in the military population: a systematic review and meta-analysis.

BACKGROUND: Although there are numerous studies on the global prevalence of cardiometabolic risk factors (CMRFs) in military personnel, the pooled prevalence of CMRFs in this population remains unclear. We aimed to systematically review the literature on the estimation of the global prevalence of CMRFs in the military population. METHODS: We simultaneously searched PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS with using standard keywords. All papers published up to March 2018 were reviewed. Two independent reviewers assessed papers and extracted the data. Chi-square-based Q test was used to assess the heterogeneity of reported prevalence among studies. The overall prevalence of all CMRFs, including overweight, obesity, high low-density lipoprotein (LDL), high total cholesterol (TC), high triglyceride (TG), low high-density lipoprotein (HDL), hypertension (HTN) and high fasting blood sugar (FBS) was estimated by using the random effects meta-analysis. A total of 37 studies met the eligibility criteria and were included in the meta-analysis. RESULTS: According the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of MetS, high LDL, high TC, high TG, low HDL and high FBS were 21% (17-25), 32% (27-36), 34% (10-57), 24% (16-31), 28% (17-38) and 9% (5-12), respectively. Moreover, global pooled prevalence of overweight, generalized obesity, abdominal obesity and HTN were estimated to be 35% (31-39), 14% (13-16), 29% (20-39) and 26 (19-34), respectively. CONCLUSIONS: The overall prevalence of some cardio-metabolic risk factors was estimated to be higher in military personnel. Therefore, the necessary actions should be taken to reduce risk of developing cardiovascular diseases. SYSTEMATIC REVIEW REGISTRATION NUMBER IN PROSPERO: CRD42018103345.

How to calculate incidence rates from proportionate data.

This paper describes the methodological aspects of calculation of incidence rates from incomplete datain occupational epidemiology. Proportionate measures in epidemiological studies are useful e.g. to describethe proportion of slips, trips and falls compared to other types of injury mechanisms within singleage-strata. However, a comparison of proportions of slips, trips and falls among the different age-stratagives no meaning and can hamper the conclusions. Examples of a constructed example and some selectedstudies show how estimates of incidence rates can be calculated from the proportionate data by applyingestimates of denominators available from other information. The calculated examples show how the risksbased on the incidence rates in some cases differ from the risks based on the proportionate rates withthe consequence of hampering the conclusions and the recommendations for prevention. In some casesthe proportionate rates give good estimates of the incidence rates, but in other studies this might causeerrors. It is recommended that estimates of the incidence rates should be used, where this is possible, byestimation of the size of the population. The paper is intended to be useful for students and teachers inepidemiology by using the attached Excel training file.

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.

Training needs among maritime professionals: a cross sectional study.

BACKGROUND: Maritime medical practice includes assessment of fitness, management of medical emergencies and healthcare on board and ashore. A better response to seagoing professionals' health requirements can be achieved when all the respective stakeholders have a common understanding. Training is a powerful tool to raise awareness and in particular continuing professional development is very significant in sustaining competencies of these professionals. The objective of the study was to identify maritime professionals' perceived training needs. MATERIALS AND METHODS: A cross-sectional study was conducted among maritime professionals participated in the 14th International Symposium on Maritime Health. Fifty responses with the response rate of 42.7% were received with medical doctors representing 78% of the sample. Descriptive statistics were used to describe the basic characteristics of the data needs using STATA 15.1. RESULTS: Among the 23 themes, the ranking of perceived training needs was highest for fitness evaluation and examination guidelines and working conditions (both with the same percentage 86%), onboard medicine 82%, rules and regulations and health and safety at work (with the same percentage 80%). The lowest was on gender issues 32%. CONCLUSIONS: The finding suggests the planning and effective implementation of further training for the maritime health professionals in a variety of topics including financing and management issues. Highest importance of training was expressed by those over 40 years and by medical doctors with more than 10 years of practice. These findings could usefully be combined with a qualitative study to gain in-depth results and may help the respective authorities to organise relevant training.

Pesticide Residues in Commercial Lettuce, Onion, and Potato Samples From Bolivia-A Threat to Public Health?

Bolivia does not have a surveillance program for pesticide residues in food. The few published studies have suggested that pesticide contamination in food may present a public health problem. Data are lacking for all foods except tomatoes and breast milk. In this study 10 potato, 10 onion, and 10 lettuce samples from La Paz were sampled on August 15, 2015 at a local market and screened for 283 pesticides. Residues of cypermethrin, chlorpyrifos, difenoconazol, or/and λ-cyhalothrin were detected in 50% of the lettuce samples, whereas no pesticides were found in potatoes and onions. In 20% of the lettuce samples, the measurements were above the maximum residue limits, and 2 or 3 pesticides were identified simultaneously. Washing almost halved the pesticide levels, but still 20% of the samples showed measurements above the limits. No samples contained concentrations of pesticides which alone or together would lead to exposures that exceeded the acceptable daily intake or the acute reference dose. To protect consumers from pesticide poisonings and chronic effects, the development of measures for prevention, control, and monitoring of food contamination by pesticides in Bolivia is suggested.

Factors affecting health-promoting lifestyle profile in Iranian male seafarers working on tankers.

BACKGROUND: Seafaring is a risky occupation that is associated with a high incidence of lifestyle-related diseases. The present study was carried out to examine health promotion behaviour and its associated factors in seafarers of the National Iranian Tanker Company. MATERIALS AND METHODS: A cross-sectional study was performed on 200 Iranian male seafarers in 2015. A self-administered socio-demographic and Health Promotion Lifestyle Profile II (HPLP-II) questionnaire was completed. One-way analysis of variance was used to identify significant differences among the various departments. The t-test was utilised to compare the HPLP-II scores according to the demographic variables. Multiple linear regression analysis was performed to assess the association between demographic variables and the overall HPLP-II score, in addition to the six health-promoting lifestyle subscale scores. RESULTS: The mean age of the participants was 35.93 ± 9.51 years. Most of the seafarers were categorised as having a moderate (32%) or good lifestyle (61.5%). The mean lifestyle score was 136.14 ± 19.90, with the subscale spiritual growth showing the highest score (26.16 ± 5.03) and the subscale exercise behaviour showing the lowest score (19.95 ± 4.23). The lowest score for nutrition was found among the seafarers working in the engine department (engine: 20.41 ± 4.50, deck: 23.52 ± 4.97, and galley: 24.83 ± 4.64) (p < 0.05). Working in the engine department was found to have a significant negative effect on the nutrition score (B = -3.57, p < 0.05). Moreover, educational level was found to have a significant positive effect on spiritual growth (B = 2.97, p < 0.05). CONCLUSIONS: The findings suggest that health-related issues in this occupation, especially workers in the engine room, are a matter of concern.

Management of Empty Pesticide Containers-A Study of Practices in Santa Cruz, Bolivia.

AIMS: The mismanagement of empty containers of pesticides, posing a risk to the environment and the health of people, has motivated the promotion of international policies and guidelines to mitigate such problems. Despite these guidelines, attention to this problem is inadequate in Bolivia. The objective was to study the knowledge and practical management of the containers and to implement a responsible management plan for empty pesticide containers. METHODS: This study implemented the project from 2014 to 2016 in 2 municipalities of the Department of Santa Cruz. Integral and participatory processes of information, education, and training were used. A questionnaire study among pesticide users was used to investigate knowledge and management of the empty pesticide containers. RESULTS: The authorities and the population responded to the program by taking a critical and active approach to the problem, improving their responsible practices, and 5500 kg of empty containers were collected. The cross-sectional study showed that 93% of the empty containers were disposed of in vulnerable places; 62% of the population did not know what triple washing is; 60% felt discomfort, headache, and/or dizziness while using pesticides; and 31% of the empty containers had pesticide residue inside them. CONCLUSIONS: The study illustrates a complex situation, mainly caused by lack of knowledge and clear guidelines. We recommend documentation of the social, economic, and productive characteristics of the region before any municipal program action is undertaken. The key element to sustainable change is an informed and coordinated participation of all actors.

Health status and occupational risk factors in Greek small fisheries workers.

BACKGROUND: Fishing is an extremely dangerous occupational activity that predisposes to occupational diseases and accidents. Greece, with about 16,000 km of coastline and its unique morphological characteristics with small islands and peninsulas, represents a strong proof of its great tradition in the fisheries sector since ancient times. The aim of the study was to examine the health status and the health risk factors present in Greek fishery workers, by exploring their working environment, thus providing a current baseline for documentation of the needs for prevention and health promotion. MATERIALS AND METHODS: An interviewer-administered questionnaire was distributed in 2013 to a random sample of 172 professional small-scale fishermen of the Evros district in North-Eastern Greece. RESULTS: Eighty-eight per cent worked in coastal fisheries and 73% were using small fishing vessels, less than 10 m in length overall. Health disorders included musculoskeletal, cardiovascular and visual problems and to a minor degree by hearing, dermatologic and respiratory problems in all age groups. Seventy per cent had experienced at least one occupational accident. Heavy smoking and daily alcohol consumption was seen among nearly half of the fishermen. CONCLUSIONS: The health effects observed are causally related to the work process exposures on board and to diet, smoking, and lack of exercise. This in turn relates to the specific working conditions, the culture and level of education in small-scale fishing that need to be taken into consideration together in the prevention programmes.