Trends in the medical repatriation of Filipino seafarers: a ten year study of a Philippine maritime shipping company (OSM Maritime).

BACKGROUND: Seafarers, confronted with unique health challenges, occasionally necessitate medical repatriation. This study examines the trends in medical repatriation cases among Filipino seafarers employed by OSM Maritime shipping company over a 10-year period from 2013 to 2022. MATERIALS AND METHODS: Medical records of OSM Maritime seafarers were reviewed, obtaining causes for and dates of medical repatriation. International Classification of Diseases (ICD-11) was utilised to classify repatriation cases. Proportion of repatriation cases were calculated and their annual trends were analysed. RESULTS: Our findings reveal that the majority of repatriation cases are attributed to injury/trauma (19.91%), musculoskeletal (18.40%), gastrointestinal (16.56%), cardiovascular (8.77%), infectious (6.82%), and genitourinary conditions (5.30%). Significantly, the study identifies a declining trend in the proportion of cardiovascular, gastrointestinal, and genitourinary conditions in annual repatriation cases, particularly in ischaemic heart conditions, cholelithiasis, cholecystitis, and urinary calculus. CONCLUSIONS: These results emphasize the critical need for multisectoral collaboration to enhance seafarers' health and well-being. Prioritizing comprehensive care programmes, ensuring safe working conditions, and exploring holistic healthcare initiatives are essential steps to enhance seafarers' occupational health.

Health risk classification patterns among Filipino seafarers. Analysis from a pre-employment clinic in the Philippines: a 5-year review.

BACKGROUND: Seafaring is a demanding profession that exposes individuals to unique health risks and challenges. This study investigates risk classification patterns among seafarers who underwent physical and medical examination at the Nordic Medical Clinic, a pre-employment clinic in the Philippines. MATERIALS AND METHODS: The analysis involved data obtained from medical records, including demographic information, diagnoses, medical risk classification, corresponding management, and occupational details. medical risk classification, based on guidelines from the Philippine Department of Labour and Employment, categorised fit to work seafarers into risk class A, B, or C. Descriptive statistics and statistical tests, with a significance level set at p < 0.05, were utilised for data analysis using R Studio (version 4.2.3). RESULTS: The study population consisted of 11,831 seafarers seen at the Nordic Medical Clinic between 2018 and 2022. The results revealed a significant proportion of seafarers falling into higher risk classifications, with risk class C being the most prevalent at 48.16%. Pre-employment medical examinations (PEME) to fit to work duration demonstrated a significant association with risk classification, revealing that lower-risk classes had shorter fit-to-work times compared to higher-risk classes. Moreover, risk classification exhibited uneven distribution across specific demographic and occupational characteristics, with older seafarers, males, married individuals, and those in higher-ranking positions having a higher proportion of risk class C. CONCLUSIONS: Our findings highlight the need for comprehensive and customised pre-boarding medical screening standards for seafarers based on factors such as their specific role, vessel type, voyage, contract length, and work location. Moreover, health implementation of health promotion and preventive strategies that are based on the specific occupational and demographic needs of the seafarers are needed.

Prevalence of arterial hypertension in Vietnamese seafarers aboard merchant vessels: a cross-sectional study.

BACKGROUND: Hypertension is one of the leading causes of morbidity and mortality globally. It is a major risk factor for major cardiovascular events such as stroke, myocardial infarction, heart failure, kidney failure, and blindness. The aim of this research is to assess the prevalence and some factors related to arterial hypertension on Vietnamese seafarers aboard merchant vessels. MATERIALS AND METHODS: Seven hundred eight Vietnamese seafarers working aboard merchant ships were examined at the Institute of Marine Medicine before going to sea during the period from January 2022 to December 2022. It was a cross-sectional descriptive epidemiological study. The following parameters were measured: blood pressure, height, weight, waist circumference, buttock circumference to assess the prevalence of hypertension, overweight, and obesity. Seafarers we directly interviewed about workplace on ships and physical exercise, smoking tobacco, alcohol abuse, and anxiety symptoms to identify several factors associated with hypertension. RESULTS: The prevalence of hypertension in seafarers was 32.9%, prehypertension 26.4%, overweight 32.4%, obesity 13.3%, abdominal obesity 47.7%. Factors related to hypertension of seafarers included: job duration at sea > 10 years, odds ratio (OR) = 8.23 (95% confidence interval [CI] 4.34-17.27); non-officers, OR = 2.11 (95% CI 1.45-2.82); engine room crew, OR = 2.11 (95% CI 1.45-3.58); obesity, OR = 3.34 (95% CI 2.15-5.63); abdominal obesity, OR = 9.12 (95% CI 4.23-18.45); current smoking, OR = 1.32 (95% CI 1.02-1.99); irregular exercise, OR =1.43 (95% CI 1.03-2.18); anxiety symptoms, OR = 1.56 (95% CI 1.08-2.27). CONCLUSIONS: Hypertension is a health problem for Vietnamese seafarers. To minimise hypertension, seafarers need to adjust their lifestyle, increase regular exercise and improve psychological issues on board.

Five-year (2015-2019) follow-up study of 6,526 cases of medical repatriation of Filipino seafarers.

BACKGROUND: There is a limited number of studies on the medical repatriation of seafarers. The aim of the study was to follow up on the previous 2010-2014 study using data from 2015-2019 to evaluate the epidemiology of medical repatriation among Filipino seafarers. MATERIALS AND METHODS: Data from medical repatriation records of Filipino seafarers from January 2015 to December 2019 were collected from various claims departments of different manning agencies in Manila, Philippines. RESULTS: Data from a total of 6,526 medical repatriation cases and 464,418 deployments in a 5-year period resulted in a medical repatriation rate calculated at 1.4%. We used the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) to determine the most common causes of repatriation. We found that these were musculoskeletal disorders, gastrointestinal problems, and traumatic injuries. The distribution of the specific illnesses per organ system is presented. CONCLUSIONS: Filipinos continue to represent the most numerous group of seafarers in the world. The continued profiling of health issues should lead to better health protocols and controlling medical costs. It should also lead to better prioritisation of health protection and care on board ships. Within the present 10-year database of medical repatriations coinciding with the implementation of Maritime Convention Labour Convention 2006, there is a compelling need to compare the two data sets to have an objective evaluation of the convention's projected goals.

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

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.

Dispositional resilience predicts psychological adaptation of seafarers during and after maritime operations.

BACKGROUND: Seafarers, whether on cargo, fishery, or naval ships, may be exposed to unique and unusual psychological demands related to the often isolated, confined, and extreme environments associated with ocean-going vessels. This necessitates optimal psychological adaptation to maintain individual well-being during the mission and afterwards. This study set out to explore whether psychometric measures could predict psychological adaptation of seafarers, specifically navy sailors, during and after maritime operations. It used emotional regulation as marker of adaptation, and examined the role of psychometric measures of dispositional resilience and emotional regulation to predict psychological adaptation at subsequent time-points. MATERIALS AND METHODS: A total of 168 sailors completed the Brief Sailor Resiliency Scale, Dispositional Resilience Scale 15, and Mental Toughness Questionnaire 18 prior to departing for sea, as well as the Brunel Mood Scale at 5 time points over a 12-month operational cycle. RESULTS: Higher resilience scores were consistently associated with more adaptive emotional regulation. Multiple linear regressions indicated that the Brief Sailor Resiliency Scale predicted emotional regulation over the shorter term, while the Mental Toughness Questionnaire 18 predicted emotional regulation over the longer term. Further, mid-mission emotional regulation also predicted emotional regulation at the end of deployments. CONCLUSIONS: The findings support several practical applications. Firstly, formal organizational initiatives to promote resilience could be useful to enhance adaptation during and after missions. Secondly, measuring seafarers' dispositional resilience could allow the streaming of vulnerable individuals towards appropriate mental health support services. Thirdly, past indicators of adaptation could be useful to enhance decision- making regarding subsequent utilisation. This may be applicable to seafarers in both naval services and commercial shipping, and to personnel in remote weather stations or other isolated and inaccessible research facilities.

Longitudinal Study on the Effect of Onboard Service on Seafarers' Health Statuses.

Seafaring is considered one of the most stressful professions. Stressors in seafaring lead to typical symptoms of stress, such as insomnia, loss of concentration, anxiety, lower tolerance of frustration, changes in eating habits, psychosomatic symptoms and diseases, and overall reduced productivity, with the possibility of burnout and chronic responsibility syndrome. It has been previously determined that seafarers belong to high-risk occupations in terms of developing metabolic syndrome, and according to their BMIs, almost 50% of all seafarers belong to the overweight and obesity categories. This is the first longitudinal study conducted with the aim of using the BIA method to determine the anthropometrical changes that occur during several weeks of continuous onboard service. This study included an observed group consisting of 63 professional seafarers with 8 to 12 weeks of continuous onboard service and a control group of 36 respondents from unrelated occupations. It was determined that Croatian seafarers fit into the current world trends regarding overweight and obesity among the seafaring population, with the following percentages in the BMI categories: underweight, 0%; normal weight, 42.86%; overweight, 39.68%; and obesity, 17.46%. It was established that the anthropometric statuses of the seafarers significantly changed during several weeks of continuous onboard service. Seafarers who served on board for 11 weeks lost 0.41 kg of muscle mass, whereas their total fat mass increased by 1.93 kg. Changes in anthropometric parameters could indicate deterioration of seafarers' health statuses.

Exploration and mortification: Fragile infrastructures, imperial narratives, and the self-sufficiency of British naval "discovery" vessels, 1760-1815.

Eighteenth-century naval ships were impressive infrastructures, but subjected to extraordinary strain. To assist with their "voyage repairs," the Royal Navy gradually established numerous overseas bases, displaying the power, reach, and ruthless logistical efficiency of the British state. This article, however, is concerned with what happened where no such bases (yet) existed, in parts of the world falling in between areas of direct British administration, control, or influence. The specific restrictions imposed by technology and infrastructures have been studied by historians interested in naval strategy, but they can also help to reframe national narratives of power or observe the transnational interactions surrounding access to knowledge and resources. This paper discusses the material, cultural, and diplomatic constraints that could appear when vessels, and especially "discovery ships," sailed in strange waters or sought technical assistance in allied ports. I argue that the "mortification" of some commanders at their vessels' unfitness for service was an important - and often neglected - element on the palette of emotions undergone by voyagers, capturing their strong sense of ultimate material powerlessness. Such frustration even became embedded in imperial cartography, as shown by the case study of Matthew Flinders. This perspective highlights the limits of naval technology, complicating imperialistic "success stories" and better reintegrating the navy into the history of maritime travel and transportation, from which it is often singled out.

Teleconsultation at Sea and Acute Wound Management Onboard.

Introduction: The French Tele-Medical Assistance Service (TMAS) provides medical teleconsultation for any ship at sea. At the end of the consultation, the doctor decides whether the problem can be taken care of onboard or not. In this study, we determined the factors associated with the decision for disembarkation or evacuation in case of wounds. Methods: We conducted a retrospective epidemiological study between 2011 and 2019 from consultations with the French TMAS. The inclusion criterion was the presence of an acute wound. Results: One thousand six patients (n = 1,006) were analyzed and 586 (58%) patients were disembarked or evacuated. Factors associated with disembarkation or evacuation are wound characteristics (severity and location), the onboard staff's medical training, the availability of photography, and the ship's location. Wound severity is a risk factor for disembarkation or evacuation. The availability of photography, staff with advanced training, and being at >1 day of navigation from a harbor are protective factors against being disembarked or evacuated. Conclusion: The added value of photography and an update of medium medical training could increase the number of wounds taken care of onboard.

The usefulness and practicality of the International Medical Guide for Ships.

BACKGROUND: The third edition of the International Medical Guide for Ships (IMGS) was published in 2007 and supported a main principle of the newly adopted International Maritime Labour Convention (MLC) 2006: to ensure that seafarers are given health protection and medical care as comparable as possible to that which is available to workers ashore. In 2021, the revisions and drafting of the fourth edition of the IMGS began. Taking the COVID-19 pandemic into consideration, it was decided that a stakeholder study was necessary to ascertain the usefulness and practicality of the guide as well as provide input for which new topics to include. MATERIALS AND METHODS: The study applied data triangulation, with respondents from a geographically broad sample of the International Maritime Organization's five regional areas of the world. The data was analysed using thematic analysis. RESULTS: The results show that the IMGS is widely known and used among persons involved in medical care on board ships, but the IMGS is not as practical as stakeholders would wish it to be. For the guide to be useful, it must be ensured that telemedical advice information is included and if possible, ensure there is one single and global medical guide. Also, there is a need for new medical information, and respondents pointed to pandemic information, medicines list, medical chest, mental health issues, a women's section, updated cardiopulmonary resuscitation instructions, human immune defect virus information (human immune defect-virus) and information on how seafarers may self-monitor and be monitored on board in relation to chronic diseases. CONCLUSIONS: Respondents understand a medicine chest on board is mandatory according to the MLC 2006, 98% are familiar with its content, and 86% use the IMGS.

The Effects of Individual Characteristics of the Naval Personnel on Sleepiness and Stress during Two Different Watchkeeping Schedules.

BACKGROUND: Naval service can have a significant impact on the wellbeing of seafarers, and the operation of warships is highly dependent on the personnel on board. Nevertheless, there is a lack of knowledge concerning the impact of seafarers' individual characteristics on their wellbeing in a naval environment. Therefore, the aim of this study was to investigate individual characteristics of the naval personnel that may be associated with the amount of sleepiness, fatigue and stress responses experienced during shift work and irregular working hours in a naval environment. METHODS: The study took place on a Finnish Defence Forces' Navy missile patrol boat on which 18 crewmembers served as study participants. The measurement periods lasted two separate weeks (seven days and six nights) during shift work with two different watchkeeping systems (4:4, 4:4/6:6). The onboard measurements consisted of the Karolinska Sleepiness Scale, salivary stress hormones, cognitive tests (Sustained Attention to Response Task and N-back Task) and heart rate variability. RESULTS: Participants of older ages or with a longer history in naval service were associated with a greater amount of sleepiness, fatigue and stress responses on board. On the contrary, increased physical activity and a higher level of physical fitness, especially standing long jump, were associated with a lower amount of sleepiness, fatigue and fewer stress responses. In addition, an athletic body composition together with a healthy lifestyle may be beneficial, considering the stress responses on board. CONCLUSION: The present results are well in line with the previous literature regarding shift work and irregular working hours. The results highlight the importance of regular physical activity and good physical fitness during service in the naval environment.

Medical treatment of seafarers in the Southern Indian Ocean - interaction between the French Telemedical Maritime Assistance Service (TMAS) and the medical bases of the French Southern and Antarctic Lands (TAAF).

BACKGROUND: The waters surrounding the French Southern Lands are a fishing zone, accessible only by sailing for several days in a region where weather conditions are often difficult. The scientific bases of the region have medical staff whose services can be called upon if seafarers require assessment and rapid medical treatment. We conducted an epidemiological study of the maritime teleconsultations carried out by the French Telemedical Maritime Assistance Service (TMAS), where patients navigating in the Southern Indian Ocean zone were advised to disembark on the medical bases in the French Southern Lands, between 2015 and 2020, to receive medical treatment. MATERIALS AND METHODS: We extracted data from all of the maritime records from 1 January 2015 to 31 December 2020 relating to patients who attended a maritime teleconsultation with a French TMAS doctor in the Southern Indian Ocean zone and who had been redirected to the medical bases in the French Southern Lands. Data were collected on the patients' age, gender, nationality, rank, type of vessel, teleconsultation diagnosis, patient management on board and in the French Southern Lands medical bases, as well as the medical outcome. We carried out a descriptive data analysis. RESULTS: French TMAS doctors managed 11,908 cases including 76 in the Southern Indian Ocean zone (0.6%). Nineteen (25%) patients were redirected to the French Southern Lands over the study period. Eighteen patients were men with an average age of 45 ± 10 years. Eighteen patients were on board a trawler and 11 of them were sailors. Nine patients were treated for a trauma-related condition, 8 for a medical condition and 2 for a surgical disease. Eleven (58%) patients were evacuated to Reunion Island and 8 (42%) patients received medical treatment and were able to re-embark aboard their vessel. CONCLUSIONS: Relatively few patients are redirected to the French Southern Lands for medical assistance, but referrals occur on a regular basis. The presence of these medical bases is unusual in a maritime setting, but they can be a valuable asset when maritime medical assistance is required in this region. The type of condition encountered, and the patient profile, were typical of the fishing community. The presence of these bases and communication between the various stakeholders delivering maritime medical assistance provided these patients with optimal care despite their isolated location.

Self-medication practices among seafarers: a bibliometric review.

Self-medication could be a public health concern if done inappropriately, and additional research is required to better comprehend the population-wide nature of the problem. Seafarers are more inclined to self-medicate due to the nature of their work. We performed a rapid bibliometric analysis to determine the volume of research on self-medication habits among seafarers. Our analysis revealed a major knowledge gap regarding self-medication practices among seafarers. There is an urgent need to address this paucity of data and formulate appropriate interventions.