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

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

Estimating the risk of outbreaks of COVID-19 associated with shore leave by merchant ship crews: simulation studies for New Zealand.

AIM: We aimed to estimate the risk of COVID-19 outbreaks in a COVID-19-free destination country (New Zealand) associated with shore leave by merchant ship crews who were infected prior to their departure or on their ship. METHODS: We used a stochastic version of the SEIR model CovidSIM v1.1 designed specifically for COVID-19. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics and plausible control measures. RESULTS: When no control interventions were in place, we estimated that an outbreak of COVID-19 in New Zealand would occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1,000 population per week, crews of 20 with a voyage length of 10 days and 1 day of shore leave per crew member both in New Zealand and abroad, and 108 port visits by international merchant ships per week). For this example, the uncertainty around when outbreaks occur is wide (an outbreak occurs with 95% probability between 1 and 124 days). The combination of PCR testing on arrival, self-reporting of symptoms with contact tracing and mask use during shore leave increased this median time to 1.0 year (14 days to 5.4 years, or a 49% probability within a year). Scenario analyses found that onboard infection chains could persist for well over 4 weeks, even with crews of only 5 members. CONCLUSION: This modelling work suggests that the introduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. But the risk can be substantially mitigated by control measures such as PCR testing and mask use.

Temporal trends in the healthy soldier effect in a cohort of Royal Norwegian Navy servicemen followed for 67 years.

OBJECTIVES: To investigate temporal trends in the 'healthy soldier effect' (HSE) among 28 300 Royal Norwegian Navy servicemen who served during 1950-2004. METHODS: Standardised mortality ratios (SMRs) for all causes, diseases and external causes were calculated from national rates for the entire study period (1951-2017), and for seven successive follow-up periods after the first recorded day of Naval service, for the overall cohort and for two subgroups: land-based personnel and vessel crews. Poisson regression, expressed as rate ratios, was used to compare all-cause mortality between the subgroups. RESULTS: In the overall cohort, SMRs for all-cause mortality increased steadily during the first six 10-year follow-up periods, from 0.52 to 0.94, which was still lower than national rates. After 60 years, the lower mortality compared with national rates was no longer statistically significant (SMR=0.93). Low non-neoplastic disease mortality contributed most to the longevity of the HSE. For neoplastic diseases, there was a mortality deficit only for the first and third 10-year follow-up periods. External-cause mortality rose to national rates after 40 years. An HSE was present among vessel crews, but their total mortality rate was 24% higher than that among land-based personnel, who also showed a longer-lasting HSE. CONCLUSIONS: The HSE eroded gradually over time but was still present at 60 years of follow-up for all-cause mortality. The effect was strongest and most long-lived for non-neoplastic disease, lasted up to 40 years for external causes, and was relatively short for cancers. Land-based personnel showed stronger and longer-lasting HSE than vessel crews.

Hematologic malignancy in tanker crewmembers: A case-referent study among male Swedish seafarers.

BACKGROUND: Work on Swedish petroleum tankers before the late 1980s has been associated with an increased risk of hematologic malignancy (HM). Since then, ship modernizations have decreased occupational exposure to gases, including the carcinogen benzene. We explored the risk of HMs in Swedish seafarers who had worked on newer types of tankers. METHODS: A case-referent study in male seafarers from a cohort of all Swedish seafarers was set up by record linkage with the Swedish Cancer Registry using the subjects' personal identification number. For each case (N = 315), five referents were randomly chosen from within the cohort, matched by birth year and three different periods of first sea service (<1985, 1985-1991, and ≥1992). Information on the type of ship and dates of service was retrieved from the Swedish Seafarers' Registry. Odds ratios (OR) were calculated by conditional logistic regression together with 95% confidence intervals (CI). RESULTS: The OR of HM was 1.07 (95% CI, 0.80-1.42) for work on tankers. In seafarers that had started to work on tankers ≥1985, the OR was 0.85 (95% CI, 0.50-1.43). For those who started to work on tankers before 1985, the OR was 1.17 (95% CI, 0.84-1.21) and 1.32 (95% CI, 0.86-2.03) if the cumulative time on tankers exceeded 5 years of service. In this last group, the OR of multiple myeloma was 5.39 (95% CI, 1.11-26.1). CONCLUSION: Although limited by crude exposure contrast and a short follow-up, work on tankers after 1985 was not associated with an increased risk of HM among Swedish seafarers.

COVID-19: in the footsteps of Ernest Shackleton.

We describe what we believe is the first instance of complete COVID-19 testing of all passengers and crew on an isolated cruise ship during the current COVID-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription-PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.

Suicide, fatal injuries and drowning among the crews of United Kingdom and Bermuda registered cruise and passenger ships from 1976 to 2018.

BACKGROUND: Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures. MATERIALS AND METHODS: A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches. RESULTS: One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans. CONCLUSIONS: The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.

Assessing Surgical Task Load and Performance: A Comparison of Simulation and Maritime Operation.

INTRODUCTION: This study examined the effects of simulated and actual vessel motion at high seas on task load and surgical performance. METHODS: This project was performed in phases. Phase I was a feasibility study. Phase II utilized a motion base simulator to replicate vessel motion. Phase III was conducted aboard the U.S. Naval Ship Brunswick. After performing surgical tasks on a surgical simulation mannequin, participants completed the Surgical Task Load Index (TLX) designed to collect workload data. Simulated surgeries were evaluated by subject matter experts. RESULTS: TLX scores were higher in Phase III than Phase II, particularly at higher sea states. Surgical performance was not significantly different between Phase II (84%) and Phase III (89%). Simulated motions were comparable in both phases. CONCLUSIONS: Simulated motion was not associated with a significant difference in surgical performance or deck motion, suggesting that this simulator replicates the conditions experienced during surgery at sea on the U.S. Naval Ship Brunswick. However, Surgical TLX scores were dramatically different between the two phases, suggesting increased workload at sea, which may be the result of time at sea, the stress of travel, or other factors. Surgical performance was not affected by sea state in either phase.

Cancer incidence among seafarers and fishermen in the Nordic countries.

Objectives Maritime workers may be exposed to several occupational hazards at sea. The aim of this study was to assess cancer incidence among seafarers and fishermen in the Nordic countries and identify patterns in morbidity in the context of existing studies in this field. Methods A cohort of 81 740 male seafarers and 66 926 male fishermen was established from census data on 15 million citizens in the five Nordic countries. Using personal identity codes, information on vital status and cancer was linked to members of the cohort from the national population and cancer registries for the follow-up period 1961-2005. Standardized incidence ratios (SIR) were calculated applying national cancer incidence rates for each country and pooling results. Results The overall incidence of cancer was increased among the male seafarers [SIR 1.22, 95% confidence interval (CI) 1.19-1.23]. Significant excesses were observed for multiple cancer sites among the seafarers, while results for the fishermen were mixed. Lip cancer incidence was increased among both maritime populations. For mesothelioma (SIR 2.17, 95% CI 1.83-2.56 seafarers) and non-melanoma skin cancer (SIR 1.23, 95% CI 1.14-1.32 seafarers), incidence was increased among the seafarers. Conclusion In our cohort, seafaring was associated with a higher overall incidence of cancer compared to the general population. While the majority of cancers could not be linked to specific occupational factors, increases in mesothelioma, lip and non-melanoma-skin cancer indicate previous exposure to asbestos, ultraviolet radiation and potentially also chemicals with dermal carcinogenic properties at sea.

Prevalence of alcohol consumption among seafarers and fishermen.

BACKGROUND: Over the decades, several published studies showing the relevance of alcohol use among seafarers/fishermen have highlighted the dangers of alcohol consumption during working time. The present study aims to provide an up-to-date overview of the prevalence of alcohol consumption among seafarers/fishermen. It also points out their consumption behaviour, depending on socio-demographic and job-related factors. MATERIALS AND METHODS: To detect relevant studies for this systematic review, the electronic database PubMed was searched. All identified studies published between January 2014 and September 2019 were included using the subsequent terms: (alcohol OR ethanol) AND (seafarer OR fishermen OR ship crew OR merchant ship). RESULTS: According to the applied search string, 18 studies were identified. Thirteen of them were selected for this review. The results of the studies about alcohol consumption among seafarers and fishermen showed a wide range of prevalence, from 11.5% to 89.5% (median 53.0%). Concerning seafarers no stratified data were available for further analyses. Among fishermen alcohol consumption has decreased over the period examined (56.9% [2010-2014] vs. 42.3% [2015-2018]). The evaluation of socio-demographic factors showed alcohol consumption was less prevalent in fishermen > 60 years (15.0%). Furthermore, a higher prevalence of alcohol intake was found in those with a lower education (63.9%). In respect of job-related data, 61.0% of the alcohol consuming fishermen reported they had been involved in an accident due to alcohol consumption. CONCLUSIONS: The consumption of alcohol among fishermen has declined over time. Compared with the landbased European population, seafarers and fishermen show a lower prevalence of alcohol use, at least during their stay on board. Due to the limited data available - especially concerning seafarers - further studies on the prevalence of alcohol consumption among shipboard crews are recommended. In particular, these should provide more data on alcohol consumption related to socio-demographic and job-related factors.

Epidemiology of physician interventions in maritime environment by the Marseille Fire Brigade (BMPM) from 2005 to 2017.

BACKGROUND: Marseille is the second largest city in France. The Marseille Fire Brigade (BMPM) is the largestunity of the French Navy. This organization is in charge of rescue operations and medical intervention in theMarseille area. The aim of the study was to describe the epidemiology of interventions that required a physicianto be present that were performed by the BMPM between the years of 2005 to 2017. MATERIALS AND METHODS: The statistical office database of the BMPM and the medical interventions forms (FIM)acquired from the BMPM medical ambulances (SMUR) archives were analysed from the years 2005 to 2017. RESULTS: The BMPM performed a total of 2,375 interventions in the maritime environment between 2005and 2017. A physician was necessary for intervention a total of 186 times. The extraction and analysisreports of 107 medical intervention forms found the BMPM archives revealed a significant number ofinterventions (67%) in the southern bay of Marseille and Frioul, specifically from the If and Planier islands.The majority of interventions (77%) took place within the 300m band. The most common cause of medicalintervention was due to an accidental fall into the water, followed by boating (sailing and motor), and swimming.Drowning was the most common cause of mortality, consisting of 34% of all interventions. Divingaccidents represented 14% of interventions. Trauma affected 22% of the study population and 83% oftrauma patients were transported to the hospital under the supervision of a physician. CONCLUSIONS: Potential areas for improvement in the management of drowning victims are the use ofSzpilman's classification, sonography, and non-invasive ventilation. A recertification course for medicaleducation training of BMPM doctors on the management of diving accidents could help to optimize theinformation recorded on FIM. Accident prevention training should be continued and reinforced when itcomes to maritime activities.

Fatal and serious injuries on board merchant cargo ships.

BACKGROUND: Merchant seafaring is one the most dangerous occupation over the world which hosts the physical, ergonomic, chemical, biological, psychological and social elements, which could lead to occupa- tional accidents, injuries and diseases. Therefore, it is a field that should be studied on meticulously and frequently. The aim of this study is to investigate the frequency, circumstances, and causes of occupational accidents on board merchant cargo ships and to identify the risks factors during the daily routine works and dangerous works to be fulfilled. MATERIALS AND METHODS: Data used in this study obtained various occupational accident reports issued by countries' accident investigation units or maritime authorities such as Marine Accident Investigation Branch (MAIB), Marine Safety Investigation Unit (MSIU) and Australian Transport Safety Bureau (ATSB). A total of 331 reports met the inclusion criteria for the 11-year period from 2006 to 2016. Descriptive statistics were given related to data and chi-square analysis was used to test for significant association between categorical variables (seafarer's age, accident type and etc.) and injury severity. RESULTS: Several findings were notable in this study. Ratings (63.5%) were the most affected group suffe- red from occupational injuries among the crew and the most critical cause of occupational accidents was found the dangerous work practices and ignorance of rules and instructions. CONCLUSIONS: Occupational accidents are still crucial concern in maritime industry which imposes a major burden on both seafarers and shipping companies. Reduction in occupational injuries could be achieved by improving the working environment and the quality of life on board, mitigating the mental and physical burden of work and developing policies to encourage the seafarers to obey safety rules and instructions.

Crew and passenger deaths from vessel accidents in United Kingdom passenger ships since 1900.

BACKGROUND: There is very limited systematic analysis of the causes and consequences of maritime accidents across the whole passenger sector during the twentieth century either in United Kingdom (UK) or in other maritime nations, but some of the larger events have been the subject of detailed investigations that led to improved safety measures. In recent years, there has been increased attention to the analysis of passenger ship accidents, especially in relation to the two now dominant markets: vehicle/passenger ferries and cruise ships. MATERIALS AND METHODS: Long-term trends since 1900 in passenger and crew deaths on UK seagoing pas- senger ships that have sustained a maritime accident, as defined by Lloyds Register, have been collated and analysed. RESULTS: Over the course of the 20th century, there has been a continuous fall in the number of incidents and in their severity. This may be a reflection of improved vessel safety, however the scale and nature of UK passenger shipping has also changed markedly over the period. CONCLUSIONS: In addition to the reducing frequency of deaths it is apparent that the majority of fatalities in both crew and passengers came from a very small number of major events during the study period. Altho- ugh there has been no major disaster involving a UK passenger ship in the last 30 years, major casualties with heavy loss of life continue in the world passenger fleet, in recent years involving flags such as Greece, Indonesia, Italy, Panama and The Philippines.

Request for professional medical aid on board ocean-going ships in the Republic of Croatia.

Despite modern ship technologies, high-quality crew accommodation and exceptional communications, the absence of a doctor on board presents an issue in terms of the timely, adequate and efficient response to acute health disorders and life-threatening injuries. A serious health condition of an injured or sick person, insufficient medical knowledge of the on-board officers, inadequately equipped ship's infirmary, or scarce supply of medicines are among the typical reasons for requesting professional shore-based medical assistance. This can be achieved by requesting Radio Medical Advice or by activating air-borne medical assistance, i.e. bringing a doctor by helicopter or by Medical Evacuation, i.e. transferring the ill or injured person to the shore medical institution. The Maritime Telemedical Assistance Services are available across the world. They use all the technical possibilities available, including e-mails and very widely used photo and video attachments as well as the emergency real-time live videos. In on-board practice, the most common solution is to use medical advice over the radio (through terrestrial or satellite networks). This paper discusses the ways of requesting professional medical advice or aid on board ocean-going merchant ships in the Republic of Croatia.

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.

The complexity of human performance variability on watch standing task.

The primary objective of this study was to examine the complexity of human temporal variability of topside roving watch task in naval operations concerning the reported times of ship status and to explore the potential presence of chaotic behavior and fractal properties of the reported log times. Topside rover reporting time intervals recorded in the deck logs of the USS Jason Dunham over the 2013-2015 period were analyzed to understand the underlying complexity of the watch standing task that is critical to the success of naval operations. The results on the 0-1 test, analysis of the largest Lyapunov exponents, as well the exploration of the fractal dimension and 1/f spectral analyses, showed that the fluctuation of standing watch time reports data exhibits chaotic and fractal system properties. The critical implications of the study findings for the human-centered design of complex systems were also discussed.

Turkish Telemedical Assistance Service: last four years of activity.

BACKGROUND: Telemedical Assistance Service (TMAS) is very important for seafarers and passengers who are far from full-fledged health services. This study aimed to determine the frequency of using Turkish TMAS by seafarers and other patients and to compare the given services. MATERIALS AND METHODS: The data obtained from calls to Turkish TMAS in between 2014 and 2017 are composed of 5080 calls. In the study, they were examined in two groups as calls regarding seafarers and other patients. Also, the diseases or injuries related to these calls were evaluated in 22 main groups according to ICD-10 code. All of these cases were analysed by using descriptive statistics according to types of callers, type of diseases, types of given services and methods of contacts. RESULTS: There were 5080 contacts to Turkish TMAS from January 2014 to December 2017. Contacts were 92.3% for seafarers and 7.7% for other patients. The most common reason of contacts was similar for both seafarers and other patients and it was injury and poisoning situations. While the most common service given to seafarers was giving a medicine or other treatment, the most common service given to other patients was medical evacuation. CONCLUSIONS: This study laid weight on diseases or injuries of seafarers and other patients at sea. According to this situation, TMAS can improve and maintain its service quality and also in the light of the findings, a guide for seafarers and other patients can be prepared in order to lessen such diseases and injuries.

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.

Physical Therapists Forward Deployed on Aircraft Carriers: A Retrospective Look at a Decade of Service.

Introduction: Navy physical therapists (PTs) have been a part of ship's company aboard Aircraft Carriers since 2002 due to musculoskeletal injuries being the number one cause of lost duty time and disability. This article describes a decade of physical therapy services provided aboard aircraft carriers. Materials and Methods: A retrospective survey was conducted to evaluate the types of services provided, volume of workload, value of services provided, and impact of PTs on operational readiness for personnel aboard Naval aircraft carriers. Thirty-four reports documenting workload from PTs stationed onboard aircraft carriers were collected during the first decade of permanent PT assignment to aircraft carriers. Results: This report quantifies a 10-yr period of physical therapy services (PT and PT Technician) in providing musculoskeletal care within the carrier strike group and adds to existing literature demonstrating a high demand for musculoskeletal care in operational platforms. A collective total of 144,211 encounters were reported during the 10-yr period. The number of initial evaluations performed by the PT averaged 1,448 per assigned tour. The average number of follow-up appointments performed by the PT per tour was 1,440. The average number of treatment appointments per tour provided by the PT and PT technician combined was 1,888. The average number of visits per patient, including the initial evaluation, was 3.3. Sixty-five percent (65%) of the workload occurred while deployed or out to sea during training periods. It was estimated that 213 medical evacuations were averted over the 10-yr period. There were no reports of adverse events or quality of care reviews related to the care provided by the PT and/or PT technician. Access to early PT intervention aboard aircraft carriers was associated with a better utilization ratio (lower average number of visits per condition) than has been reported in prior studies and suggests an effective utilization of medical personnel resources. Conclusions: The impact of Navy PTs serving afloat highlights the importance of sustaining these billets and indicates the potential benefit of additional billet establishment to support operational platforms with high volumes of musculoskeletal injury. Access to early PT intervention can prevent and rehabilitate injuries among operational forces, promote human performance optimization, increase readiness during war and peace time efforts, and accelerate rehabilitation from neuromusculoskeletal injuries. With the establishment of Electronic Health Records within all carrier medical groups a repeat study may provide additional detail related to musculoskeletal injuries to guide medical planners to staff sea-based operational platforms most effectively to care for the greatest source of battle and disease non-battle injuries and related disability in the military.

The epidemiology of operations performed by the National Sea Rescue Institute of South Africa over a 5-year period.

BACKGROUND: Injuries remain a major contributor of morbidity and mortality worldwide, with drowning accounting for 7% of all injury-related deaths with rates of between 4 and 8 per 100,000. The African region has death rates comparable to most low-income countries. Non-fatal drowning in Africa remains unquantified but it is estimated to be ten times higher than the fatal drowning rate. Timely search and rescue, initial resuscitation and rapid transportation to definitive care play a crucial role in preventing injury- related morbidity and mortality. The National Sea Rescue Institute (NSRI) of South Africa is a non-profit organisation responsible for ~97% of maritime search and rescue operations in South Africa (including inland navigable waters). The aim of the study was to describe the epidemiology of operations performed by the NSRI of South Africa over a 5-year period. MATERIALS AND METHODS: The NSRI operational database was analysed from 1 January 2010 to 31 December 2014. Summary statistics are presented. RESULTS: The NSRI launched 3281 operations over the study period. Marked seasonal variation were noticeable with peak periods in December and January, corresponding to the South African summer holiday season. Water-based operations (67.6%) were the most frequent operation performed. The NSRI assisted 3399 individuals of which 77% were male. The mean age of rescued persons was 42 years. Eight hundred and thirty-six (25%) individuals had non-fatal injuries or illnesses requiring medical assistance. Medical emergencies (35%), traumatic injuries (32.8%), and non-fatal drownings (23%) were the most common types of injury and illness. The majority of the 184 (18%) deaths recorded were due to drowning (75%). CONCLUSIONS: Injury and illness, specifically drowning utilise a large proportion of search and rescue services. The results suggest further preventative measures and public health strategies be implemented to minimise traumatic and medical incident severity and subsequent casualties at sea.

Benzodiazepine prescriptions on merchant ships without a doctor on board: analysis from medical records of Centro Internazionale Radio Medico (CIRM).

BACKGROUND: Benzodiazepines are drugs widely used for the treatment of anxiety and insomnia. The present study has analysed the prescriptions of this class of drugs among sailing seafarers, to evaluate the appropriateness of prescribed therapies. MATERIALS AND METHODS: This study assessed the benzodiazepine prescriptions made by Centro Internazionale Radio Medico (CIRM) doctors from 2011 to 2015. A total of 17,844 medical records were examined. Analysis considered the prescriptions of benzodiazepines in monotherapy, or in association with other drugs. Diagnoses of pathologies for which benzodiazepines were prescribed were made according to the ICD-10 classification system proposed by the World Health Organisation. RESULTS: Among medical records analysed, benzodiazepines were prescribed in 765 cases (3.29% of total cases assisted by CIRM). Benzodiazepines were prescribed as a single-drug treatment in 626 (81.83%) cases, whereas in 139 cases they were associated with other classes of drugs. In case of opioids prescribed in association with benzodiazepines, the drug used was codeine. This therapeutic association was prescribed in cases of severe pain. CONCLUSIONS: Although the "off label" use of benzodiazepines is not uncommon in medical practice, clear evidence indicates their potential side effects for human health. In this respect, medical professionals should comply with international guidelines on the use of benzodiazepines, both when prescribed as a single drug or in combination with other classes of drugs. These recommendations should be considered seriously in case of limited medical facilities such as on board of sailing ships.