Overweight among seafarers working on board merchant ships.

BACKGROUND: Obesity and overweight represent a relevant risk factor for seafarer's health. The frequency and distribution of overweight and obesity among seafarers working on board of Italian flag ships were studied. Analysis was made on occupational medicine files collected, in the frame of health surveillance inspections, between 2013 and 2016 from Centro Internazionale Radio Medico (CIRM). METHODS: The data of nationality, age, weight, height, blood glucose and blood pressure values obtained from 1155 seafarers were analyzed. Body mass index (BMI) values were calculated and compared with data reported for the general population of the same nationality of seafarers examined. RESULTS: BMI values revealed a tendency to overweight, whereas blood glucose and systolic blood pressure values were in general in the normal range. Approximtely 40% of subjects investigated were overweight, and more than the 10% of them were obese. Underweight was noticeable only in 1.22% of crew members and 0.34% of officers. The 0.52% of subjects investigated was diabetic, and 2.68% were hypertensive. Seafarers, regardless their nationality and rank, showed a greater tendency to overweight and obesity compared with general population of the same ethnicity. CONCLUSIONS: Due to the occurrence of overweight and obesity among seafarers, campaigns for promoting awareness of the phenomenon and on the danger of these conditions for health should be promoted. Specific initiatives to avoid the assumption of junk food and the organization of adequate spaces, times and programs for physical exercise sessions on board should be offered for keeping seafarers healthier.

Metabolic syndrome, hypertension, and nervous system injury: Epidemiological correlates.

Metabolic syndrome (MetS) is a common and complex disorder combining hypertension, obesity, dyslipidemia, and insulin resistance. MetS represents a risk factor for changes in cognitive functions in older age, and several studies have suggested that MetS may be linked to dementia. This article reviews the main evidences about the relationship between MetS and neurodegenerative disease. Starting from an epidemiological point of view, the article analyzes medico-social aspects related to MetS, considering the reduction of work capacity and the condition of disability that it involves. Some authors affirm that on the basis of current Italian legislation, it is possible to consider the syndrome as a disability. This is because all the diseases that make up MetS are high-risk clinical pathological conditions. For these reasons, a joint action is required to contain the incidence of MetS, the high social costs, and the loss of productivity related to the syndrome. In conclusion, healthcare initiatives could be adopted in order to increase the understanding of the pathogenic contributions of each element on MetS and how they can be modified. These actions will be useful to reduce healthcare costs and can lead to more effective prevention of metabolic disease, thus promoting good health. ABBREVIATIONS: MetS: Metabolic syndrome; WHO: World Health Organization; CVD: cerebrovascular diseases; AD: Alzheimer's Disease; VaD: Vascular Dementia; IDF: International Diabetes Federation; T2DM: type 2 diabetes mellitus; CAD: coronary artery disease; MCI: mild cognitive impairment; NCDs: Non Communicable Diseases; BMI: Body Mass Index; ICIDH: International classification of impairments, disabilities and handicaps.

Medical assistance at the sea: legal and medico-legal problems.

BACKGROUND: In case of pathologies or accidents on board which require medical intervention but lacking on-board medical or paramedical personnel, the ship's captain, or his delegate can contact a Telemedical Maritime Assistance Service (TMAS). International Maritime Organisation considers telemedicine at sea as an integral part of rescue procedures. Five key elements contribute to the delivery of good medical assistance at sea: one or more coordination and rescue centres; the TMAS; the possibility of intervention at sea; an organisation of appropriate institutions on ground and common operating procedures. This paper analyses the responsibility of the ship's captain and of the TMAS doctor in case of diseases or injuries on board in the frame of the main important international regulations. RESPONSIBILITY OF THE SHIP CAPTAIN: In case of a disease or injury on board a ship, the captain must contact the TMAS as soon as possible. A captain not acting promptly and not doing whatever it is possible for the ill/injured person by consulting the TMAS or a physician and/or not following prescriptions received, could be charged for omission of responsibility. A captain underestimating a medical problem and knowing that the patient's condition could worsen, but still not consulting a medical centre for assistance, should be ready to accept the consequences of his choices. RESPONSIBILITY OF THE PHYSICIAN: The doctor of TMAS has full responsibility for the diagnosis, prescription and treatment, while the ship's captain is responsible for the final decision. Regarding the medical treatment and assistance on board a ship, the TMAS doctor should pay attention not only for the diagnosis, but also for the prognosis. Telemedicine implies that the doctor should make decisions without a clinical examination, often without some additional medical examinations and by maintaining a contact with other people who are in direct contact with the patient. The physician usually has to rely on the account of colleagues of the sick seafarer as far as medical history is concerned. This may make harder to take a decision. CONCLUSIONS: The ship's captain is guilty if he fails to contact a TMAS in case of diseases or accidents on board. Similar to a traditional relationship between a patient and a physician, the doctor consulted via telecommunication systems is also responsible for his diagnosis and treatment. However, in telemedicine the contrasts with the most basic principles of the traditional medicine are obvious. This makes the delivery of medical care of seafarers on board ships quite complicated.