Injury, illness, and disability risk in American seafarers.

BACKGROUND: Seafarers are an understudied and essential workforce, isolated from medical care. This study describes injuries, illness, and risk factors for resultant disability in one shipping company with a majority of American seafarers. METHODS: The study used a telemedicine database of injury and illness incidence in seafarers, and applied descriptive statistical methods and logistic regression modeling. RESULTS: Illnesses were more frequently reported than injuries (860 vs 479). The overall injury rate was 113 per 1000 person-years, and the overall illness rate was 211 per 1000 person-years. Seafarer ratings had higher risk for disability compared to officers (OR = 1.60; 95%CI 1.17, 2.18), and incidents on dry cargo ships (OR = 2.70; 95%CI 1.49, 4.91) and articulated tug-barges (ATBs) (OR = 2.21; 95%CI 1.26, 3.86) had higher disability risk compared to container vessels. CONCLUSION: Additional research in this vital American workforce may be useful to confirm these findings forming a basis for preventive interventions.

"Injury, illness, and work restriction in merchant seafarers".

BACKGROUND: Research on seafarer medical conditions at sea is limited. This study describes the frequency and distribution of seafarer injury and illness at sea, and explores potential risk factors for resultant lost work. MATERIALS AND METHODS: The study analyzed a telemedicine database of 3,921 seafarer medical cases between 2008 and 2011 using descriptive statistics and logistic regression. RESULTS: There were over twice as many illness cases (n = 2,764, 70.5%) as injury (n = 1,157, 29.5%) cases. Disability was more often secondary to illness (n = 646, 54.3%), predominantly from gastrointestinal, dermatologic, and respiratory conditions. Logistic regression revealed age, rank, and worksite as potential risk factors for lost work. CONCLUSIONS: This study emphasizes illness as a significant problem occurring in seafarers at sea. Future research should further elucidate risk factors for illness, as well as injury, to inform preventive measures and reduce seafarer disability.

Reality bites: a case of severe rattlesnake envenomation.

Rattlesnake venoms can cause a wide range of adverse human health effects. However, with the availability of modern antivenin, toxicity can generally be minimized and controlled. We present a rare case of rattlesnake envenomation resulting in severe systemic effects and syndrome relapse. Management considerations and patient course are described in the context of the current literature.

Injury, Illness, and Mental Health Risks in United States Domestic Mariners.

OBJECTIVE: Describe health conditions and injury and illness rates in a population of United States mariners, an understudied workforce vital to economic security. METHODS: In this survey study, mariner health data was collected and analyzed to provide injury and illness rates (including mental health conditions) and associated risk factors. RESULTS: In this mariner population of highly tenured vessel masters and pilots, hypertension, obesity, sleep disorders, smoking, alcohol consumption, and symptoms of depression and anxiety were common. BMI ≥35 was associated with increased likelihood of work injury (OR 5.7; 95%CI 1.01, 32.59). CONCLUSIONS: The mariners were in poor overall health, raising public health and safety concerns in this population of essential transportation workers. Follow-up studies including a wider distribution of domestic mariners (deck hands, engineers) would further characterize occupational risks.

Paederus dermatitis in a seafarer diagnosed via telemedicine collaboration.

Seafarers are traveling workers, subject to unique exposures and generally isolated from adequate medical care. This case report of paederus dermatitis diagnosed at sea highlights the importance of a multidisciplinary diagnostic approach and telecommunication in providing remote medical advice to isolated traveling workers such as seafarers.

Risk factors for merchant seafarer repatriation due to injury or illness at sea.

BACKGROUND: Repatriation represents a serious outcome of illness or injury among seafarers at sea. The aim of this study was to describe repatriation patterns due to injury and illness in a seafarer cohort, and determine risk factors for repatriation. MATERIALS AND METHODS: The study analysed a telemedicine database of 3,921 seafarer injury and illness cases over a 4 year period using descriptive statistics and logistic regression. RESULTS: There were 61 repatriations over the study period (1.6% of cases). Most repatriations were due to illness (38; 62.3%) as opposed to injury (23; 37.7%). Back injuries and gastrointestinal illness were the most frequent causes of repatriations. Using logistic regression, nationality was identified as a significant risk factor for repatriation. CONCLUSIONS: This study emphasizes illness as a major cause of seafarer repatriation, and suggests opportunities for future studies to identify potentially modifiable risk factors.

Critical role for the alpha-1B adrenergic receptor at the sympathetic neuroeffector junction.

The alpha-1 adrenergic receptors (alpha(1)ARs) are critical in sympathetically mediated vasoconstriction. The specific role of each alpha(1)AR subtype in regulating vasoconstriction remains highly controversial. Limited pharmacological studies suggest that differential alpha(1)AR responses may be the result of differential activation of junctional versus extrajunctional receptors. We tested the hypothesis that the alpha(1B)AR subtype is critical in mediating sympathetic junctional neurotransmission. We measured in vivo integrated cardiovascular responses to a hypotensive stimulus (induced via transient bilateral carotid occlusion [TBCO]) in alpha(1B)AR knockout (KO) mice and their wild-type (WT) littermates. In WT mice, after dissection of the carotid arteries and denervation of aortic baroreceptor buffering nerves, TBCO produced significant pressor and positive inotropic effects. Both responses were markedly attenuated in alpha(1B)AR KO mice (change systolic blood pressure 46+/-8 versus 11+/-2 mm Hg; percentage change in the end-systolic pressure-volume relationship [ESPVR] 36+/-7% versus 12+/-2%; WT versus KO; P<0.003). In vitro alpha(1)AR mesenteric microvascular contractile responses to endogenous norepinephrine (NE; elicited by electrical field stimulation 10 Hz) was markedly depressed in alpha(1B)AR KO mice compared with WT (12.4+/-1.7% versus 21.5+/-1.2%; P<0.001). In contrast, responses to exogenous NE were similar in alpha(1B)AR KO and WT mice (22.4+/-7.3% versus 33.4+/-4.3%; NS). Collectively, these results demonstrate a critical role for the alpha(1B)AR in baroreceptor-mediated adrenergic signaling at the vascular neuroeffector junction. Moreover, alpha(1B)ARs modulate inotropic responses to baroreceptor activation. The critical role for alpha(1B)AR in neuroeffector regulation of vascular tone and myocardial contractility has profound clinical implications for designing therapies for orthostatic intolerance.