The effective connectivity analysis of fMRI based on asymmetric detection of transfer brain entropy.

It is important to explore causal relationships in functional magnetic resonance imaging study. However, the traditional effective connectivity analysis method is easy to produce false causality, and the detection accuracy needs to be improved. In this paper, we introduce a novel functional magnetic resonance imaging effective connectivity method based on the asymmetry detection of transfer entropy, which quantifies the disparity in predictive information between forward and backward time, subsequently normalizing this disparity to establish a more precise criterion for detecting causal relationships while concurrently reducing computational complexity. Then, we evaluate the effectiveness of this method on the simulated data with different level of nonlinearity, and the results demonstrated that the proposed method outperforms others methods on the detection of both linear and nonlinear causal relationships, including Granger Causality, Partial Granger Causality, Kernel Granger Causality, Copula Granger Causality, and traditional transfer entropy. Furthermore, we applied it to study the effective connectivity of brain functional activities in seafarers. The results showed that there are significantly different causal relationships between different brain regions in seafarers compared with non-seafarers, such as Temporal lobe related to sound and auditory information processing, Hippocampus related to spatial navigation, Precuneus related to emotion processing as well as Supp_Motor_Area associated with motor control and coordination, which reflects the occupational specificity of brain function of seafarers.

[The actual issues of detection of risk factors and prevention of myocardium infarction in sailors].

In Russia, increases morbidity of myocardial infarction. The statistics of recent years demonstrate failure in meeting target indicators of national programs on reducing number of deaths from this disease. At that, able-bodied population is in high risk zone and their professional activity is under influence of large combination of risk factors of myocardial infarction. This risk area covers profession of seafarer that is characterized by irregular work schedule, high levels of stress and mental tension, low physical activity or, contrariwise, increased working loads, unbalanced diet, isotherm stress and interaction with harmful substances. Besides that, situation is aggravated by limited set of first medical aid measures at exacerbation of disease in view of remoteness from hospitalization centers. Thus, considering high mortality rate from myocardial infarction, it is extremely important for ship crews to have full and timely information about diagnostic, symptomatic and prevention of this disease. The article examines statistics data of morbidity and mortality of myocardial infarction in population of the Russian Federation on the basis of Rosstat data and target indicators of the National project "Health Care". The risk factors of myocardial infarction established by INTERHEART studies are analyzed. The specifics of work conditions of crew members of marine vessels are established. The collection of professional modifying risk factors was selected. The recommendations for their correction were developed to enhance efficiency of primary preventive measures and to decrease morbidity and mortality among seafarers.

Depressive symptoms among Thai male seafarers during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Prevalence of depressive symptoms among seafarers is higher than the general population because of their unique work conditions. Factors that can be changed must be considered and promptly addressed in order to decrease the prevalence of depression. This study aims to clarify the prevalence of depressive symptoms and its related factors among Thai seafarers in an effort to contribute to policies and to prevent depression among Thai seafarers. METHODS: This cross-sectional study was conducted among 381 male seafarers working onboard ocean-going vessels of five Thai shipping companies. The questionnaire items comprised of personal factors, working factors and depressive symptoms. Depressive symptoms were assessed using the Thai version of the Patient Health Questionnaire-9. First, the chi-square test was used for univariate analysis. Then, variables significantly associated by the chi-square test were used for multivariate logistic regression analysis (employing the stepwise method) as independent variables. RESULTS: The average age of participants in this study was 36.4 years. Prevalence of depressive symptoms was 19.5%. One half of the participants (58.3%) reported subjective sleep problems, and most (75.1%) experienced poor coping behaviors. Two thirds (67.5%) were officers, and 10.1% of participants reported that they sometimes or never performed occupational safety behaviors. Regarding work environments, 62.2% reported that their work was disturbed from performing repetitive tasks. Multivariate logistic regression analysis showed two personal factors; sleep problems (Adjusted Odds Ratio (AOR) = 7.97, 95% Confidence interval (CI) = 3.52-18.05) and poor coping behaviors (AOR = 4.46, 95%CI = 1.61-12.34), and three working factors; job assignment (AOR = 2.50, 95%CI = 1.33-4.70), inadequate occupational safety behaviors (AOR = 4.51, 95%CI = 1.85-11.01) and performing repetitive task (AOR = 2.27, 95%CI = 1.16-4.45), were significantly associated with depression. CONCLUSION: During COVID-19 pandemic, 19.5% of Thai male seafarers had depressive symptoms. Personal and working factors including subjective sleep problems, poor coping behaviors, job assignment, performing inadequate occupational safety behaviors and performing repetitive tasks were risk factors of depressive symptoms among Thai male seafarers. Monitoring work environment rigorously and coping with work-related stress of the occupational safety behaviors program should be suggested.

Are there differences between officers and ratings on merchant vessels concerning effort-reward imbalance: a cross-sectional maritime field study.

PURPOSE: Today, measures to economise in the operation of ships can cause either an effort-reward imbalance or health impairments. The goal of this study was to assess the risk of effort-reward imbalance including overcommitment among officers and ratings on merchant vessels during their assignments and to evaluate lifestyle factors of seafarers as well as the health-promoting conditions on board. METHODS: A study sample of 308 male seafarers was examined during a total of 20 sea voyages on German container ships (participation rate 91.9%). RESULTS: Only 11 seafarers were identified as having an increased health risk of an effort-reward imbalance (ER ratio > 1). Officers tended to have a higher risk of an elevated ratio than ratings (4.4% vs. 3.1%) and also showed a significantly higher risk of an ER ratio above the median (58.8% vs. 41.8%; p = 0.022). Compared to land-based populations, the average overcommitment score of seafarers was high (17.9)-particularly among officers (20.3 vs. 16.5; p = 0.031). This corresponded to an elevated risk of overcommitment among officers compared to ratings (OR 2.14; 95% CI 1.78-2.37). This elevated risk remained significant after adjustment for age (OR 2.11; 95% CI 1.76-2.35) and job-related stressors. CONCLUSION: Although an elevated risk of effort-reward imbalance was only observed in few seafarers, this study revealed a high prevalence of overcommitment particularly among officers. In the course of time, overcommitment can lead to mental exhaustion. Therefore, shipboard health-promoting conditions need to be optimised.

Mental health problems and their related factors among seafarers: a scoping review.

BACKGROUND: Seafarers are often reported to be engaged in a dangerous physical and psychosocial work environment. However, mental health status among seafarers has not been focused on compared with physical health issues. Systematic, comprehensive reviews of mental health problems and their relevant factors are lacking. This review aimed to clarify beneficial approaches to the mental health problems faced among seafarers using a scoping review to systematically map the evidence regarding mental health issues and their related factors. METHODS: Studies were searched on MEDLINE/PubMed, Science Direct, Academic search complete using EBSCOhost databases, SCOPUS, EMBASE, and Web of science on 20, August 2020. This scoping review was conducted based on the framework of Arksey and O'Malley and Preferred Reporting items for Scoping Reviews flow diagram. The inclusion criteria were studies which determined the relationship between factors relevant to working conditions or working environment, and mental health in seafarers, and etc. Data were narratively summarized and reported. RESULTS: Twenty-four were included in this review while two major findings were clarified. Firstly, the prevalence of stress, depressive symptoms, and burnout have been mentioned for decades. Secondly, factors related to mental health and psychological issues can be categorized as individual and work environmental factors. The individual factors include experience, age, health status (high BMI, poor sleep, and diabetics), and resilience. The work environmental factors consist of two parts. Job demands comprise pressure from contractors/customers/time, working hours, ship department, job title, voyage episodes, period of seafaring, noise, and vibration. The job resources included instrumental support, team cohesion, shipboard caring and effort-reward imbalance. CONCLUSIONS: A beneficial approach to mental health problems faced among seafarers is necessary to understand comprehensively at individual and organization levels. Promoting health behaviors, training resilience, and managing obesity and chronic diseases comprise individual level strategies. Providing seafarers with adequate instrumental support, and practical support to communicate with customers, managing their distinct work-rest hours and adequate effort-reward balance comprise organization level methods.

Cancer incidence in a cohort of Swedish merchant seafarers between 1985 and 2011.

PURPOSE: Lung cancer, mesothelioma and several lifestyle-associated cancer forms have been reported more common in merchant seafarers. However, few studies reflect recent occupational settings and women seafarers are usually too scarce for meaningful analyses. We conducted a study on cancer incidence between 1985 and 2011 in a Swedish cohort consisting of male and female seafarers. METHODS: All seafarers in the Swedish Seafarers' Register with at least one sea service between 1985 and 2011 and a cumulated sea service time of ≥ 30 days (N = 75,745; 64% men, 36% women; 1,245,691 person-years) were linked to the Swedish Cancer Register and followed-up until 31 December 2011. Standardized incidence ratios (SIR) were calculated with the general population as reference. RESULTS: There were 4159 cancer cases in total, with 3221 among men and 938 among women. Male seafarers had an increased risk of total cancer (SIR 1.05; 95% CI 1.01-1.09), lung cancer (SIR 1.51; 95% CI 1.35-1.67) and urinary bladder cancer (SIR 1.17; 95% CI 1.02-1.33). Several lifestyle-associated cancer forms were more common in men. Previous work on tankers was associated with leukaemia (SIR 1.41; 95% CI 1.00-1.86). The risk of cancer decreased with a start as a male seafarer after 1985, with a significant trend for total cancer (P < 0.001), lung cancer (P = 0.001) and, for tanker seafarers, leukaemia (P = 0.045). Women seafarers had an increased risk of lung cancer (SIR 1.54; 95% CI 1.23-1.87) but the risk of total cancer was not increased (SIR 0.83; 95% CI 0.78-0.89). CONCLUSIONS: In this cohort of merchant Swedish seafarers 1985-2011, the risk of total cancer was increased in men but not in women compared to the general population. Lung cancer was increased in both genders. The risk of cancer seems to decrease over the last decades, but better exposure assessments to occupational carcinogens and longer observation times are needed.

Work-family conflict and job stress among seafarers: the moderating role of job satisfaction.

Work-family conflict (WFC) is not only prevalent among seafarers but also may cause their job stress. The objective of this research is to investigate the relationship between WFC and job stress, examining the moderating role of job satisfaction, which plays in this relationship. A cross-sectional survey was conducted in Yangshan Port, Shanghai, China, from August to October 2019. Seafarers working on merchant vessels participated in the present study. Hierarchical linear regression analyses were employed to test the moderating role of job satisfaction. The results demonstrated that WFC was positively associated with job stress. Job satisfaction played a moderating role in the association of WFC with job stress. The findings show that job satisfaction was a crucial factor to reduce seafarers' job stress. Managers should therefore enhance organizational investment and support in job satisfaction to reduce seafarers' job stress.

The impact of 2008 financial crisis and COVID-19 pandemic on the demand and supply of seafarer officers: Evidence from China.

During the shipping market boom in the 2000s, China adopted initiatives to expand its maritime education and training (MET) capacity, which significantly increased the supply of seafarer officers in the next few years. Drawing on multiple types of statistical information, including MET enrolments, seafarer numbers, seafarer wages, and labour market analyses, this paper examines the outcomes of the initiatives in the aftermath of the 2008 financial crisis and the COVID-19 outbreak. It shows that the financial crisis together with the expanded training capacity led to a serious oversupply problem, characterised by a lack of job opportunities, depressed wages, and slow career progression for junior officers. When the situation improved in 2017, however, a shortage of junior officers ensued, and their number plummeted quickly. The recent COVID-19 pandemic increased the demand for Chinese officers. Nevertheless, the decline in the number of 3rd officers continued. This paper discusses the causes and policy implications of the quick reverse from an oversupply to an acute shortage.

Seafarers' mental health during the COVID-19 pandemic: An examination of current supportive measures and their perceived effectiveness.

As the current COVID-19 pandemic and the resulting crew change crisis exacerbates the mental health problem faced by seafarers, various maritime stakeholders have mobilised their resources and strengths to provide a variety of supportive measures to address the issue. This paper aims to find out what measures have been adopted in the industry and how widely they have been experienced/received by seafarers and evaluate their effectiveness. To achieve this aim, this research employed a mixed methods design involving qualitative interviews with 26 stakeholders and a quantitative questionnaire survey of 817 seafarers. The research identified a total number of 22 mental health support measures, all of which were perceived to have contributed positively to seafarers' mental health. However, not all of them were widely available to or utilised by seafarers. The findings also highlighted the importance of family, colleagues, shipping companies, and government agencies, as they are associated with the most effective support measures, namely communication with family, timely crew changes, being prioritised for vaccination, being vaccinated, and a positive and collegial atmosphere on-board. Based on the findings, recommendations are provided.

Can adopting skin cancer preventive behaviors among seafarers be increased via a theory-based mobile phone-based text message intervention? A randomized clinical trial.

BACKGROUND: One of the main occupational hazards for seafarers is the long exposure to sunlight. This study aimed to determine the efficacy of a mobile phone-based text message intervention in adopting skin cancer preventive behaviors among a sample of seafarers in Genaveh port located in Bushehr province, Iran. METHODS: In this randomized controlled trial, 136 seafarers were randomly selected and assigned to the intervention (n = 68) or a control groups (n = 68). As a theoretical basis, we followed the Protection Motivation Theory (PMT) variables to develop the text messages. The data related to PMT variables and skin cancer preventive behaviors were collected through a questionnaire. Forty-five text messages were designed, pre-tested and sent to the seafarers' phones in the intervention group in 45 days. Both groups were followed up 1 month after the intervention. Data collected in the two stages were analyzed using paired-samples t-test, ANCOVA, and Chi-square tests. RESULTS: Following the intervention, the mean scores of adopting skin cancer preventive behaviors (p = 0.001), perceived self-efficacy (p = 0.01), protection motivation (p = 0.02), and fear (p = 0.001) were significantly higher in the intervention group than the control group. There was significant reduction in the response costs (p = 0.05) and perceived rewards (p = 0.01) scores in the intervention group compared with the control group after the intervention. However, there were no significant differences in the perceived vulnerability (p = 0.14), perceived severity (p = 0.09), and response efficacy (p = 0.64) between the two groups after the intervention. CONCLUSIONS: The results of the study indicated the effectiveness of mobile phone-based text message intervention for increasing skin cancer preventive behaviors in Iranian seafarers. TRIAL REGISTRATION: Iranian Registry for Clinical Trial (the link to trial: https://www.irct.ir/trial/7572 ). Registered 16 July, 2016. Prospectively registered.

Long working hours, poor sleep quality, and work-family conflict: determinant factors of fatigue among Indonesian tugboat crewmembers.

BACKGROUND: Tugboat crewmembers are susceptible to fatigue during their 24-h work shifts, despite the availability of rest time. The fatigue experienced by seafarers contributes to marine accidents and metabolic and cardiovascular diseases, which have long-term effects. This study aimed to analyse the association between working hours and fatigue and other possibly related factors in tugboat crewmembers. METHOD: This comparative cross-sectional study included 127 tugboat crew members from 15 randomly chosen tugboats in Samarinda Harbor, Indonesia. Their fatigue levels while at work were measured using a reaction timer and standardised questionnaire. Personal and occupational data of crewmembers, including age, marital status, rating (job ranking), duration on board, length of seafaring experience, watch system, smoking status, coffee and alcohol consumption, and working hours, were collected. Moreover, sleep quality and stress levels related to work-family conflict were measured and analysed using the Pittsburgh Sleep Quality Index (PSQI) and Work-Family Conflict Scale (WCFS), respectively. RESULTS: The study found that 40.2% of the subjects were classified as having fatigue. The determinant factors were long working hours (> 72 h/week), poor sleep quality, and work-family conflict [adj. OR = 13.32; 95%-CI (4.78-31.23)] and p < 0.001, [adj. OR = 4.49 (1.39-14.52)] and p = 0.012, [adj. OR = 2.87 (1.12-7.33)] and p = 0.028, respectively. However, personal and occupational factors, including age, marital status, duration on board, length of seafaring experience, smoking status, and coffee and alcohol consumption, were not significantly associated with crewmember fatigue. CONCLUSION: The incidence of fatigue among Indonesian tugboat crewmembers operating on the Mahakam River was considerably high. Working hours, sleep quality, and work-family conflict were strongly associated with fatigue in tugboat crewmembers; therefore, the working hours of tugboat crewmembers need to be improved. Crewmember lifestyle variables need to be studied further.

Mortality from cardiovascular disease in a cohort of Swedish seafarers.

PURPOSE: The aim of this study was to investigate whether Swedish seafarers have increased mortality from cardiovascular disease compared with the general population. METHODS: Register-based longitudinal cohort study of 85,169 Swedish seafarers where all subjects with a minimum of 30 days service registered in the Seafarers' Register 1985-2013 were included. Mortality from coronary heart disease, cerebrovascular disease and total mortality for comparison were analysed by calculating standardised mortality ratios (SMRs), with 95% confidence intervals (CIs). Mortality was further analysed by gender, duty on board, type of vessel, and over time. RESULTS: There was no increase in either mortality from cardiovascular disease or total mortality for seafarers, who had worked solely on passenger ferries. Mortality from coronary heart disease and cerebrovascular disease was increased for male seafarers < 46 years old who had worked on different types of vessels, SMR 1.48 (95% CI 1.06-2.01) and SMR 1.93 (95% CI 1.16-3.02), respectively. Analysing the seafarers by duty showed significantly increased SMRs from coronary heart disease in males aged < 46 of the categories "deck crew" and "engine officer/crew (ever)". The total mortality for seafarers who had worked on different types of vessels was increased; males SMR 1.05 (95% CI 1.02-1.09) and females SMR 1.17 (95% CI 1.04-1.30), but decreased over time. CONCLUSIONS: No increased mortality on passenger ferries but younger male seafarers on different types of vessels had increased mortality from cardiovascular disease. Reduction of hazardous occupational exposures onboard is important, such as shift work, stress and noise.

Quantitative Risk Assessment of Seafarers' Nonfatal Injuries Due to Occupational Accidents Based on Bayesian Network Modeling.

Reducing the incidence of seafarers' workplace injuries is of great importance to shipping and ship management companies. The objective of this study is to identify the important influencing factors and to build a quantitative model for the injury risk analysis aboard ships, so as to provide a decision support framework for effective injury prevention and management. Most of the previous research on seafarers' occupational accidents either adopts a qualitative approach or applies simple descriptive statistics for analyses. In this study, the advanced method of a Bayesian network (BN) is used for the predictive modeling of seafarer injuries for its interpretative power as well as predictive capacity. The modeling is data driven and based on an extensive empirical survey to collect data on seafarers' working practice and their injury records during the latest tour of duty, which could overcome the limitation of historical injury databases that mostly contain only data about the injured group instead of the entire population. Using the survey data, a BN model was developed consisting of nine major variables, including "PPE availability," "Age," and "Experience" of the seafarers, which were identified to be the most influential risk factors. The model was validated further with several tests through sensitivity analyses and logical axiom test. Finally, implementation of the result toward decision support for safety management in the global shipping industry was discussed.

Mortality among seafarers: a register-based follow-up study.

BACKGROUND: Seafarers are exposed to many occupational risk factors. AIMS: To study whether there are differences in mortality between seafarers and other employees, whether there are variations in seafarers' mortality between different seafaring occupations and whether these differences can be explained by sociodemographic factors. METHODS: A register-based study of all seafarers aged 25-64 years, resident in Finland in 2000 with minimum 5 years of cumulative seafaring experience on Finnish vessels and other employees, followed for mortality 2001-13. Analysis methods included age standardized death rates, mortality ratios (SMR) and Cox proportional hazard model. RESULTS: During the follow-up period 2001-13, there were 81,035 person years and 382 deaths in the cohort of seafarers. Seafarers had 1.3 times higher risk of death (men SMR 132, 95% confidence intervals [CI] 118-147, women SMR 125, 95% CI 99-157) than other employees. Mortality was especially high in alcohol-related causes (men SMR 172, 95% CI 126-233, women SMR 262, 95% CI 131-525) and causes related to smoking. Controlling for sociodemographic characters strengthened the risk compared to other occupations. Mortality was high among male deck and engine crew and among male and female galley personnel. The mortality differences between different seafaring occupations were partly explained by adjustments of sociodemographic characters. CONCLUSIONS: Seafarers still have increased mortality among men after adjustment of sociodemographic characters. Results by causes of death suggest that changing practices to enable healthy behaviour are important.

Recreational possibilities for seafarers during shipboard leisure time.

PURPOSE: This study is aiming to document the leisure time opportunities and their actual utilization on board merchant ships. METHODS: A scientist examined the whole crew on board 22 container ships (323 seafarers; participation rate 88.5%). Data about energy consumption and heart rate were continuously collected during the seafarers' leisure and sleeping time through a SenseWear® wrist monitor and a Polar watch RS 800 worn for at least 2.5 days. RESULTS: The seafarers spent an average of 28.2% of the day for leisure time activities and 32.6% for sleeping. A significantly higher energy consumption was found among deck ratings compared to engine room personnel and nautical officers. Across all occupational groups, the variability of the heart rate was lower during sleeping hours than during leisure time. Suggestions for substantial improvement of the leisure time opportunities on board included more frequent and free opportunities for telecommunication (59.1%), shorter work assignments, and a stronger cohesion of the crew. The following coping strategies were paramount: "calming down/settling down" (41.9%), getting in touch with the family (32.0%) and relaxing/sleeping (30.4%). CONCLUSIONS: The limited heart rate variability during sleeping hours suggests a reduced quality of sleep that might be due to the permanent heaving motions of the vessel, noise, and vibration. The (deck) ratings had more physical activities that corresponded with their higher energy consumption during leisure time. Altogether, there is a need to optimize opportunities for relaxation and recreation on board, taking into consideration characteristics of the different occupational and ethnic groups.

Rates and occupational characteristics of international seafarers with mental illness.

BACKGROUND: Seafarers enable 90% of global commerce, working in isolation from social support and medical care. While occupational conditions of isolation may suggest possible excess risk of mental illness and suicide, research on seafarer mental illness is limited. AIMS: To describe seafarers with mental illness and associated incidence rates in a large population of international seafarers. METHODS: We used mental illness claims data from a large international marine insurance provider arising from working seafarers during the years 2007-15. We used descriptive statistics and calculated mental illness incidence rates in this seafarer population. RESULTS: There were 278 seafarer mental illness claims in the study data. Claims were more often reported in deck workers (46%) and ratings (58%). The crude mental illness rate was 3.9 per 100 000 person-years. CONCLUSIONS: Using objective data on a large seafaring population, our analysis highlights the important issue of mental illness in this isolated and underserved international workforce. The low observed mental illness claims rate is likely due to the high threshold for claims reporting.

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.

Pattern of some risk factors of cardiovascular diseases and liver enzymes among Iranian seafarers.

Background: Little information is available on the trend in cardiovascular risk factors and hepatic enzymes in Iranian seafarers. The present study aimed at assessing the pattern of obesity, hypertension, diabetes, elevated serum glutamic oxaloacetate transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) in Iranian seafarers during 2010 to 2014. Methods: Data on cardiovascular risk factors and hepatic enzymes were extracted from seafarers' annual health examination of National Iranian Tanker Company (NITC) of 2010, 2012, and 2014. The repeated measure ANOVA was used to compare continuous variables across 3 years. Categorical data were analyzed using Chi-square test. Over weight was defined as BMI (Body Mass Index) >25 kg/m2; obesity was defined as BMI>=30 kg/m2; hypertension was defined as systolic blood pressure (SBP)> 140 mmHg, and diastolic blood pressure (DBP)> 90 mmHg, or a history of antihypertensive drug use. Diabetes (DM) was defined as fasting blood sugar (FBS) > 110 mg/dl, or having a history of oral hypoglycemic agents; and elevated SGOT and SGPT were defined as SGOT > 40 U/L and SGPT > 40 U/L, respectively. Results: The BMI mean±SD values of Iranian seafarers were 24.81±3.07 kg/m2, 25.51±2.96 kg/m2, and 25.96 ± 3.02 kg/m2 in 2010, 2012, and 2014, respectively. A significant difference was observed in BMI over the study period. The mean of systolic and diastolic blood pressure did not significantly increase over time. The SGOT and SGPT means were not significantly different from 2010 to 2014. The prevalence of overweight increased significantly from 46.7% to 60.9% over the study period; however, the prevalence of obesity, hypertension, elevated SGOT, and elevated SGPT did not change significantly. Conclusion: The current survey showed that the obesity problem has increased among Iranian seafarers working on tankers, which is a concerning problem because obesity has negative effects on seafarers' health.

Outcomes of seafarer work fitness qualifications in the Netherlands.

BACKGROUND: Seafaring is a dangerous profession involving high fatality rates and little research has been done to identify conditions that may lead to failing the seafarer's medical qualification (SMQ). AIMS: To determine the proportion of seafarers failing to pass the SMQ in the Netherlands during 2012, to analyse the outcomes of the SMQ according to qualification, age, duties and requirements of additional evaluations and to describe the reasons for considering a seafarer unfit for duty. METHODS: A retrospective descriptive study of SMQs registered in the Netherlands Shipping Inspectorate database. RESULTS: Less than 1% (46 cases; 0.6%) of the 7617 final SMQ candidates were considered unfit for duty with 53% (24) of these being temporarily unfit. Four per cent (276) of cases were classified 'fit with restrictions' and 1% (66) 'fit by exemption' (FEx). Re-examination was required in 2% (122) of cases. A second opinion from a medical referee was sought in 4% of cases. The highest rate of FEx was found in older seafarers (aged over 55) due to restrictions in hearing and vision in the majority (59%) of cases. The leading causes of unfitness were other medical reasons, mainly associated with cardiovascular conditions and morbid obesity, in 52% of cases and visual impairment in 34%. CONCLUSIONS: The proportion of seafarers considered unfit in the SMQ carried out in the Netherlands in 2012 is relatively low. The proportion of FEx was higher in older groups, mainly due to hearing or visual impairments.

[Exploring the reality of seafarers' deaths and injuries and preventive measures from the cases of overwork-related disorders].

OBJECTIVES: Till date, only few studies have detailed the reality of overwork-related disorders among seafarers. Therefore, in this study, we aimed to evaluate the prevalence of overwork-related disorders among seafarers and assess factors such as patient attributes, diseases diagnosed at the time of determination, workload factors, and other aspects, thereby suggesting relevant preventative measures. METHODS: Among all the patients identified with overwork-related disorders from April 2010 to March 2017, 2,280 cases of cerebrovascular and cardiovascular diseases and 3,517 cases of mental disorders were selected. To identify seafarer-related cases, keywords related to seafarers were extracted. Subsequently, 33 cases of cardiovascular disease and 19 cases of mental disorders were obtained. RESULTS: The average age of the patients with cerebrovascular and cardiovascular diseases was 56.7 years; for those with mental disorders, it was 45.2 years. The patients were most commonly engaged in fishing, transportation, and postal services. Most patients were employed in the deck department or were captains. The most common types of vessels were fishing and cargo ships. Among the diseases diagnosed at the time of determination, cerebrovascular diseases accounted for 20 cases (60.6%) and cardiovascular diseases accounted for 13 cases (39.4%), with cerebral and myocardial infarctions being the most frequent conditions. Among mental disorders, "mood disorders" accounted for 7 cases (36.8%), and "neurotic disorders, stress-related disorders, and somatoform disorders" accounted for 12 cases (63.2%), with major depressive episodes, post-traumatic stress disorder, and adjustment disorders being the most common. The most common workload factor for patients with cerebrovascular and cardiovascular diseases was "long-term excessive work," and among non-workload factors, "long working hours" and "irregular working hours" were prevalent. For mental disorders, 8 cases were attributed to "extreme psychological stress." Specific events leading to these diseases included "interpersonal relationships," "experiencing accidents or disasters," and "work quantity and quality." CONCLUSIONS: Both cerebrovascular and cardiovascular diseases, as well as mental disorders, showed a notable aging trend among seafarers. Thus, measures that consider the characteristics of elderly workers, such as their physical function, are important. Additionally, as seafarers are distributed across various industries and occupations, measures should be specifically tailored to their industry and job type. Our study confirmed that long working hours and irregular working hours were prevalent in both cases. Therefore, there is an urgent need for further efforts to prevent and mitigate overwork-related deaths among seafarers, including organizational support from onshore workplaces and enhancement of medical and operational support using information and communication technology.