Past, present, and future perspectives of telemedical assistance at sea: a systematic review

Background: Telemedicine is an effective technology for evaluating, diagnosing, treating, and providing health care services for remote populations, including seafarers, in case of diseases or accidents on board. Delivery of telemedicine in a maritime environment is not an easy task and, in general, differs from what can be done onshore. The aim of this review is to provides an overview of Telemedical Maritime Assistance Services (TMAS) in Europe by describing the previous and current status in terms of communication technologies as well as the nature of services rendered at sea. Secondly, to discuss the areas needing improvement and future directions to improve the quality of offshore telemedicine services. Materials and methods: Different databases, including PubMed (Medline), Google Scholar, Scopus, and journal of International Maritime Health, were searched between August 1 and September 15, 2019. Articles only published from 1969 to 2019 were considered. Relevant articles were selected by reviewing keywords, titles, and abstracts initially based on our inclusion and exclusion criteria. We critically reviewed the full-text articles included in this review. Information on the means of communication, telemedicine services, years of publication, and the name of the first author was extracted from selected studies. The quality of the selected studies was assessed using the criteria of the Newcastle-Ottawa scale. Results: Initially, 135 articles were identified through searching various databases by using keywords, abstracts, and titles. After removing the duplicates, 121 articles remained. Then we performed an independent article assessment and selection based on the selection criteria, which removed an additional 61 studies, leaving 60 papers. Finally, 27 full-text papers left, and we critically reviewed it. In 27 accepted articles, email and telephone were used most often and accounted for 30% (17/57) and 28% (16/57) of all communication links, respectively. Teleconsultation was the most used telemedicine service on board and represented 58.6% (17/29) of accepted papers. Conclusions: Email and telephone were the principal means of TMAS doctors to provide medical advice as well as assistance for patients at sea. Despite the potential offered by technological progress, there are still many limitations to the provision of adequate medical care at sea. The modernisation of telemedicine services will help decrease the gap in healthcare delivery at sea

Past, present, and future perspectives of telemedical assistance at sea: a systematic review

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Activity of Choline Alphoscerate on Adult-Onset Cognitive Dysfunctions: A Systematic Review and Meta-Analysis

Background: Choline alphoscerate (alpha glyceryl phosphorylcholine, α-GPC) is a choline-containing phospholipid used as a medicine or nutraceutical to improve cognitive function impairment occurring in neurological conditions including adult-onset dementia disorders. Despite its 1985 marketing authorization, there are still discrepancies between countries regarding its approval as a prescription medicine and discussions about its effectiveness. Objective: This study aimed to evaluate the efficacy of the α-GPC compound for treating cognitive impairment in patients with adult-onset neurological disorders. Methods: Relevant studies were identified by searching PubMed, Web of Science, and Embase. Studies that evaluated the effects of α-GPC alone or in combination with other compounds on adult-onset cognitive impairment reporting cognition, function, and behavior were considered. We assessed the risk of bias of selected studies using the Cochrane risk of bias tool. Results: A total of 1,326 studies and 300 full-text articles were screened. We included seven randomized controlled trials (RCTs) and one prospective cohort study that met our eligibility criteria. We found significant effects of α-GPC in combination with donepezil on cognition [4 RCTs, mean difference (MD):1.72, 95% confidence interval (CI): 0.20 to 3.25], functional outcomes [3 RCTs, MD:0.79, 95% CI: 0.34 to 1.23], and behavioral outcomes [4 RCTs; MD: -7.61, 95% CI: -10.31 to -4.91]. We also observed that patients who received α-GPC had significantly better cognition than those who received either placebo or other medications [MD: 3.50, 95% CI: 0.36 to 6.63]. Conclusion: α-GPC alone or in combination with donepezil improved cognition, behavior, and functional outcomes among patients with neurological conditions associated with cerebrovascular injury

COVID-19 outbreak reproduction number estimations and forecasting in Marche, Italy

Background: COVID-19 disease is becoming a global pandemic and more than 200 countries were affected because of this disease. Italy is one of the countries is largely suffered with this virus outbreak, and about 180,000 cases (as of 20 April 2020) were registered which explains the large transmissibility and reproduction case numbers. Objective: In this study, we considered the Marche region of Italy to compute different daily transmission rates (Rt) including five provinces in it. We also present forecasting of daily and cumulative incidences associated after the next thirty days. The Marche region is the 8th in terms of number of people infected in Italy and the first in terms of diffusion of the infection among the 4 regions of the center of Italy. Methods: Epidemic statistics were extracted from the national Italian Health Ministry website. We considered outbreak information where the first case registered in Marche with onset symptoms (26 February 2020) to the present date (20 April 2020). Adoption of incidence and projections with R statistics was done. Results: The median values of Rt for the five provinces of Pesaro and Urbano, Ancona, Fermo, Ascoli Piceno, and Macerata, was 2.492 (1.1-4.5), 2.162 (1.0-4.0), 1.512 (0.75-2.75), 1.141 (1.0-1.6), and 1.792 (1.0-3.5) with 95% of CI achieved. The projections at end of 30th day of the cumulative incidences 323 (95% CI), and daily incidences 45 (95% CI) could be possible. Conclusions: This study highlights the knowledge of essential insights into the Marche region in particular to virus transmission dynamics, geographical characteristics of positive incidences, and the necessity of implementing mitigation procedures to fight against the COVID-19 outbreak

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Seafarers: A Cross-Sectional Study of Prevalence and Clustering

Background: Cardiovascular diseases (CVD) are the major cause of work-related mortality from diseases onboard ships in seafarers. CVD burden derives mainly from modifiable risk factors. To reduce the risk factors and the burden of CVD onboard ships in seafarers, it is important to understand the up-to-date prevalence of modifiable risk factors. The primary purpose of this study was to assess the prevalence and clustering of self-reported modifiable CVD risk factors among seafarers. We have also explored the association between socio-demographic and occupational characteristics and reported modifiable CVD risk factor clustering. Materials and methods: A cross-sectional study was conducted among seafarers from November to December 2020 on board ships. In total, 8125 seafarers aged 18 to 70 were selected from 400 ships. Data were collected using a standardized and anonymous self-reported questionnaire. The prevalence value for categorical variables and mean differences for continuous variables were compared using chi-square and independent sample t-tests. Multinomial logistic regression models were performed to identify independent predictors for modifiable CVD risk factor clustering. Results: Out of a total of 8125 seafarers aged ≥18 years on selected vessels, 4648 seafarers volunteered to participate in the survey, with a response rate of 57.2%. Out of 4318 participants included in analysis, 44.7% and 55.3% were officers and non-officers, respectively. The prevalence of reported hypertension, diabetes, current smoking and overweight or obesity were 20.8%, 8.5%, 32.5%, and 44.7%, respectively. Overall, 40%, 20.9%, 6% and 1.3% of the study participants respectively had one, two, three and four modifiable CVD risk factors. Older age (51+ years) (odds ratio (OR): 3.92, 95% confidence interval (CI): 2.44–6.29), being non-officers (OR: 1.36, 95% CI: 1.09–1.70), job duration (10–20 years) (OR: 2.73, 95% CI: 2.09–3.57), job duration (21+ years) (OR: 2.60, 95% CI: 1.79–3.78), working 57–70 h per week (OR: 2.03, 95% CI: 1.65–2.49) and working 71+ h per week (OR: 3.08, 95% CI: 2.42–3.92) were independent predictors for at least two self-reported modifiable CVD risk factor clustering. Conclusion: The results of our study demonstrate that more than four in six (68.5%) seafarers aged between 19 and 70 years have at least one of the modifiable CVD risk factors. Therefore, CVD prevention and modifiable risk factors reduction strategies targeting high-risk groups should be designed and implemented on board ships

Risk prediction model of self-reported hypertension for telemedicine based on the sociodemographic, occupational and health-related characteristics of seafarers: a cross-sectional epidemiological study

Objectives: High blood pressure is a common health concern among seafarers. However, due to the remote nature of their work, it can be difficult for them to access regular monitoring of their blood pressure. Therefore, the development of a risk prediction model for hypertension in seafarers is important for early detection and prevention. This study developed a risk prediction model of self-reported hypertension for telemedicine. Design: A cross-sectional epidemiological study was employed. Setting: This study was conducted among seafarers aboard ships. Data on sociodemographic, occupational and health-related characteristics were collected using anonymous, standardised questionnaires. Participants: This study involved 8125 seafarers aged 18-70 aboard 400 vessels between November 2020 and December 2020. 4318 study subjects were included in the analysis. Seafarers over 18 years of age, active (on duty) during the study and willing to give informed consent were the inclusion criteria. Outcome measures: We calculated the adjusted OR (AOR) with 95% CIs using multiple logistic regression models to estimate the associations between sociodemographic, occupational and health-related characteristics and self-reported hypertension. We also developed a risk prediction model for self-reported hypertension for telemedicine based on seafarers' characteristics. Results: Among the 4318 participants, 55.3% and 44.7% were non-officers and officers, respectively. 20.8% (900) of the participants reported having hypertension. Multivariable analysis showed that age (AOR: 1.08, 95% CI 1.07 to 1.10), working long hours per week (AOR: 1.02, 95% CI 1.01 to 1.03), work experience at sea (10+ years) (AOR: 1.79, 95% CI 1.33 to 2.42), being a non-officer (AOR: 1.75, 95% CI 1.44 to 2.13), snoring (AOR: 3.58, 95% CI 2.96 to 4.34) and other health-related variables were independent predictors of self-reported hypertension, which were included in the final risk prediction model. The sensitivity, specificity and accuracy of the predictive model were 56.4%, 94.4% and 86.5%, respectively. Conclusion: A risk prediction model developed in the present study is accurate in predicting self-reported hypertension in seafarers' onboard ships

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

Text mining with sentiment analysis on seafarers' medical documents

Abstract Digital health systems contain large amounts of patient records, doctor notes, and prescriptions in text format. This information summarized over the electronic clinical information will lead to an improved quality of healthcare, the possibility of fewer medical errors, and low costs. Besides, seafarers are more vulnerable to have accidents, and prone to health hazards because of work culture, climatic changes, and personal habits. Therefore, text mining implementation in seafarers' medical documents can generate better knowledge of medical issues that often happened onboard. Medical records are collected from digital health systems of Centro Internazionale Radio Medico (C.I.R.M.) which is an Italian Telemedical Maritime Assistance System (TMAS). Three years (2018–2020) patient data have been used for analysis. Adoption of both lexicon and Naive Bayes' algorithms was done to perform sentimental analysis and experiments were conducted over R statistical tool. Visualization of symptomatic information was done through word clouds and 96% of the correlation between medical problems and diagnosis outcome has been achieved. We validate the sentiment analysis with more than 80% accuracy and precision

First Surveillance of Violence againstWomen during COVID-19 Lockdown: Experience from “Niguarda” Hospital in Milan, Italy

Violence against women emerges with tragic regularity in the daily news. It is now an evident trace of a dramatic social problem, the characteristics of which are not attributable to certain economic, cultural, or religious conditions of the people involved but affect indiscriminately, in a unanimous way, our society. The study is a survey about the number of hospital admissions due to episodes attributable to violence against women, recorded by the Niguarda Hospital in Milan in the period 1 March–30 May from 2017 to 2020. This period, in 2020, corresponds to the coronavirus Lockdown in Italy. All the medical records of the Emergency department were reviewed, and the extracted data classified in order to identify the episodes of violence against women and the features of the reported injuries and the characteristics of the victims. The data did not show an increase in the number of cases in 2020 compared to previous years, but we did find a notable increase in the severity of injuries

Factors affecting the quality and reliability of online health information

Background: Internet represents a relevant source of information, but reliability of data that can be obtained by the web is still an unsolved issue. Non-reliable online information may have a relevance, especially in taking decisions related to health problems. Uncertainties on the quality of online health data may have a negative impact on health-related choices of citizens. Objective: This work consisted in a cross-sectional literature review of published papers on online health information. The two main research objectives consisted in the analysis of trends in the use of health web sites and in the quality assessment and reliability levels of web medical sites. Methods: Literature research was made using four digital reference databases, namely PubMed, British Medical Journal, Biomed, and CINAHL. Entries used were “trustworthy of medical information online,” “survey to evaluate medical information online,” “medical information online,” and “habits of web-based health information users”. Analysis included only papers published in English. The Newcastle Ottawa Scale was used to conduct quality checks of selected works. Results: Literature analysis using the above entries resulted in 212 studies. Twenty-four articles in line with study objectives, and user characteristics were selected. People more prone to use the internet for obtaining health information were females, younger people, scholars, and employees. Reliability of different online health sites is an issue taken into account by the majority of people using the internet for obtaining health information and physician assistance could help people to surf more safe health web sites. Conclusions: Limited health information and/or web literacy can cause misunderstandings in evaluating medical data found in the web. An appropriate education plan and evaluation tools could enhance user skills and bring to a more cautious analysis of health information found in the web