Occupational lung cancer among fisherman: a triple case report

Background: The World Health Organisation places lung cancer as the leading cause of cancer mortality in the world. The fishermen are one of the most important consumers of tobacco, which remains the main risk factor for lung cancer. However, there are no epidemiological data on the role of other causes, particularly occupational ones, in genesis of this disease. The objective of our work is to expose medical and occupational data of 3 fishermen with lung cancer and discuss a possible occupational origin of their pathology. Case presentation: This is a case report where we describe medical and occupational data of 3 fishermen working in the port of Tangier (Morocco) who have lung cancer. The first one is an ordinary fisherman, the second is a mechanic on board and the third is an ordinary fisherman but who worked 21 years ago aboard deep-sea fishing ships as a helper in the mechanic room. All fishermen were in the fifties; the third one never smoked while the other two were described as heavy smokers. All of them were exposed during their daily work to some chemicals liable to cause lung cancer. The anatomopathological types found were 2 cases of adenocarcinoma which is the histopathological variant often found in cases of occupational origin and one case of squamous cell carcinoma. Conclusions: The results obtained after studying these 3 cases suggest the possibility of occupational origin in the genesis of lung cancer among fishermen; however, the increased smoking rate in this population remains the most probable factor and helps the preventive approach to be adopted. More detailed epidemiological studies would highlight the possible role of occupational causes in the carcinogenesis of this pathology.

Prevalence of consumption of addictive substances amongst Moroccan fishermen

Background: The prevalence of toxic habits is constantly increasing in developing countries and all professional sectors are concerned. Seafarers are a particular target because of the dangerousness and complexity of their work. However, few studies have investigated toxic habits in this population. The aim of the study was to determine the prevalence of the use and misuse of addictive substances in seafarers and to appreciate poly-consumptions according to socio-demographic and occupational characteristics. Materials and methods: This cross-sectional study was conducted amongst 1,219 fishermen. Subjects filled a questionnaire during their medical examination. The questionnaire covered socio-demographic and occupational characteristics, toxic habits (tobacco, alcohol, cannabis and others psychotropic substances). The misuse was assessed by specific tests: dependence on smoking tobacco (Fagerstrom), Cannabis Abuse Screening Test (CAST) and Alcohol Use Disorders Identification Test (AUDIT). Results: The prevalence of consumption was 58.5% for smoking tobacco, 36.2% for cannabis, and 36.5% for alcohol. Amongst consumers, the prevalence of dependence or misuse was 49% for smoking tobacco, 61.2% for cannabis and 86% for alcohol. Only 115 (9.4%) people had no toxic habit. 56.4% had one toxic habit, 20.4% had two toxic habits, 11.9% had three toxic habits and 1.9% had four toxic habits. The most frequent associations were tobacco-cannabis (10.5%) and tobacco-alcohol (6.1%). Conclusions: In this sector, occupational health physicians have to play a key role in raising awareness and fighting against toxic habits.

Occupational risk perception, stressors and stress of fishermen

Background: The aim of this survey was to assess the stress in fishermen by analysing its relationshipwith sociodemographic and professional characteristics, by evaluating work stressors, and by estimatingpsychosomatic symptoms.Materials and methods: This cross-sectional survey involved representative sample of 828 artisanal andcoastal fishermen. All participants were men and had a regular activity for at least 2 years. We used anindividual questionnaire inspired by those of the National Institute for Research and Security of Franceand of the Karasek’s Job Content Questionnaire.Results: The prevalence of self-reported stress was 53.9%. The average age was 36.7 ± 8.7 years, it washigher among stressed than non-stressed. The prevalence of stress was higher in subjects with dependents(69.1%) versus 30.9% without dependents, and among those living alone (61%) versus 47.5% amongthose living in couple. The prevalence of harmful habits was 68.5% for tobacco smoking or snuff, 36.8%for cannabis smoking, 35.4% for alcohol consumption, 8.6% for other psychotropic substances and medications,and 21.4% for antalgic drugs. These toxic habits were significantly higher in stressed individuals.Thirty-three point seven per cent had self-reported chronic pathologies (40.5% among stressed vs. 25.7%non-stressed). Thirty-four per cent were overweight (38.3% among stressed vs. 28.8% non-stressed), and14% obese (19.3% among stressed vs. 7.6% non-stressed). The average daily working hours were 11.2 h(12.8 h among stressed subjects vs. 10.5 h non-stressed). Psychological demand was higher in stressedsubjects, while decisional latitude and social support were lower. Psychosomatic symptoms were higheramong stressed than non-stressed. The main suggestions of the fishermen were to improve income, socialwelfare, health insurance, safety on board, quality of lifestyle, sport and leisure activities, information andawareness campaigns of occupational stress, and fight against addictive behaviours.Conclusions: Fishermen were at a high risk of chronic stress with its health consequences. Health promotion andeducation initiatives should be conducted to raise fishermen’s awareness of the dangers of occupational stressors

Occupational safety and health in maritime sector in Morocco 60 years after independence: current state, constraints and prospects

Background: The aim of this study was to evaluate the situation 60 years after independence, to assessthe current state, to highlight the constraints and to propose recommendations for improving occupationalhealth in the maritime sector. Materials and methods: This study was based on collecting data of: 1) Legislative texts on occupationalhealth and safety; 2) Statistics from administrations (Ministry of Health and Ministry of Marine Fisheries),general medical council of Morocco, scientific societies and associations of occupational health and maritimemedicine; 3) Analysis of a self-questionnaire sent to 22 physicians working in fishermen’s health servicesand listed in the yearbook 2017 of the Moroccan Society of Maritime Medicine. It included five sections:socio-demographic and professional characteristics, training, assessment of activities, constraints in theirexercise and ten priority recommendations to improve the situation. Results: Health and safety in maritime sector are progressing since the Labour Code of 2004 and theConvention of December 27, 1996 between the Ministry of Health and the Ministry of Marine Fisheries. Itconcerns the organisation of a fishermen’s health prevention with the establishment of the fishermen’s healthoffice at central level and fishermen’s health services at the main ports. However, medical coverage isstill insufficient. Maritime medicine remains an unattractive specialty because the physicians are a poorlypaid and have some difficult working conditions. Conclusions: The absence of up-to-date synthetic data on safety and health in maritime sectors led usto carry out this study, which showed some dysfunctions and deficiencies that hinder the promotion ofworkers’ health in this sector. The recommendations proposed by the physicians should be the backboneof any improvement related to occupational health and safety. It is the practitioners themselves who, facedwith their practice, are the best able to disseminate a reflection qualified as ethical, which cannot bedissociated from their everyday activities

The assessment of seafarers’ knowledge, attitudes and practices related to STI/HIV/AIDS in northern Morocco

Background: The purpose of this study was to assess the knowledge, attitudes and practices of seafarers in relation to sexually transmitted infections (STI) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Materials and methods: This transversal, descriptive and behavioural study was conducted in 2014 on a representative sample of 1447 seafarers. Results: The rate of participation was 95%. The mean age was 36.1 ± 8.2 years. Knowledge about transmission and prevention mode was satisfactory on HIV/AIDS; however, some misconceptions still persist. The level of stigmatisation and discrimination towards people living with the virus was considered high. The prevalence of sexual high-risk behaviour was significant: 32% had at least two sexual partners and 26.3% have had sex with sex workers, 60% of them were not protected; 42.8% have never used the condom and only 15.1% used it systematically. The sailors who had sexual intercourse under the influence of alcohol or drugs are less protected. As too HIV testing, only 10.2% did it. Conclusions: This study showed a gap in knowledge about transmission and prevention of HIV infection/AIDS and sexual risk behaviour. Increasing awareness and information among seafarers is of prime importance.

Prevalence of consumption of psychoactive substances amongst dockers

Background: Dockers in the port facilities are exposed to significant psychosocial risks (stress, suffering atwork, etc.) related to heavy organisational, environmental, physical, chemical constraints, etc. These workersare particularly affected by the consumption of psychoactive substances because of the dangerousnessand complexity of their work. To what extent can these numerous occupational risks be at the origin ofbehaviour favouring the consumption of psychoactive substances? However, in our country no study hasinvestigated toxic habits in this population. The aim of this study was to determine the prevalence of theuse and misuse of psychoactive substances amongst dockers, and to appreciate the poly-consumptionaccording to socio-demographic and occupational characteristics. Materials and methods: This cross-sectional study was conducted amongst 665 dockers. The interview tookplace at the occupational health service and lasted between 15 and 20 minutes for each person respectingthe confidentiality. The questionnaire covered socio-demographic characteristics, socio-professionalcharacteristics, and toxic habits (tobacco, alcohol, cannabis and others psychotropic substances). Themisuse was assessed by specific tests: Fagerström test for tobacco smoking, Cannabis Abuse ScreeningTest (CAST) and Alcohol Use Disorders Identification Test (AUDIT). Results: The prevalence of use was 30.5% for tobacco smoking, 9.1% for cannabis smoking, and 16.5%for alcohol consumption. The prevalence of toxic habits was significantly higher in handlers than in machineryoperators: tobacco smoking (39.7% vs. 27%; p = 0.002), snuff tobacco (12.5% vs. 4.6%; p = 0.001),hookah (7.6% vs. 2%; p = 0.001), cannabis smoking (20.6% vs. 4.5%; p = 0.001) and alcohol consumption(22.3% vs. 14.3%; p = 0.019). Amongst consumers, the prevalence of dependence or misuse was 45.3%for tobacco smoking, 56.7% for cannabis smoking and 44.5% for alcohol consumption. Fifty-two point fiveper cent had no toxic habit, 36.7% had one toxic habit, 9.9% two toxic habits, and 0.9% three toxic habits.The most frequent associations were tobacco-alcohol (6.5%), and tobacco-cannabis (3%). Conclusions: Occupational health professionals have to play a key role in raising awareness and fightingagainst consumption of psychoactive substances amongst dockers

Prevalence of skin diseases amongst Moroccan fishermen

Background: The main objective was to evaluate the prevalence of skin diseases amongst fishermen, to  specify the different clinical forms, associations and most frequent localisations, and to identify potential  aetiological factors. The secondary objectives were to assess the knowledge, attitudes and practices of  seafarers regarding occupational dermatoses to conduct information, awareness and education campaigns  on risk factors and behaviours and to propose adapted prevention.  Materials and methods: This cross-sectional survey involved 1102 artisanal fishermen who attended the  annual legal medical consultation at the occupational health service. All participants were men and had  a regular activity for at least 2 years. It included an individual questionnaire, a clinical examination and  a technical visit to the workplace  Results: The skin disorders were palmar hyperkeratosis in 67.1% of fishermen, plantar hyperkeratosis in  59.4%, scares in 52.2%, facial wrinkling in 32%, and marine stings in 11.2%. The skin infections were  fungal (44.4%), bacterial (8.3%), viral (5.5%) and scabies (1%). Only 192 (17.4%) fishermen did not have  any dermatologic disease, 43% had one type of dermatologic diseases, 27.2% two types, 9.5% three types  and 2.5% four types. Concerning personal protective equipment, only 87.4% wore protective clothing,  12.8% high visibility clothing, 52.6% safety shoes, 30.1% protective gloves, and 63.5% protective caps  or hats. Only, 12% knew that mycosis were infectious origin and were contagious. Eighty-two per cent  ignored the mode of contamination, 78% the means of prevention and 91% the existence of a medical  treatment. Ninety-five per cent thought that pityriasis versicolor was due to sunrays especially in summer  and not to fungus.  Conclusions: The elaboration of the prevention approach needs a cooperative spirit; it will be more  accepted and applied by all fishermen, if their representatives are involved in its preparation. The realisation  of information and sensitization campaigns about the skin health must be based on the results  of prevalence surveys.  

Prevalence of chronic obstructive respiratory diseases amongst fishermen

Background: The objective was to screen and evaluate the prevalence of respiratory diseases and obstructive  ventilatory defects among fishermen in Morocco.  Materials and methods: This observational and cross-sectional epidemiological study involved 924 men  over 20 years old and with at least two years of seniority. It included a questionnaire and a spirometry.  The questionnaire is composed of four sections: sociodemographic and occupational characteristics, toxic  habits, medical history and respiratory clinical symptoms.  Results: The prevalence of symptoms of tracheobronchial irritation was 9.2% for cough, 8.2% for sputum  7.8% for dyspnoea and chest wheezing 8.1%. The frequency of rhinitis was 17.1%, asthma 6.8%, chronic  bronchitis 5.6% and chronic obstructive pulmonary disease (COPD) 4.1% (5.4% for current and former  smokers versus 1.1% for non-smokers). The prevalence was reaching 6.8% among those who smoked  more than 10 pack-years and 17.9% among those who smoked more than 20 pack-years. Among subjects  over 40 years old who had smoked more than 10 pack-years, the prevalence of COPD was 8.1%. The  comorbidities were frequent.  Conclusions: Smoking was very common among fishermen. Symptoms and respiratory diseases remain  underdiagnosed and undertreated. Prevention and early detection must be a priority in this sector.

Risk-taking behaviours among fishermen in Morocco by the evaluation of “ordalique” functioning

Background: The aim was to investigate the potential fishermen’s psychological functioning which induces risk-taking behaviours by evaluating the ordalique functioning. Materials and methods: This cross-sectional epidemiological study was conducted in three ports of northern Morocco in 2016 and concerned 1413 traditional fishermen working in small embarkations and 1049 administrative staff working in the maritime sector on land. Both groups were male, comparable for age and educational level. The survey support was an individual questionnaire covering socio-demographic characteristics, toxic habits and ordalique functioning questionnaire (le questionnaire de fonctionnement ordalique, QFO). It is composed of 42 items and four dimensions which are evaluated: risk-taking, transgression, positive representation of risk-taking and believes. Results: The prevalence of the ordalique behaviour and its four dimensions was significantly higher among traditional fishermen than administrative staff on land; 66.4% vs. 33.6% (p < 0.0001) for risk-taking, 65.2% vs. 34.8% (p < 0.0001) for transgression, 60.4% vs. 39.6% (p < 0.0001) for positive representation, 59.8% vs. 51.2% (p < 0.0001) for believes. For all range ages, the prevalence of ordalique functioning was higher among fishermen than administrative staff on land. Among fishermen, the prevalence of the was significantly higher among the under 40 years old (69.1% vs. 54.7%, p < 0.0001). The prevalence of toxic habits among ordalique fishermen was significantly greater than no-ordalique ones: tobacco (54.5% vs. 48.6%, p < 0.035), alcohol (42.8% vs. 32.4%, p < 0.0001), cannabis (34.8% vs. 26.6%, p < 0.0001), psychotropic drugs (13.8% vs. 10.4%, p < 0.081) and a combination of toxic habits (27.7% vs. 19.6%, p < 0.0001). Conclusions: Ordalique behaviour among fishermen may explain the partial failure of preventive measures in this sector. Risk-taking behaviours into account in the safety system could reduce occupational hazards in the fishery

Measurement of early maladaptive schemas in heroin addicts treated with methadone in north of Morocco

The Early Maladaptive Schema (EMS) are the cognitive structures and the set of processes guiding our behaviors by serving the filtering and the treatment of the information, these dysfunctional schemas have a close relationship with the additive behaviors. The aim of this work measuring EMS in heroin addicts undergoing methadone treatment as well as making a comparison between the activation of the schemas before and after treatment. The present study was carried out on 101 Moroccan patients in a medicopsychological center in Tangier with 85 men and 16 women (mean age was 35), having been diagnosed with opioid dependence described in the DSM-V. EMS were measured using Young's questionnaire short version with 13 schemas. The results showed difference between the activation of schemas in the preand post-treatment (difference=21, CI=11.07-10.63, p<0.001) with an activation of the schema Fear of losing control (M=166.86 (65.3%). In addition Unrelenting standards schema that is significant in men (t=1.97, p=0.048), against emotional deprivation and vulnerability with women (t=4.56, p≤0.001), for the correlation between age and EMS was low, except for the schema of losing control which is highly correlated with age (R=0.55, p≤0.001). Thus, the substance abuse and personality disorders are often coexisting, confirming in part the hypothesis put forward by Ball and Young, which postulates that individuals displaying criteria of substance abuse have an activation of inappropriate schemas of insufficient self-control or Entitlement/Grandiosity