Can a transgender person be an occupational diver? Demonstration from a case report

This is the first case report about a transgender professional diver. The purpose of this article is to show the professional adaptations to help him to continue occupational dive and to raise the question of the impact on diving risks of hormonal treatment in this case. He was a 39-year-old man when he began his transition. He had worked as a diver for 9 years before his transition. When he changed to look like a woman, there were a few difficulties in continuing his professional activity. The main difficulty was that he looked like a woman while working with men. Modesty was a crucial issue in the enterprise. There were other problems such as the organisation of premises, the physical workload and the interaction between treatments and diving. There is a lack of a law to guide the employer. French legislation does not address the issue of transsexuals for this profession. The medical recommendations do not specify contraindications or adaptations for diving safely. Because of his transition, he lost muscle mass. The occupational physician helped to adjust his activity: decreasing the weight of his diving suit, creating a female-like locker room etc. Finally, the question of the risk of decompression illness arose. Legal hormonal medication seems not to significantly increase the risk of decompression illness, but this diver was taking illicit treatment to speed up the transition. The occupational physician recommended taking the legal hormonal medication

Health effects of hyperbaric exposure on chamber attendants: a literature review

Background: Inside attendants working in hyperbaric chambers are exposed to risks related to the hyperbaric environment, handling and care. The aim of this study is to review the literature focusing on the impact of this activity on health. Materials and methods: This is a literature review using the Medline database. Results: Eight articles studied decompression illness (DCI). The incidence of DCI ranged from 0 to 37 per 100,000 sessions in hyperbaric chambers (SHC). The incidence of injuries ranged from 0 to 412 per 100,000 SHC. The most prevalent cause of accidental death was fire: 77 deaths (patients and attendants) between 1923 and 1996. Dysbaric osteonecrosis has been reported in one study only. Conclusions: Inside attendants face risks in the chamber, even if serious health effects seems rare compared to the total number of SHC

Evolution of the respiratory function of professional divers over 15 years

Background: The study was aimed at assessing changes in respiratory function after 15 years of profes- sional diving, among scientific divers. Materials and methods: A retrospective study was performed on divers who underwent an initial visit and a visit 15 years later at the same medical centre, among divers who had a scientific activity (monitoring the coastline, fauna and flora). Pulmonary function tests were performed in the same laboratory with the same operating standards and using a Jaeger MasterBody plethysmograph. Each subject acted as his or her own control. The data were analysed by Student’s t-test and Spearman’s correlation coefficient.  Results: Twenty-six divers were included. Changes over 15 years included: a decrease in the forced expired volume in 1 second/functional vital capacity (FEV1/FVC) ratio (–6 for absolute value, p < 0.01; and –5% for theoretical value, p = 0.02); a decrease in forced expiratory flow (FEF)25% (–1.1 for absolute value, p < 0.01; and –21% for theoretical value, p < 0.01); a decrease in transfer factor for carbon monoxide (TLCO) (–0.7 for absolute value, p = 0.04); and an increase in vital capacity (VC) (+8% for theoretical value, p = 0.03). A significant correlation was found between the consumption of tobacco in packs per year (PY) and the variations in VC (r = 0.89; p < 0.01) and the variations in the theoretical FEV1 (r = 0.76; p = 0.03). There was a significant relationship between the number of dives and the variations in the percentage of the theoretical FEV1/FVC ratio (r = –0.42; p = 0.04). The same relationship was found for the average of dive duration (r = –0.59; p < 0.01)  Conclusions: With increasing length of diving activities service, the pulmonary function displays a trend toward both a decrease in TLCO and a decrease in FEF25%.

Longitudinal change in professional divers’ lung function: literature review

Background: The aim of this study was to assess changes in lung function of professional divers. Materials and Methods: This is a review of the literature. Only studies about professional divers were included. All published studies between 01.01.1984 and 07.01.2014 were systematically searched. The search was performed in Medline and Embase databases and in the “Medicina Maritima” journal. The results of pulmonary function tests were extracted from each study. Results: Fifteen articles were found. Four studies showed a significant decrease in forced vital capacity (FVC). Five studies demonstrated a significant decrease in forced expiratory flows (FEF) at 75% and 50% of FVC expired (FEF75% and FEF50%) after 3 years of diving. Seven studies demonstrated a significant decrease in forced expiratory volume in 1 second (FEV1) after 3 years of diving. But only 2 studies did an age-standardisation so that only 1 study demonstrated a significant decrease in FEV1 after age-standardisation. Three articles showed a decrease in transfer factor for carbon monoxide (TLCO) after 5 years. Dives parameters (like depth, number by year) were not always related to variations on the different lung variables. Conclusions: This literature review showed a decrease in TLCO, FEF75% and FEF25–75%. One wonders whether these variations are due to the age or to diving. The results of such a long-term study would be interesting and might help to guide fundamental research

Infectious diseases affecting occupational divers: review of 2017 literature

Background: Occupational divers are prone to many health risks. For instance, they can get infections. We reviewed the infectious diseases in occupational divers. Materials and methods: This is a literature review which went on up to 31.12.2017. The research was carried out on Medline and Scopus databases, in French and English languages. Results: Fifteen papers report cases of infections in occupational divers. They are mainly skin infections, but also ear-nose-throat and ophthalmological infections. Discussion and conclusions: According to data collected, infections among occupational divers are quite scarce. These diseases are not specific to the workplace, and are comparable with data on recreational diving. Prevention is mainly based on hygiene and equipment maintenance

Cardiovascular risk factors and cardiovascular risk assessment in professional divers

Background: The professional diver’s activity implies body cardiovascular stress. Little data on cardiovascular risk factors is available. Some studies report a high prevalence of tobacco consumption. The purpose of this study is to investigate the cardiovascular risk factors of professional divers and calculate the predicted 5-year risk and the predicted 10-year risk of an acute coronary event. Materials and methods: In one medical centre, data on dives and cardiovascular risk factors were analysed on Epidata® software, by Pearson c2 test or by Fisher’s exact test, by analysis of variance test or by Kruskal-Wallis test, and by Spearman correlation coefficient. Cardiovascular risk scores at 5 and 10 years were calculated using SCORE. Results: A total 200 professional divers were included. Of these, 31% were smokers or had stopped smoking for less than 3 years; 40% had an abnormal body mass index; 50% had raised total cholesterol levels; 11% had an advanced age; 6.5% had high blood pressure; 81% had at least one risk factor; 66% had an alterable risk factor; 25.5% had a 5-year risk greater than that of the general population of the same age; 2.5% had a high cardiovascular risk at 10 years; and 34% were at intermediate risk. Conclusions: The majority of divers had at least one cardiovascular risk factor. Cardiovascular risk scores were lower than that of the general population. However, some of this population is at high risk. One third of the divers had an intermediate risk, which should lead to the consideration of conducting additional biological examinations to better assess their risk

L'oedème pulmonaire en plongée sous marine autonome (étude de cas)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF