Incidence Of Injury And Illness In Merchant Seafarers

This retrospective study estimates cumulative incidences of injury and illness in a seafarer cohort using data from one company providing remote medical services and claims auditing for seafarers. There were 3,526 medical events and 16,626 individual medical services in the merchant seafarers covered by these services between 2008 and 2012. The majority of medical events occurred in men, numbering 3,099 (97.5%); median age was 38.9 years (range: 18-80). The total at-risk seafarer population was estimated by utilizing standard crew size for each class of vessel, and this was used to calculate cumulative incidence for injury and illness. The four-year overall cumulative incidence rate (per 100 seafarers) for injuries and illness was equal at 8.5. Cumulative incidence for subcategories of illness was determined. The most significant limitation of this study is that the true at-risk population and demographic distribution of this population are unknown. Important next steps in this research include refining the estimated number of at-risk seafarers, obtaining baseline demographic information for seafarers in this cohort, and understanding other potential risk factors

International Occupational Health Research on an Invisible Workforce

There are many professions in which employees are located in remote locations. International maritime workers make up one such occupation. They are a vulnerable, underserved and neglected population of approximately 1.2 million people with high rates of disease and injury. During their typical nine month deployments, they live in relative isolation with no health care professional on board. To understand the root causes of disease and injury among this remote workforce, strategies to collect information, analyze data, and report results and recommendations have been developed. These strategies, which include gathering of data through an alliance of companies involved in seafaring, have yielded initial results as to the predictors of serious illness and injury on board vessels requiring the repatriation of the employee. These same methods should be applicable to other isolated international workforces

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