Psychological stress in seafarers: a review

Background: Seafaring is a particular profession, in which workers are usually exposed to several stressors that are related to the different duties on board ships. This paper has reviewed the main publications on different factors affecting seafarers with the purpose of identifying specific stress factors related to a particular duty on board. Materials and methods: A literature search was conducted using the online databases PubMed and OvidSP. A survey on health, stress, and fatigue of Australian Seafarers published by the Australian Maritime Safety Authority (AMSA) fulfilling the selection criteria was also examined. This publication provided relevant data obtained from a large sample of seafarers. Results: Our analysis confirmed that seafaring is associated with mental, psychosocial, and physical stressors. The most important factors were separation from family, loneliness on board, fatigue, multi-nationality, limited recreation activity, and sleep deprivation. The AMSA report gave a more detailed analysis on lifestyle and relevant factors inducing psychological distress. Stressors affecting seafarers working in the engine room were different from those involving the deck crew. Sleep quality and duration were reported to be poor mainly in pilots, whereas deck crew tended to be less adherent to physical exercise and healthy lifestyle recommendations. Conclusions: Seafaring is still associated with relevant mental health risks. Information on known stress factors on board should be provided to seafarers to help them in lowering stress perception. Strategies for coping with “inevitable” stress conditions should also be investigated and developed. Strategies to decrease risks of stress should be directed to the different categories of seafarers, and the results of specific interventions should be evaluated

The Psychological General Well-Being Index (PGWBI) for assessing stress of seafarers on board merchant ships

Background: In their working activity, seafarers are exposed to high levels of stress that should be accuratelyinvestigated, measured, followed up and, if possible, countered. This is also required by regulations recently entered into force such as the Maritime Labour Convention 2006, recommending to consider special physiological or psychological problems created by the shipboard environment. The choice of the tools for this evaluation is challenging, and a common basic standard usable in a large scale should be identified.Aim: The aim of this study was to evaluate: 1) the suitability of the Psychological General Well-Being Index (PGWBI) questionnaire conducted on board for assessing stress in the sailing seafarers, 2) The presenceof stress in seafarers of different categories (deck officers, engine officers, deck crew, engine crew, chiefstewards/catering staff) monitored by the PGWBI.Materials and methods: 162 male seafarers on board of 7 tankers belonging to the same shipping companywere evaluated through the PGWB questionnaire. Analysis of variance (ANOVA) was used to analyse thedifferences in the scores of the questionnaire.Results: Engine officers exhibited significantly higher anxiety levels than the deck or engine crew, andshowed lower satisfaction than the deck crew. Deck and engine officers revealed higher self-control levelsthan the engine crew. Chief stewards/catering staff showed lower vitality levels than the deck crew.Conclusions: Deck or engine officers should achieve a greater self-control than the crew and this is documentedby the present study. Our findings support the view that management responsibility is more often associated with higher levels of stress. In our opinion, the PGWB questionnaire is a reasonable compromise forobtaining a global evaluation of psychological conditions, including stress of seafarers. It should be therefore considered as a large scale tool for assessing the well-being and eventual stress levels of sailing seafarers

Late and early onset dementia: what is the role of vascular factors? A retrospective study.

Neuropathology of Alzheimer's disease (AD) demonstrates that the common occurrence of vascular lesions and vascular factors is suggested to contribute significantly to the clinical progression of the disease. This study has assessed the presence of vascular brain lesions and risk factors in subjects with diagnosis of AD and their influence on the disease course both in Late Onset Dementia (LOD) and in Early Onset Dementia (EOD). METHODS: MRI scans of 374 LOD and of 67 EOD patients were evaluated for the presence of vascular associated lesions and rated according to the age-related white matter changes (ARWMC) scale as "pure degenerative", "mixed" and "vascular" cases of dementia. Vascular risk factors burden (hypertension, diabetes, dyslipidemia, myocardial infarction) and disease progression were also assessed. RESULTS: 44% of LOD cases and 46% of EOD were classified as "mixed dementia cases". The vascular risk factors burden showed an increase from the pure degenerative to the pure vascular forms. Disease progression, calculated in two years using the Mini Mental State Evaluation (MMSE), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores, did not reveal differences among the three different classes of dementias. CONCLUSIONS: Vascular lesions are found in the majority of LOD cases and in about one half of EOD. This observation is consistent with the hypothesis of a synergistic effect of the degenerative and vascular factors on the development of cognitive dysfunction. The linear increase of the vascular burden supports the idea of a continuum spectrum between the pure degenerative and the pure vascular forms of adult-onset dementia disorder

the psychological general well being index pgwbi for assessing stress of seafarers on board merchant ships

Background: In their working activity, seafarers are exposed to high levels of stress that should be accuratelyinvestigated, measured, followed up and, if possible, countered. This is also required by regulations recently entered into force such as the Maritime Labour Convention 2006, recommending to consider special physiological or psychological problems created by the shipboard environment. The choice of the tools for this evaluation is challenging, and a common basic standard usable in a large scale should be identified. Aim: The aim of this study was to evaluate: 1) the suitability of the Psychological General Well-Being Index (PGWBI) questionnaire conducted on board for assessing stress in the sailing seafarers, 2) The presenceof stress in seafarers of different categories (deck officers, engine officers, deck crew, engine crew, chiefstewards/catering staff) monitored by the PGWBI. Materials and methods: 162 male seafarers on board of 7 tankers belonging to the same shipping companywere evaluated through the PGWB questionnaire. Analysis of variance (ANOVA) was used to analyse thedifferences in the scores of the questionnaire. Results: Engine officers exhibited significantly higher anxiety levels than the deck or engine crew, andshowed lower satisfaction than the deck crew. Deck and engine officers revealed higher self-control levelsthan the engine crew. Chief stewards/catering staff showed lower vitality levels than the deck crew. Conclusions: Deck or engine officers should achieve a greater self-control than the crew and this is documentedby the present study. Our findings support the view that management responsibility is more often associated with higher levels of stress. In our opinion, the PGWB questionnaire is a reasonable compromise forobtaining a global evaluation of psychological conditions, including stress of seafarers. It should be therefore considered as a large scale tool for assessing the well-being and eventual stress levels of sailing seafarers

Desire to institutionalize in Alzheimer's caregivers: An empirical analysis on Italian data.

OBJECTIVE: Families choice to institutionalize an Alzheimer's disease (AD)-affected relative is hard and possibly painful. Recent literature contributions have investigated the causes of the emergence of desire to institutionalize (DI) who is affected by AD. This paper contributes to the topic by providing an Italy-based empirical analysis of factors correlated with DI in primary informal caregivers of patients affected by AD. METHODS: Data were drawn from an original survey carried out over 2009. 171 primary informal caregivers of patients followed in two Italian outpatients AD Care Units, located in two of the major Italian cities, Naples (46.78%) and Rome (53.22%), were interviewed. The caregiver desire to institutionalize AD affected patients was observed and its heterogeneity was studied through logistic regression. RESULTS: DI was positively correlated with patient poor autonomy, to the housewife/househusband status of primary caregiver and to the presence of a formal caregiving. DI was also barely correlated with patient gender and with the hours of informal supervision (p < 0.10). The housewife status of the primary caregiver was also positively associated with DI, while the female gender of the patient was negatively associated to it. DISCUSSION: The institutionalization of an AD-affected relative is a painful decision which is discouraged by the scarcity of adapted facilities and the need of an economical contribution in case of institutionalization in private facilities not receiving public support

Efficacy of memantine, donepezil, or their association in moderate-severe Alzheimer's disease: a review of clinical trials

BACKGROUND: Acetylcholinesterase (AChE)/cholinesterase (ChE) inhibitors (Is) and memantine are licensed for symptomatic treatment of mild-moderate and moderate-severe forms of Alzheimer's disease (AD), respectively. High doses of the AChE-I donepezil were licensed in the USA for moderate-severe AD, and the association AChE/ChE-Is plus memantine was proposed for AD at this stage. OBJECTIVES: This paper has reviewed evidence from clinical trials of the effectiveness of memantine, donepezil, or the two drugs in association in managing moderate-severe AD. METHOD: Double-blind, placebo-controlled randomized trials (RCTs) using memantine or donepezil alone or in association versus placebo in moderate-severe AD were reviewed. Analysis done in January 2013 considered the years 2007-2012. RESULTS AND CONCLUSION: Only 83 of the 941 papers selected were considered relevant, and only 13 met the criterion of "adequacy and representativeness." Memantine and donepezil lead to improvements in moderate-to-severe AD and the choice between the compounds should be based on their contraindications more than on disease severity. No evidence was found of advantages of the association of memantine-donepezil. The heterogeneity of conditions explored by RCTs, the relatively short time of observation (24-52 weeks), and the different cognitive assessment tools used did not allow comparing properly different trials

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)