Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance

Background: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. Methods: Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM’s official archives in Rome. Results and Conclusions: The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers

Dental hygiene habits and oral health status of seafarers

Background: This study has assessed the dental hygiene habits and problems of seafarers and their attitudes/ perceptions regarding oral hygiene using a dental hygiene/habits questionnaire. Materials and methods: A research questionnaire on oral hygiene habits was prepared along with a summary of all the questions and sent to ships via e-mail by Centro Internazionale Radio Medico (CIRM) networks. CIRM, is the Italian Telemedical Maritime Assistance Service (TMAS), and represents the Centre with the largest number of seafarers assisted on board ships worldwide. CIRM proposed the questionnaire to all ships (n = 1,198) asking for medical advice from 1 July 2014 till 31 October 2014. Two dental professionals were involved in the development and analysis of the questionnaire. Results: Seafarers are at risk of several dental health problems due to their oral hygiene and dietary habits, smoking and alcohol consumption, poor oral hygiene knowledge and motivation. Dietary habits during voyages were also questionable and seafarers consume food rich in fermentable carbohydrates, which is a major risk factor for dental caries. Conclusions: Seafarers need better oral hygiene education and care to enable them to manage their oral health in a better way. Life at the sea, under challenging circumstances is not without stress, that is why it is important that seafarers are given complete information about correct oral hygiene protocols and dental hygiene and the advantages for their health of keeping a healthy mouth.

Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance.

Background: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. Methods: Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM's official archives in Rome. Results and Conclusions: The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers

The Telehealth Chain: a protocol for secure and transparent telemedicine transactions on the blockchain

Blockchain technology provides a secure and decentralized platform for storing and transferring sensitive medical data, which can be utilized to enable remote medical consultations. This paper proposes a theoretical framework for creating a blockchain-based digital entity to facilitate telemedicine services. The proposed framework utilizes blockchain technology to provide a secure and reliable platform for medical practitioners to remotely interact with patient transactions. The blockchain will serve as a one-stop digital service to secure patient data, ensure privacy, and facilitate payments. The proposed framework leverages the existing Hyperledger Fabric platform to build a secure blockchain-assisted telemedicine platform

Identification of World Health Organisation ship’s medicine chest contents by Anatomical Therapeutic Chemical (ATC) classification codes

Background: Ships should carry mandatory given amounts of medicinal products and basic first aid items, collectively known as the ship’s medicine chest. Type and quantities of these products/items are suggested by the World Health Organisation (WHO) and regulated by individual flag states. In countries that lack national legislation, it is assumed that ships should follow WHO indications. An objective difficulty mainly involving vessels of international long-haul routes could be to recognise medicinal compounds obtained in other countries for replacing products used or expired. Language barrier may complicate, if not make it impossible to interpret the name of the medicinal product and/or of the active principle as indicated in a box printed in a completely different language. Handling of the ship’s pharmacy may be difficult in case of purchasing of drugs abroad due to language barriers. Medicinal products are identified by the international non-proprietary name of the active principle and/or by their chemical or invented (branded) names. This may make the identification of a medicinal product difficult, primarily if it is purchased abroad and the box and instructions are written in the language of the country where it is marketed. Therefore, there is a simpler classification system of the medicinal compounds the ATC (ATC: Anatomy, Therapeutic properties, Chemical, pharmacological properties). This paper has reviewed the list of medicinal products recommended by WHO and assigned to each one the ATC code as a solution to the problem of medicinal compounds organisation. Materials and methods: Two researchers independently examined the list of medicinal compounds indicated in the third edition of the International Medical Guide for Ships and attributed to each compound the ATC code according to the 2013 Guidelines for ATC classification and Defined Daily Dose (DDD) assignment. Results: The ATC code was attributed to the medicinal compounds indicated in the third edition of the International Medical Guide for Ships. Conclusions: The availability of an objective system to identify medicinal products is required for ships, which will contribute in making the identification of items purchased simpler, making it easier to understand which drug seafarers need to be administer, and consequently reduce possible therapeutic mistakes.

Quantitative Measurements of the Depth of Enamel Demineralization before and after Bleach: An In Vitro Study

Objective. This study is aimed at determining two main points. First, if the Canary System™ (CS), initially used to assess caries, can measure a decalcification depth of bleached enamel quantitatively, and second, whether or not whitening has a harmful effect on enamel. This device can be considered a useful tool in the clinical assessment of the progression of demineralization after bleaching. Materials and Methods. This study collected sixty human premolars that are in a good state recently extracted for orthodontic reason. To properly disinfect and preserve the premolars, they were stored in a saline solution and later in distilled water for a period of two weeks to allow the premolars to rehydrate. Later, 24 hours before the experiment, the premolars were introduced into a solution of artificial saliva to acquire back their minerals. The mineral content of the teeth was measured by the Canary System™ before bleaching. The teeth were bleached with 30% hydrogen peroxide (fläsh HP 30%), 30 min per week and for 3 consecutive weeks to simulate the conditions of strong bleaching in the clinic. The extent of demineralized enamel was measured by the Canary System™ at three points on the enamel surface of each tooth. The data were averaged for each application of the bleaching product. The demineralization extent of the teeth was measured by the Canary System™ before and after bleaching. The significance level was set at 0.05, and SPSS version 26 was used. The data were analyzed by using Wilcoxon’s and Student’s tests. Results. Mineral loss occurred after the first bleaching session; the Canary System™ detected a decalcification in the first bleaching session ( μm) compared to the other sessions (), while no significant change was detected between the second and the third sessions (). Conclusion. Based on the findings of the present study, under in vitro conditions, it was possible to measure the demineralization extent of bleached enamel with the Canary System™

Oral Manifestations of Rett Syndrome—A Systematic Review

Rett Syndrome is an x linked developmental disorder which becomes apparent in females after 6 to 18 months of age. It leads to severe impairments including loss of speech, loss of hand movements/manual dexterity, characteristic hand movements such as hang wringing and intellectual disability/learning problems. This systematic review was carried out to identify the dental manifestation of Rett syndrome and to shed light on treatment options available for oral health problems associated with Rett syndrome. A systematic literature search was conducted on the PubMed, Scopus, Biomed, Web of Science, Embase, Google Scholars, Cochrane and CINAHL using the following entries: Rett syndrome (n = 3790), Oral health and Rett syndrome (n = 17), dental health of Rett syndrome patients (n = 13), and the MeSH terms listed below: Rett syndrome and Oral Health (n = 17), Rett syndrome and dentistry (n = 29). The final review included 22 search articles. The most common oral findings was bruxism. Masseteric hypertrophy was also reported. Anterior open bite and non-physiological tooth wear was observed. Other oral manifestations of Rett syndrome included mouth breathing, tongue thrusting, digit/thumb sucking, high arch palate. Increased awareness and dental education amongst dentists and assistants regarding the dental manifestations of Rett syndrome and similar neurodevelopmental disorders is required to improve the level of care and empathy they can provide to these differently able patients. Research on dental aspects of Rett is scarce and this remains a neglected topic

Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance

Background: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. Methods: Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM's official archives in Rome. Results and Conclusions: The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers

Relationship between Socioeconomic Inequalities and Oral Hygiene Indicators in Private and Public Schools in Karachi: An Observational Study

Background: The study investigated the relationship between socioeconomic status and oral hygiene indicators in two schools located in Karachi, Pakistan. Oral hygiene indicators of public and private school children were compared. Private schools cater to children of relatively wealthier families compared to public school, whose attendees are generally children from less affluent backgrounds. The aim of this study was to determine whether socio-economic differences and inequalities have an impact on key oral hygiene indicators. Methodology: Primary data for this research was collected from community school visits conducted by the community dentistry department of Jinnah Medical and Dental and Medical College from January to September 2019. A convenience sample of the two schools, comprising 300 school students was selected. Data was collected using modified World Health Organization (WHO) oral health care forms. A pre-tested/customized dental hygiene form based on WHO forms was created by the research team. This form was used to measure DMFT/dmft scores and key oral hygiene indicators in the sample. Results: A total sample size of 300 school-children affiliated with public and private schools was selected. The children’s age ranged from 2 to 18 years. The mean DMFT scores of private and public-school children were not significantly different (private (1.82) vs. public (1.48)). (p = 0.257). The mean of carious teeth was 1.69 in private school children compared to 1.34 in government school children, whereas the mean values of other key indicators of oral hygiene including plaque deposition (p = 0.001), dental stains (p < 0.001) and bleeding gums/gingivitis (p < 0.001), were statistically significant between public and private school children. Conclusion: Oral health inequalities can be reduced with increased awareness and public funding to cater for the oral health needs of children of less affluent families. A dynamic and practical community-oriented program is fundamental for enhancing pediatric oral hygiene status, particularly for children attending government schools

Telerehabilitation: Review of the State-of-the-Art and Areas of Application

BACKGROUND: Telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Various types of telerehabilitation treatments and their relative intensities and duration have been reported. OBJECTIVE: The objective of this review is to provide a detailed overview of the rehabilitation techniques for remote sites (telerehabilitation) and their fields of application, with analysis of the benefits and the drawbacks related to use. We discuss future applications of telerehabilitation techniques with an emphasis on the development of high-tech devices, and on which new tools and applications can be used in the future. METHODS: We retrieved relevant information and data on telerehabilitation from books, articles and online materials using the Medical Subject Headings (MeSH) "telerehabilitation," "telemedicine," and "rehabilitation," as well as "disabling pathologies." RESULTS: Telerehabilitation can be considered as a branch of telemedicine. Although this field is considerably new, its use has rapidly grown in developed countries. In general, telerehabilitation reduces the costs of both health care providers and patients compared with traditional inpatient or person-to-person rehabilitation. Furthermore, patients who live in remote places, where traditional rehabilitation services may not be easily accessible, can benefit from this technology. However, certain disadvantages of telerehabilitation, including skepticism on the part of patients due to remote interaction with their physicians or rehabilitators, should not be underestimated. CONCLUSIONS: This review evaluated different application fields of telerehabilitation, highlighting its benefits and drawbacks. This study may be a starting point for improving approaches and devices for telerehabilitation. In this context, patients' feedback may be important to adapt rehabilitation techniques and approaches to their needs, which would subsequently help to improve the quality of rehabilitation in the future. The need for proper training and education of people involved in this new and emerging form of intervention for more effective treatment can't be overstated