Risk of cardiovascular diseases in seafarers

Seafarers experience a lot of job-related risk factors for cardiovascular diseases (CVD). Considering the healthy-worker effect due to the biennial pre-employment examination and the periodical medical fitness tests, a (slightly) elevated risk for CVD among seafarers is assumed compared to the reference population ashore. In seafaring, the most important, influenceable risk factors for CVD refer to the ship-specific stress situation, the malnutrition and the lack of exercises on board. Furthermore, the prognosis of acute severe CVD often depends on the measures taken in the first few hours after occurrence of the symptoms. Owing to the lack of health professionals on board and the limited treatment options of events at sea, effective cardio-pulmonary resuscitation is often delayed and the outcome of cardiac events is worse compared to that ashore

Maritime field studies: methods for exploring seafarers’ physical activity

In order to determine the health status of seafarers, questionnaires are frequently applied or medical/ /psychological examinations conducted ashore, for example, in the form of medical fitness examinations or simulator training. In such a survey design, the occupational influences and the individual reaction cannot be ascertained. However, these aspects are especially important in the maritime context as employees on board are often exposed to the typical shipping-related stressors in the workplace for many months, both during working hours and during leisure time. In particular, it is assumed that working on board requires a high level of physical effort. Therefore, an exploration of occupational stress and strain, particularly the assessment of the seafarers’ physical activity, should preferably be carried out in a comprehensive and realistic way in a maritime field study, i.e. an on-the-job survey directly on board

Non-cancer diseases requiring admission to hospital among German seafarers

Background: This study estimated the discharge diagnosis due to non-cancer diseases of German seamen employed on German vessels in comparison to the general German male population. Materials and methods: In a database, the German health insurance company for seafarers determined the discharge diagnoses from hospital for all German seafarers. In the time period from January 1997 to December 2007, this database encompassed on average more than 21,000 German seamen per year. It served as a source for comparison with the official national database on discharge diagnoses from the general German population. Thus, the standardised hospitalisation ratio (SHR) could be calculated. Results: During the above mentioned time period, the most prominent non-cancer diagnoses among seafarers were diseases of the circulatory system, diseases of the digestive system, diseases of the musculoskeletal system, as well as injury and poisoning. Compared to the reference population, decreased SHRs were observed for almost all examined diseases with the exception of asbestosis (SHR: 1.79; 95% CI 0.65–3.90). In contrast to the deck and engine room crew, the galley staff demonstrated an increased SHR for almost all examined diseases, particularly for lifestyle-related diseases. Conclusions: Although the presented data are likely biased by the healthy worker effect and by underreporting due to treatment on board or abroad, an elevated SHR for (lifestyle-related) diseases was observed in the galley staff. Therefore, especially this occupational group seems to need specific advice on healthy behaviours both on board and ashore

Maize pollen is an important allergen in occupationally exposed workers

<p>Abstract</p> <p>Background</p> <p>The work- or environmental-related type I sensitization to maize pollen is hardly investigated. We sought to determine the prevalence of sensitization to maize pollen among exposed workers and to identify the eliciting allergens.</p> <p>Methods</p> <p>In July 2010, 8 out of 11 subjects were examined who were repeatedly exposed to maize pollen by pollinating maize during their work in a biological research department. All 8 filled in a questionnaire and underwent skin prick testing (SPT) and immune-specific analyses.</p> <p>Results</p> <p>5 out of the 8 exposed subjects had repeatedly suffered for at least several weeks from rhinitis, 4 from conjunctivitis, 4 from urticaria, and 2 from shortness of breath upon occupational exposure to maize pollen. All symptomatic workers had specific IgE antibodies against maize pollen (CAP class ≥ 1). Interestingly, 4 of the 5 maize pollen-allergic subjects, but none of the 3 asymptomatic exposed workers had IgE antibodies specific for grass pollen. All but one of the maize pollen-allergic subjects had suffered from allergic grass pollen-related symptoms for 6 to 11 years before job-related exposure to maize pollen. Lung function testing was normal in all cases. In immunoblot analyses, the allergenic components could be identified as Zea m 1 and Zea m 13. The reactivity is mostly caused by cross-reactivity to the homologous allergens in temperate grass pollen. Two sera responded to Zea m 3, but interestingly not to the corresponding timothy allergen indicating maize-specific IgE reactivity.</p> <p>Conclusion</p> <p>The present data suggest that subjects pollinating maize are at high risk of developing an allergy to maize pollen as a so far underestimated source of occupational allergens. For the screening of patients with suspected maize pollen sensitization, the determination of IgE antibodies specific for maize pollen is suitable.</p

The Hamburg Port Health Center: history, organisation, activities

Controlling hygiene conditions and the state of health on incoming vessels and in ports are the tasks of port health authorities. In Hamburg, the respective department (also responsible for the local airport) is combined with the research department Maritime Medicine. Both departments represent the Hamburg Port Health Center and are part of the Central Institute and Professorship of Occupational Medicine (&#8220;ZfA&#8221;). This arrangement has proven to be very effective since it connects routine control activities with research on the work related health risks of seafarers and dockers, and their minimalization. Examples are the improvement of various work conditions on board and of life saving equipment including telemedicine devices, investigations of action of toxic substances and allergic disorders caused by the transport of hazardous cargo. The recent activities of the Center are presented in detail in this paper. The Central Institute of Occupational Medicine (&#8220;ZfA&#8221;), Department Science and Health of the Free and Hanseatic Town of Hamburg, is affiliated with the Medical Faculty of Hamburg University and is a WHO Collaborating Centre on Occupational Health. An essential task of the institute is conducting of scientific and practice-oriented investigations on the relations between the health of seafarers and dockers and their work and on prevention of accidents and diseases among them. The Institute pursues its tasks in the field of research, education, consultation and care of patients as well as in training of students, physicians and scientists in the departments Clinical Occupational Medicine, Occupational Toxicology and Molecular Biology, Allergology, and Mental Stress and Strain. The Hamburg Port Health Center with its Port and Airport Health Authority and Maritime Medicine department is also part of the Institute (ZfA). The activities are presented

Overview and prospect: food and nutrition of seafarers on merchant ships

During stay on board, seafarers have limited influence on quality and quantity of food over several months. Furthermore, the nutrition on board is characterised by different dietary habits in the multi-ethnic crews, differential food supply in crew’s and officers’ mess room and irregular mealtimes due to the shifts on board. Internationally, nutritional situation on board is not standardised, but reflects the flag-state standard. Up to date, there is only little comprehensive research published concerning food patterns of seafarers; these studies often lack in objective examination methods to estimate the actual food intake and activity-related energy requirements. Therefore, to examine the food and nutrition of seafarers, shipping companies should be interviewed about food provisions on board, and seafarers about eating habits in consideration of possible socio-cultural and psychological backgrounds for malnutrition. These studies should also encompass seafarers’ health parameters related to nutrition on board (energy consumption, bioelectrical impedance analysis, ergospirometry and blood analysis). In total, further research directly on board is needed to know more about seafarers’ food and nutrition situation at sea

The risk of coronary heart disease of seafarers on vessels sailing under a German flag

Background. This study aimed to predict the risk of coronary heart disease (CHD) among seafarers on German-flagged vessels and to assess the association of shipboard job duration at sea with the risk of CHD. Material and methods. During the legally required medical fitness test for nautical service, 161 seafarers in Hamburg participated in a cross-sectional study which included an interview, blood sampling, and blood pressure measurements (response 84.9%). The predicted 10-year risk of an acute coronary event of the examined German seafarers aged 35 to 64 years (n = 46) was assessed in comparison with a sample of male German employees of the same age working ashore (PROCAM study). The number of independent CHD risk factors (according to the PROCAM study) was compared in the groups with &#8216;shorter&#8217; and &#8216;longer&#8217; median shipboard job duration at sea (15.0 years). Results. The examined German seafarers had a similar age-standardized predicted 10-year CHD risk as the German reference population. Nearly all independent CHD risk factors were significantly more frequent in seamen with job duration at sea of &#8805; 15 years than in those with < 15 years. After adjusting for age, the number of CHD risk factors was associated with job duration (OR 1.08 [95% CI 1.02-1.14] per year). Conclusions. Seafarers on German-flagged ships have to attend a medical fitness test for nautical service every 2 years. Thus, it can be assumed that seafarers present a healthier population than employees ashore. In this study, however, CHD risk of seafarers was similar to that of the reference population. This may indicate that working onboard implies a high coronary risk. Furthermore, the study results suggest a tendency of increased risk of CHD among seafarers with longer job duration at sea

Objective and subjective measures to assess stress among seafarers

Background: Working and living on board merchant vessels often constitute high psychophysical stress for the crews. In this study, the current stress of seafarers is examined by using observation-based and subjective measures. Materials and methods: The workplaces of 70 crew members on board 11 container ships were analysed and evaluated using the objective instrument for the situational screening of mental workload (SMW-S). In addition, standardised interviews were carried out with 198 seafarers about their subjectively experienced stress. Results: According to SMW-S, nautical and technical officers experience psychological strain due to their limited decision latitude, risky work situations and the physical and psychosocial working conditions. Among the ratings, psychological distress is more likely due to the limited decision latitude, physical and psychosocial working conditions and low qualification requirements (and, for the engine room ratings, given the low complexity and variability in their work). The interview results show that the irregular work is stressful for 79% of seafarers, the long working periods for 77%, the long working hours per day for 69% and working under time pressure for 62%. Additional psychosocial burdens are present for 95% of seafarers due to family separation and for 65% due to existing social differences in a multicultural occupation. Conclusions: Considering the stressful work on board, particular attention must be paid to shipping-specific conditions such as long working times, family and socio-cultural separation and living together in a heterogeneous crew

Training seafarers to deal with multicultural crew members and stress on board

Background: The present study describes the intercultural differences in the perception of stress and the preparation of seafarers.Materials and methods: Three hundred twenty-three seafarers (156 [48.3%] Europeans and 167 [51.7%] Southeast Asians) were interviewed about their subjective stress on board. Results: According to the interviews with ship’s officers, mostly represented by Europeans, mental stress was most often due to high responsibilities (82.0%), extensive administrative tasks (81.1%) and lack of qualification of seafarers (64.8%). Subjectively, the Europeans questioned were significantly more likely to experience mental stress on board than the Southeast Asians (74.2% vs. 56.3%), whereas the latter were more prone to being physically stressed. 43.1% of the Southeast Asian seafarers often felt lonely on board compared with 26.2% of the Europeans. Preparation for maritime-specific stress in the form of specific training units is only provided in 1 of the 5 universities surveyed. The most important reason for this is a lack of time. Intercultural leadership training was also only offered at one university.Conclusions: In view of the many psychophysical stressors in daily life on a ship and the lacking respective education, it is recommended to integrate stress management and diversity training in intercultural communication in the higher education of future superiors on board

Public health significance of chickenpox on ships - conclusions drawn from a case series in the port of Hamburg

Background: Despite international notification requirements, the magnitude of disease transmission on board ships remains undetermined. This case series aims to exemplify that varicella aboard ships is a topic of interest for maritime medicine and of public health significance. Material and methods: Systematic presentation of cases of chickenpox reported to the Hamburg Port Health Authority between November 2007 and April 2008. A systematic literature search on 'ships and chickenpox' was performed. Results: Five crew cases of chickenpox were reported from two passenger ships and two cargo ships. The cases originated from Indonesia (2), the Philippines (1), and Sri Lanka (2). Three cases were notified by the shipmaster, one by a general practitioner, and one by the immigration service. Sources of infection were other crewmembers, passengers, and persons in the home countries. Conclusions: This description of five varicella cases aboard ships points to the significance of the disease among seafarers. Many seafarers originate from tropical countries where seroconversion to varicella zoster virus generally occurs in late adolescents and adults. Thus, a substantial portion of the crew may be non-immune and have the potential to introduce the disease from their home country to the ship, or are at risk for infection on the ship. Port health authorities, shipmasters, and doctors need to be well informed about the relevance of chickenpox on ships and the recommended control measures. Travellers should be advised to report to the ship doctor with any signs of infectious disease. Int Marit Health 2010; 61, 1: 28-3