Collaborative, cross-national studies on health and safety in seafaring for evidence-based maritime policy and regulations

Background. Until recently, maritime health and safety policies and regulations were sparsely based on health and safety research, and only a small number of countries contributed to new research. Objectives. To strengthen maritime health and safety research activities by presenting a study example and discussing the possibilities and needs for more national and cross-national research. Methods. In a cross-national epidemiological study example, the seafarers from eleven countries completed small, anonymous questionnaires concerning the working conditions on their latest tours at sea while waiting for their health examinations. Results. Significant disparities were pointed out among the nationalities, e.g., the length of the tours at sea, the proportional distribution of officers and non-officers, the mean age structure, the injury incidence rates, and the differences of occupational safety standards. The analysis of all data together increased the statistical strength of the multivariate analyses and allowed for valid comparisons among the nationalities. Conclusions. The questionnaire data was used successfully in the collaborative study example, but other data sources and methods are useful for health and safety research in seafaring as well. More national and cross-national research on maritime health and safety is warranted

Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997–2012

Background: Telemedical Maritime Assistance Service (TMAS) for seafarers and traveling passengers is important and can be crucial for the optimal medical treatment on board ships. The aim of this study was to analyse and to compare the data from consultations and evacuations from merchant ships and passenger ferries for possible improvements. Materials and methods: Data for seafarers from 1997, 2002 and 2007 and for passengers on Swedish ferries for the years 2007, 2009, 2011 and 2012 from the Swedish Radio Medical were studied. Symptoms and diseases were classified according to the International Classification for Primary Care (ICPC-2). The distribution of symptoms, accidents and diseases, treatments/actions taken, evacuations and the communication forms were analysed. Results: One thousand ninety-five contacts for seafarers from merchant ships and 651 passenger patients from Swedish ferries were analysed. While the evacuations for the seafarers gradually decreased over the years from 18% in 1997 to 14% in 2007, still 39.5% of the passenger patient contacts were evacuated mainly by helicopters and 70 patients were picked up by an ambulance on the quay. Accidents were 20% for seafarers and 25% for passengers of the contacts. Evacuations for passengers were mainly in the diagnostic groups: unspecific (A), digestive (D), cardiology (K), musculoskeletal (L) and neurology (N). The use of VHF, radio communications and fax machines have been greatly reduced while the use of e-mail and satellite phone increased. Conclusions: No significant differences in reasons for contact or actions over the years have been identified. The evacuations of seafarers decreased over the years but was stable among the passenger patients (39%). The circumstances and reasons behind the evacuations should be analysed for prevention. Standard forms and digital images for documentation can facilitate knowledge exchange and further studies.

A review of fatal accident incidence rate trends in fishing

Background: Injury prevention in fishing is one of the most important occupational health challenges.Aim: The aim was to describe and compare internationally the trends of the fatal injury incidence rates and to discuss the impact of the implemented safety programs.Materials and methods: The review is based on journal articles and reports from the maritime authorities in Poland, United Kingdom, Norway, Iceland, Denmark, United States and Alaska and Canada. The original incidence rates were recalculated as per 1,000 person-years for international comparison of the trends.Results: The risk of fatal accidents in fishing in the northern countries has been reduced by around 50% to an average of about 1 per 1,000 person-years. Norway and Canada keep the lowest rates with around 0.5 and 0.25 per 1,000 person-years. About half of the fatal injuries are related to vessel disasters and drowning. The safety programs seem to have good effects, but the risk is still about 25 to 50 times higher than for onshore workers.Conclusions: The overall fatal injury rates in the European and North American studies decreased by around 50% most probably as result of the implemented safety programs. However the high risk in fishing compared to onshore workers calls for continued and intensified safety programs

A review of fatigue in fishermen: a complicated and underprioritised area of research

Background: Fatigue in fishing has been a highly underprioritised area of research, even though fatigue has been found to be the largest single contributing factor in accidents.Aim: The aim of this article/paper is to provide an overview of the research conducted on fatigue in fishermen up to date, in order to establish a starting point for further research in this area.Materials and methods: The review is mainly based on journal articles from PubMed, Google Scholar, International Maritime Health, Science Direct and some relevant articles links were also followed.Results: The research revealed that only 5 articles have been published concerning fatigue in fishermen.The articles all confirmed that fatigue is a serious health and safety issue among fishermen, and that further research therefore is warranted.Conclusions: Only 2 of the 5 studies of fishermen’s fatigue used objective measures and in one of these, the sample size was small (n = 19), effectively limiting the statistical analysis and its application. Further research using larger samples is needed, preferably with a mix of objective and subjective measures, where of some of the questions should be scenario based and some should be from standardised questionnaires. Greater understanding is also needed to assess how much of the variance in fatigue is attributable to e.g. length of trip, hours of work without rest, and type of job and specific tasks. A greater understanding of the similarities and differences between acute and long-term fatigue is also needed

Social security for seafarers globally

Background: The social security protection is one of the essential elements of decent work. The issue is complexand no previous epidemiological studies of the coverage among the seafarers have yet been performed.Aim: The aim was to overcome the gap of knowledge to promote the further discussion and plan the implementationof the social security for all the seafarers.Materials and methods: The seafarers completed a short questionnaire concerning their knowledge abouttheir social security status.Results: The significant disparities in the social security coverage were pointed out among the nationalities.Especially it is worth mentioning that more than half of the respondents believe they are economicallyuncovered for disability from an injury on board and from a work-related disease.Conclusions: The results confirm the ILO (Convention No. 143) statements that the significant part of theseafarers comes from the poorer countries without the substantial social security systems. The solutionssuggested are to implement the minimum requirements as recommended by the ILO 2006 Convention, tosurvey the implementation and — in the long term — to struggle for a global social equality

Logarithmic Corrections in Dynamic Isotropic Percolation

Based on the field theoretic formulation of the general epidemic process we study logarithmic corrections to scaling in dynamic isotropic percolation at the upper critical dimension d=6. Employing renormalization group methods we determine these corrections for some of the most interesting time dependent observables in dynamic percolation at the critical point up to and including the next to leading correction. For clusters emanating from a local seed at the origin we calculate the number of active sites, the survival probability as well as the radius of gyration.Comment: 9 pages, 3 figures, version to appear in Phys. Rev.

Coastal Wetland Restoration through the lens of Odum\u27s theory of ecosystem development

Advancing ecological restoration assessments requires a more detailed consideration of species interactions and ecosystem processes. Most restoration projects rely on a few metrics not always directly linked with ecological theory. Here, we used Odum\u27s theory of ecosystem development to assess and compare the ecosystem structure and services of created marshes (4–6 years old) with preexisting, reference marshes in a brackish water region of the Mississippi River Delta. We built ecosystem models for created and reference marshes that integrated large datasets of stomach contents, stable isotopes, and taxa abundances. Despite strong resemblance in community structure, created marshes were at an earlier succession stage compared to the reference marshes, having lower biomass (including exploited species), higher biomass turnover and production, less dependence on detritus, lower material cycling, and less energy flowing through specialist pathways. Although preserving preexisting marshes should be a priority, created marshes may still be an important tool for the restoration of coastal areas and their ecosystem services. In addition, our results show that comparisons of species biodiversity alone may fail to capture essential differences in ecosystem processes between habitats, which reinforces the importance of ecosystem modeling approaches to assess restoration projects

Can biodiversity of preexisting and created salt marshes match across scales? An assessment from microbes to predators

Coastal wetlands are rapidly disappearing worldwide due to a variety of processes, including climate change and flood control. The rate of loss in the Mississippi River Delta is among the highest in the world and billions of dollars have been allocated to build and restore coastal wetlands. A key question guiding assessment is whether created coastal salt marshes have similar biodiversity to preexisting, reference marshes. However, the numerous biodiversity metrics used to make these determinations are typically scale dependent and often conflicting. Here, we applied ecological theory to compare the diversity of different assemblages (surface and below-surface soil microbes, plants, macroinfauna, spiders, and on-marsh and off-marsh nekton) between two created marshes (4–6 years old) and four reference marshes. We also quantified the scale-dependent effects of species abundance distribution, aggregation, and density on richness differences and explored differences in species composition. Total, between-sample, and within-sample diversity (γ, β, and α, respectively) were not consistently lower at created marshes. Richness decomposition varied greatly among assemblages and marshes (e.g., soil microbes showed high equitability and α diversity, but plant diversity was restricted to a few dominant species with high aggregation). However, species abundance distribution, aggregation, and density patterns were not directly associated with differences between created and reference marshes. One exception was considerably lower density for macroinfauna at one of the created marshes, which was drier because of being at a higher elevation and having coarser substrate compared with the other marshes. The community compositions of created marshes were more dissimilar than reference marshes for microbe and macroinfauna assemblages. However, differences were small, particularly for microbes. Together, our results suggest generally similar taxonomic diversity and composition between created and reference marshes. This provides support for the creation of marsh habitat as tools for the maintenance and restoration of coastal biodiversity. However, caution is needed when creating marshes because specific building and restoration plans may lead to different colonization patterns

Agents intervening against delirium in the intensive care unit (AID-ICU) - Protocol for a randomised placebo-controlled trial of haloperidol in patients with delirium in the ICU

Background Delirium among patients in the intensive care unit (ICU) is a common condition associated with increased morbidity and mortality. Haloperidol is the most frequently used pharmacologic intervention, but its use is not supported by firm evidence. Therefore, we are conducting Agents Intervening against Delirium in the Intensive Care Unit (AID‐ICU) trial to assess the benefits and harms of haloperidol for the treatment of ICU‐acquired delirium. Methods AID‐ICU is an investigator‐initiated, pragmatic, international, randomised, blinded, parallel‐group, trial allocating adult ICU patients with manifest delirium 1:1 to haloperidol or placebo. Trial participants will receive intravenous 2.5 mg haloperidol three times daily or matching placebo (isotonic saline 0.9%) if they are delirious. If needed, a maximum of 20 mg/daily haloperidol/placebo is given. An escape protocol, not including haloperidol, is part of the trial protocol. The primary outcome is days alive out of the hospital within 90 days post‐randomisation. Secondary outcomes are number of days without delirium or coma, serious adverse reactions to haloperidol, usage of escape medication, number of days alive without mechanical ventilation; mortality, health‐related quality‐of‐life and cognitive function at 1‐year follow‐up. A sample size of 1000 patients is required to detect a 7‐day improvement or worsening of the mean days alive out of the hospital, type 1 error risk of 5% and power 90%. Perspective The AID‐ICU trial is based on gold standard methodology applied to a large sample of clinically representative patients and will provide pivotal high‐quality data on the benefits and harms of haloperidol for the treatment ICU‐acquired delirium