Hypertension among Danish seafarers

Background: Due to the high prevalence of arterial hypertension and its role in the development of atherosclerosis, myocardial infarction and stroke, hypertension is a major public health challenge worldwide. There is limited knowledge of the prevalence of hypertension among seafarers who, however, are known to have an excess morbidity and mortality from these disorders. This article addresses the prevalence of hypertension among Danish seafarers and discusses potential risk factors for hypertension in maritime settings. Materials and methods: A representative sample of 629 Danish seafarers who had statutory medical examinations was studied from the beginning of October 2011 to the end of June 2012. The medical examination included measurements of blood pressure. The prevalence of hypertension in the study population was stratified by age, work place on board, smoking status, alcohol intake, and body mass index. Results: The overall prevalence of hypertension in the study population was 44.7% (95% CI 40.8–48.6). In a comparison sample of adult Danes, the crude rate of hypertension was 12.6%. In addition, 41.8% (95% CI 38.0–45.7) of seafarers were pre-hypertensive. Hypertension was particularly increased among younger seafarers. The proportion of seafarers in antihypertensive treatment was low, in particular among the young seafarers. Conclusions: Hypertension is a major health issue among Danish seafarers. In addition to ensuring antihypertensive treatment when needed, individual and collective prevention should address lifestyle issues as well as physical and psychosocial exposures at sea

Can testing of six individual muscles represent a screening approach to upper limb neuropathic conditions? Jørgen Riis Jepsen 1,2 Jose Hernán Alfonso 3,4

Originales[ES] Antecedentes: Se ha demostrado anteriormente que un examen neurológico exhaustivo de la función muscular individual de los miembros superiores, de la sensación en zonas inervadas homónimas y la alodinia en nervios y tronco es confiable y el resultado refleja los síntomas. Debido a que este enfoque puede parecer complicado y que requiere mucho tiempo, este estudio se ocupa de la validez de un examen que se limita al chequeo manual de sólo seis músculos.Métodos: Dos examinadores cegados al estado de los síntomas realizaron exámenes musculares de manera manual de seis músculos en 82 miembros superiores con o sin dolor, debilidad y/o entumecimiento/ hormigueo. Los seis músculos representan tres pares antagonistas (pectoral mayor/ deltoideo posterior, bíceps/tríceps y flexor radial de la muñeca/extensor radial corto de la muñeca). La fiabilidad entre calificadores para detectar debilidades musculares y la relación de la debilidad con los síntomas mencionados se analizaron por medio de la analisis kappa.Resultados: Los dos examinadores reconocieron debilidad en 48 y 55 miembros respectivamente, con una coincidencia moderada (valor mediano de kappa = 0,58). De estos, 35 y 32 miembros respectivamente fueron sintomáticos. Hubo una buena correlación entre los hallazgos y los síntomas para un examinador (kappa = 0,61) y una correlación justa para el otro (kappa = 0,33). La sensibilidad fue alta (0,92 y 0,84) para ambos, pero la especificidad menos satisfactoria (0,70 y 0,50). La debilidad tuvo una correlación moderada con los síntomas (kappa = 0,57) para los dos examinadores.Conclusiones: Debilidad muscular en uno o más músculos estuvo presente en casi todos los miembros sintomáticos pero también en muchos miembros asintomáticos. El examen manual de seis músculos puede representar un enfoque diagnóstico para los trastornos neuropáticos de miembros superiores pero un diagnóstico confirmativo requiere más evaluaciones.[EN] .Background: It has previously been demonstrated that an extensive upper limb neurological examination of individual muscle function, sensation in homonymous innervated territories, and nerve trunk allodynia is reliable and that the outcome reflects symptoms. Since this approach may appear complicated and time consuming, this study deals with the value of an examination limited to manual testing of only six muscles.Methods: Two examiners blinded to symptom status performed manual muscle testing of six muscles in 82 upper limbs with or without pain, weakness, and/or numbness/tingling. The six muscles represent three antagonist pairs (pectoralis major/posterior deltoid, biceps/triceps, and radial flexor of wrist/short radial extensor of wrist). The inter-rater reliability of detecting muscular weaknesses and the relation of weakness to the mentioned symptoms were analysed by kappa-statistics.Results: The two examiners recognized weaknesses in 48 and 55 limbs, respectively, with moderate agreement (median kappa = 0.58). Out of these, 35 and 32 limbs, respectively, were symptomatic. There was good correlation between findings and symptoms for one examiner (kappa = 0.61) and fair correlation for the other one (kappa = 0.33). Both reached high sensitivity (0.92, 0.84) but less satisfactory specificity (0.70, 0.50). Weaknesses agreed upon by the two examiners correlated moderately with symptoms (kappa = 0.57).Conclusions: Weakness in one or more muscles was present in almost all symptomatic limbs but in many non-symptomatic limbs as well. Manual testing of six muscles may represent a useful screening approach to upper limb neuropathic conditions, but a confirmative diagnosis requires further assessment.N