"Injury, illness, and work restriction in merchant seafarers"

What is known about cardiovascular diseases among seafarers: A systematic scoping review and quality assessment

BACKGROUND

Seafarers are at an increased risk of developing cardiovascular diseases (CVDs), potentially due to a stressful working environment and behavioral risk factors. To develop better prevention strategies, it is important to elucidate the extent of this risk. Therefore, we conducted a systematic literature review on CVD in seafarers.

METHOD

We conducted systematic searches in five databases. All studies investigating CVDs among occupational seafarers, published in articles or conference papers, were eligible for inclusion. The identified records were screened and reviewed by two independent researchers, who also evaluated the methodological quality of the included studies.

RESULTS

Three thousand nine hundred and seventeen records qualified for screening, and 55 were eligible for inclusion. Most of the studies were observational, including cohort, frequency, incidence or prevalence studies, and review of case records. Around half were assessed at risk of biased findings. Participants in the studies were primarily from North America or the European continent and work onboard transportation vessels. Many studies investigated CVDs as a cause of death, focusing on conditions such as CVD, ischemic heart disease, and myocardial infarction. Frequency of CVD conditions varied but indicate that seafarers face a greater risk compared to the reference populations or control groups. Environmental factors were mainly investigated as risk factors.

CONCLUSION

Our results indicate a higher risk of CVDs among seafarers compared to reference or control groups. However, due to the variable quality of the evidence, well-designed studies are needed to establish the causes of cardiovascular mortality and morbidity in seafarers and to investigate behavioral aspects of cardiovascular risk.

Recipe for fatigue: sleep, work patterns, and well-being of galley workers on surface ships of the US Navy

Study Objectives

The purpose of the study was to compare the fatigue levels, work/rest patterns, health-related behaviors, and well-being of galley workers with other sailors on US Navy ships while underway.

Methods

Analysis was based on a retrospective comparison of data from 3 fit-for-duty groups of sailors: 67 galley workers, 192 non-watchstanders, and 466 watchstanders. Participants completed questionnaires (Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI], Pittsburgh Sleep Quality Index [PSQI], and Profile of Mood States [POMS]) and activity logs, and wore actigraphs.

Results

Galley workers slept MD = 6.57 (IQR = 1.42) h/d and worked MD = 12.8 (IQR = 2.42) h/d. Approximately 84% of the galley workers were classified as poor sleepers, ~57% reported having excessive daytime sleepiness (EDS), and ~38% reported elevated insomnia symptoms. Compared to non-watchstanders, galley workers had worse scores on POMS (total mood disturbance, tension-anxiety, depression, anger-hostility, fatigue, and confusion-bewilderment), ESS, ISI, and PSQI. Compared to non-watchstanders, galley workers had a higher risk for symptoms of EDS (75%), symptoms of clinically relevant insomnia (126%), and for being classified as poor sleepers (27%). Galley workers slept less and worked on average 2 h/d more than non-watchstanders. Compared to watchstanders, galley workers had worse ESS, ISI, and anger-hostility scores. More watchstanders napped compared to galley workers.

Conclusions

Although they are considered day workers, the sleep patterns, fatigue levels, and mood of galley workers are comparable to, or worse than, watchstanders or other non-watchstanders. To ameliorate the effects of long work hours on sailor well-being, ship leadership should consider adopting strategies to improve galley workers' well-being.

Incidence of occupational injuries and diseases among seafarers: a descriptive epidemiological study based on contacts from onboard ships to the Italian Telemedical Maritime Assistance Service in Rome, Italy

OBJECTIVES

Workers at sea have high mortality, injuries and illnesses and work in a hazardous environment compared to ashore workers. The present study was designed to measure the incidence of occupational injuries and diseases among seafarers and quantify the contribution of differences in rank and job onboard on seafarers' diseases and injuries rates.

DESIGN

Descriptive epidemiological study.

SETTING AND PARTICIPANTS

This study's data were based on contacts (n=423) for medical requests from Compagnie Maritime d'Affrètement/Compagnie Générale Maritime (CMA-CGM) container ships to the Italian Telemedical Maritime Assistance Service in Rome from 2016 to 2019, supplemented by data on the estimated total at-risk seafarer population on container ships (n=13 475) over the study period.

OUTCOME MEASURES

Distribution of injuries by anatomic location and types of diseases across seafarers' ranks and worksites. We determined the incidence rate and incidence rate ratio (IRR) with a 95% CI.

RESULTS

The total disease rate was 25 per 1000 seafarer-years, and the overall injury rate was 6.31 per 1000 seafarer-years over the 4 years study period. Non-officers were more likely than officers to have reported gastrointestinal (IRR 2.12, 95% CI 1.13 to 4.26), dermatological (IRR 3.66, 95% CI 1.27 to 14.42) and musculoskeletal (IRR 2.25, 95% CI 1.11 to 5.05) disorders onboard container ships. Deck workers were more likely than engine workers to be injured in the wrist and hand (IRR 3.25, 95% CI 1.19 to 10.23).

CONCLUSIONS

Rates of reported injury and disease were significantly higher among non- officers than officers; thus, this study suggests the need for rank-specific preventative measures. Future studies should consider risk factors for injury and disease among seafarers in order to propose further preventive measures.

Occupational, physical, sexual and mental health and violence among migrant and trafficked commercial fishers and seafarers from the Greater Mekong Subregion (GMS): systematic review

Background

Little is known about the health of GMS commercial fishers and seafarers, many of whom are migrants and some trafficked. This systematic review summarizes evidence on occupational, physical, sexual and mental health and violence among GMS commercial fishers/seafarers.

Methods

We searched 5 electronic databases and purposively searched grey literature. Quantitative or qualitative studies reporting prevalence or risk of relevant outcomes were included. Two reviewers independently screened articles. Data were extracted on nationality and long/short-haul fishing where available.

Results

We identified 33 eligible papers from 27 studies. Trafficked fishers/seafarers were included in n=12/13 grey literature and n=1/20 peer-reviewed papers. Among peer-reviewed papers: 11 focused on HIV/AIDS/sexual health; nine on occupational/physical health; one study included mental health of trafficked fishers. Violence was quantitatively measured in eight papers with prevalence of: 11-26% in port convenience samples; 68-100% in post-trafficking service samples. Commercial fishers/seafarers whether trafficked or not worked extremely long hours; trafficked long-haul fishers had very limited access to care following injuries or illness. Lesser-known risks reported among fishers included penile oil injections and beriberi. We found just one work safety intervention study and inconclusive evidence for differences in the outcomes by nationality. Findings are limited by methodological weaknesses of primary studies.

Conclusion

Results show an absence of high-quality epidemiological studies beyond sexual health. Formative and pilot intervention research on occupational, physical and mental health among GMS commercial fishers and seafarers is needed. Future studies should include questions about violence and exploitation. Ethical and reporting standards of grey literature should be improved.

Trial Registration

Review registration number: PROSPERO 2014: CRD42014009656.

Injury, illness, and disability risk in American seafarers

BACKGROUND

Seafarers are an understudied and essential workforce, isolated from medical care. This study describes injuries, illness, and risk factors for resultant disability in one shipping company with a majority of American seafarers.

METHODS

The study used a telemedicine database of injury and illness incidence in seafarers, and applied descriptive statistical methods and logistic regression modeling.

RESULTS

Illnesses were more frequently reported than injuries (860 vs 479). The overall injury rate was 113 per 1000 person-years, and the overall illness rate was 211 per 1000 person-years. Seafarer ratings had higher risk for disability compared to officers (OR = 1.60; 95%CI 1.17, 2.18), and incidents on dry cargo ships (OR = 2.70; 95%CI 1.49, 4.91) and articulated tug-barges (ATBs) (OR = 2.21; 95%CI 1.26, 3.86) had higher disability risk compared to container vessels.

CONCLUSION

Additional research in this vital American workforce may be useful to confirm these findings forming a basis for preventive interventions.

The costs of repatriating an ill seafarer: a micro-costing approach

Seafarers sail the high seas around the globe. In case of illness, they are protected by international regulations stating that the employers must pay all expenses in relation to repatriation, but very little is known about the cost of these repatriations. The objective of this study was to estimate the financial burden of repatriations in case of illness. We applied a local approach, a micro-costing method, with an employer perspective using four case vignettes: I) Acute myocardial infarction (AMI), II) Malignant hypertension, III) Appendicitis and IV) Malaria. Direct cost data were derived from the Danish Maritime Authority while for indirect costs estimations were applied using the friction cost approach. The average total costs of repatriation varied for the four case vignettes; AMI (98,823 EUR), Malignant hypertension (47,597 EUR), Appendicitis (58,639 EUR) and Malaria (23,792 EUR) mainly due to large variations in the average direct costs which ranged between 9560 euro in the malaria case and 77,255 in the AMI case. Repatriating an ill seafarer is a costly operation and employers have a financial interest in promoting the health of seafarers by introducing or further strengthen cost-effective prevention programs and hereby reducing the number of repatriations.