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International maritime health [journal]
- Aksel Schreiner in memoriam. [Journal Article]
- Int Marit Health 2014; 65(4):236.
- Commentary to the article by Korzeniewski et al. [Journal Article]
- Int Marit Health 2014; 65(4):235.
- Sea piracy sequelae: assessment according to the Diagnostic and Statistical Manual of Mental Disorders-5. [Journal Article]
- Int Marit Health 2014; 65(4):230-4.
Our previous studies have investigated the psychological consequences of kidnapping in a group of Italian seafarers assaulted by sea pirates and held in captivity and in their family members by the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-4. These studies have shown that both the victims and the family members showed significant psychological disturbances, corresponding to a chronic Post-Traumatic Stress Disorder (PTSD), in the victims, and a pattern of anxiety and depression in their family members. After publication of these studies, an updated edition of the DSM became available, namely, the DSM-5. The DSM-5 redefines some diagnostic criteria, including those related to the PTSD. This work was focused on the re-evaluation of the results of our previous studies in the light of the DSM-5 diagnostic criteria.Sixteen Italians including 4 kidnapped seafarers and 12 family members were examined by a semi-structured interview followed by Clinician-Administered PTSD Scale (CAPS-DX) and the Cognitive Behaviour al Assessment (CBA 2.0) for victims and by State-Trait Anxiety Inventory (STAI) X-1 and X-2 of CBA 2.0 and the Hamilton Depression Rating Scale (HDRS) for family members. Data already obtained were reviewed and re-analysed according to the DSM-5 criteria and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).The use of the CAPS-5 did not modify the diagnosis for the victims' group: 3 of 4 had a PTSD diagnosis performed through the CAPS-5. Seven of 12 family members had PTSD diagnosis performed through the CAPS-5, with negative cognitions and mood symptoms being those obtaining the highest score.Using DSM-5 criteria, the diagnosis of PTSD in the direct victims of piracy was confirmed. The same diagnosis could apply to a group of their family members. Besides anxiety and fear, in fact, we found in 7 out 12 subjects the presence of symptoms included by the DSM-5 in the PTSD spectrum. These symptoms were: avoidance, negative alterations in mood and cognition, blame of self or others. The use of updated diagnostic criteria may enable more correct assessment of the consequences of piracy acts. This may be also useful for establishing proper compensations for the damage suffered by seafarers, depending on the degree of disability resulting from the criminal acts they suffered.
- Longitudinal change in professional divers' lung function: literature review. [Journal Article]
- Int Marit Health 2014; 65(4):223-9.
The aim of this study was to assess changes in lung function of professional divers.This is a review of the literature. Only studies about professional divers were included. All published studies between 01.01.1984 and 07.01.2014 were systematically searched. The search was performed in Medline and Embase databases and in the "Medicina Maritima" journal. The results of pulmonary function tests were extracted from each study.Fifteen articles were found. Four studies showed a significant decrease in forced vital capacity (FVC). Five studies demonstrated a significant decrease in forced expiratory flows (FEF) at 75% and 50% of FVC expired (FEF75% and FEF50%) after 3 years of diving. Seven studies demonstrated a significant decrease in forced expiratory volume in 1 second (FEV1) after 3 years of diving. But only 2 studies did an age-standardisation so that only 1 study demonstrated a significant decrease in FEV1 after age-standardisation. Three articles showed a decrease in transfer factor for carbon monoxide (TLCO) after 5 years. Dives parameters (like depth, number by year) were not always related to variations on the different lung variables.This literature review showed a decrease in TLCO, FEF75% and FEF25-75%. One wonders whether these variations are due to the age or to diving. The results of such a long-term study would be interesting and might help to guide fundamental research.
- Intestinal parasites in Polish community on the example of military environment. [Journal Article]
- Int Marit Health 2014; 65(4):216-22.
The epidemiological situation concerning the prevalence of the majority of intestinal parasites in Poland has not been investigated in recent years and therefore is not known. Information on the prevalence of nematodes and most of cestodes is acquired from the studies carried out in Polish research centres. The aim of this study was to evaluate the occurrence of intestinal parasites among Polish soldiers who served in harsh environmental conditions in Afghanistan and their families living in Poland. The relation between the rates of infections in military personnel and in their families in the context of the risk of importing intestinal parasites from Afghanistan to Poland was also analysed in this article.264 families consisting of 803 persons took part in the study which was conducted in the period May 2011 - December 2012. Stool samples were subjected to parasitological examination in the Military Institute of Medicine, Poland. The tests were performed by means of three diagnostic methods (direct smear, decantation, flotation). The study population comprised 264 married soldiers and 539 civilians (soldiers' wives and children) living permanently in urban areas in Poland.Intestinal parasites were diagnosed in 4/264 studied soldiers (1.5% infected with Ascaris lumbricoides, Giardia intestinalis), in 9/253 studied women (3.6% infected with A. lumbricoides, Hymenolepis nana, Taenia spp.) and in 5/286 children (1.7% infected with A. lumbricoides, G. intestinalis). There was no more than one infection per one household.The occurrence of intestinal parasites among Polish soldiers shows the possibility of importing pathogens from the Third World countries. It also indicates, in the context of infected women and children, that the source of infection of parasites of the digestive tract can be present in Poland.
- Reasons for medical evacuations of soldiers serving in International Security Assistance Force (ISAF) operation in Afghanistan. [Journal Article]
- Int Marit Health 2014; 65(4):210-5.
The article presents the results of a research study into the reasons for medical evacuations of Polish military personnel taking part in the International Security Assistance Force (ISAF) operation in Afghanistan from 2007 to 2013.The authors have analysed medical records of 485 soldiers who were medically evacuated out of a combat zone in Afghanistan for battle injuries, non-battle injuries and diseases. Each medically evacuated Polish soldier was subjected to statistical analysis. The study population comprised 25,974 soldiers assigned to the Polish Military Contingent Afghanistan in the given period.From 2007 to 2013, 1.9% of the Polish military personnel (n = 485) participating in the ISAF operation in Afghanistan were evacuated for medical reasons before the scheduled termination of their contract. 40.6% of all medical evacuations were due to battle injuries, 32.4% due to non-battle injuries, and 27.0% due to diseases.ISAF is an example of a combat operation, in which battle injuries remain the leading health problem in mission participants. 3 of 4 Polish soldiers who were medically evacuated from Afghanistan were no longer fit for military service in the area of operations due to the traumas they had suffered.
- Medical assistance at the sea: legal and medico-legal problems. [Journal Article]
- Int Marit Health 2014; 65(4):205-9.
In case of pathologies or accidents on board which require medical intervention but lacking on-board medical or paramedical personnel, the ship's captain, or his delegate can contact a Telemedical Maritime Assistance Service (TMAS). International Maritime Organisation considers telemedicine at sea as an integral part of rescue procedures. Five key elements contribute to the delivery of good medical assistance at sea: one or more coordination and rescue centres; the TMAS; the possibility of intervention at sea; an organisation of appropriate institutions on ground and common operating procedures. This paper analyses the responsibility of the ship's captain and of the TMAS doctor in case of diseases or injuries on board in the frame of the main important international regulations.In case of a disease or injury on board a ship, the captain must contact the TMAS as soon as possible. A captain not acting promptly and not doing whatever it is possible for the ill/injured person by consulting the TMAS or a physician and/or not following prescriptions received, could be charged for omission of responsibility. A captain underestimating a medical problem and knowing that the patient's condition could worsen, but still not consulting a medical centre for assistance, should be ready to accept the consequences of his choices.The doctor of TMAS has full responsibility for the diagnosis, prescription and treatment, while the ship's captain is responsible for the final decision. Regarding the medical treatment and assistance on board a ship, the TMAS doctor should pay attention not only for the diagnosis, but also for the prognosis. Telemedicine implies that the doctor should make decisions without a clinical examination, often without some additional medical examinations and by maintaining a contact with other people who are in direct contact with the patient. The physician usually has to rely on the account of colleagues of the sick seafarer as far as medical history is concerned. This may make harder to take a decision.The ship's captain is guilty if he fails to contact a TMAS in case of diseases or accidents on board. Similar to a traditional relationship between a patient and a physician, the doctor consulted via telecommunication systems is also responsible for his diagnosis and treatment. However, in telemedicine the contrasts with the most basic principles of the traditional medicine are obvious. This makes the delivery of medical care of seafarers on board ships quite complicated.
- Consumption of addictive substances in mariners. [Journal Article]
- Int Marit Health 2014; 65(4):199-204.
For many years, studies have confirmed that there is a high prevalence of addiction amongst seafarers. The effect of this is even more serious when one considers their isolated and even hostile living environment presenting risks which require vigilance and rapid reactions. The purpose of this article is to determine the extent of knowledge about addiction among seafarers.This is a review of the literature between 1993 and 2013 with respect to the prevalence of consumption of alcohol, tobacco, cannabis, cocaine, heroin, and other drugs amongst seafarers. Total prevalence was calculated using the virtual population represented by the subjects of each article, when drug consumption definition was the same between articles and when mariners studied were different.63.1% (range 38.4-96.3%) of seafarers smoked tobacco. 14.5% (range 8.8-75%) of seafarers drank alcohol. 3.4% (range 9-45%) had used cannabis during the previous month. Few studies concerned other drugs; 3-10% of seafarers used drugs on board.The prevalence of tobacco and alcohol consumption amongst seafarers was higher than that in the general population. Further studies on the use of drugs at work would be valuable for this population who are subject to significant occupational risk.
- Prevalence of oral mucosal lesions among fishermen of Kutch coast, Gujarat, India. [Journal Article]
- Int Marit Health 2014; 65(4):192-8.
The aim of the study was to assess the prevalence of oral mucosal lesions among fishermen population in the coastal region of Kutch, Gujarat, India.A descriptive cross-sectional survey was conducted to assess the prevalence of oral mucosal lesions among the 979 fishermen of Kutch District, Gujarat, India. The proforma included information on demographic details, habits (tobacco and alcohol), oral hygiene practices and presence and location of oral mucosal lesions according to World Health Organisation, 2013. Chi-square test was used for comparisons. Confidence level and p-value were set at 95% and 5%, respectively.The majority of study population consumed tobacco and alcohol (88.1%) in some or the other form and used chewsticks (42.9%) for cleaning their teeth. Amongst all, 30.03% of the study subjects suffered from oral mucosal lesions. Leukoplakia (13.8%) was found to be the most prevalent lesion. The most affected sites were lips and vermillion border. The prevalence of oral mucosal lesions was found to be significantly associated with age, gender, oral hygiene practices and adverse habits.Oral mucosal lesions were prevalent among 30.03% of the study population. More detailed studies probing this issue should be conducted and efforts should be directed towards primordial prevention of the conditions.
- A research on obesity among Turkish seafarers. [Journal Article]
- Int Marit Health 2014; 65(4):187-91.
Obesity and overweight threaten not only seafarer's health but also the safety of operations on board a ship. The aim of the study was to investigate the statistical distribution of obesity and overweight among Turkish seafarers by using the health examination reports data collected between 2009 and 2012.The data on weight, height and age obtained from 143,341 medical examination reports of Turkish seafarers were used with the official permission of Directorate General of Health for Border and Coastal Areas. Considering the data in the health reports, body mass index (BMI) values were calculated, analysed and compared with Turkish general population and Danish seafarers.It has been found that BMI values of Turkish seafarers were boomed over the years. While Turkish male seafarers get older, their BMI values rise progressively. After the age of 28, BMI scores exceed the acceptable level. In addition, they reach maximum average 27.8 BMI value in their 50s.The activities, which will provide awareness to Turkish seafarers and the ship operators about the dangers of obesity, should be done. Also convenient environments and time for physical exercise on board a ship must be provided for seafarers.