Subjective assessments of safety, exposure to chemicals and use of personal protection equipment in seafaring

BACKGROUND: Most of the scientific publications from the maritime area are studies about the mortality and morbidity, while studies about the present hazards of potentially dangerous exposures are relatively rare. AIMS: To describe the seafarers' assessments of the occupational safety on board, their exposure to chemicals and the use of personal protection equipment and to identify the areas for further risk assessment and preventive measures. METHODS: A questionnaire study was carried out in 11 countries among seafarers who attended a regular health examination. RESULTS: The total number of seafarers who participated in the study was 6461 (response rate 93.7%). The occupational safety on board was assessed to be very good or good in 82%. Multivariate analyses showed that the safety was assessed as lowest among ratings, seafarers<30 years of age, work in the engine rooms and on dry cargo ships. It was highest on crude oil tankers and supply ships. Fifty-five per cent of seafarers were exposed to chemicals. Personal protection equipment to chemicals was used 'always/almost always' in 93% of the exposed. Multivariate analysis showed that the use of personal protection was highest on deck, on the largest ships, on roll-on roll-off ships and on crude oil tankers. CONCLUSION: The occupational safety and the use of personal protective equipment was assessed to be significantly different in some strata of the population and in specific working areas and types and sizes of ships.     

Incidence of self-reported occupational injuries in seafaring--an international study

AIMS: Seafaring is known as a high-risk industry. The aims were to describe the incidence of non-fatal injuries among seafarers, including testing the hypothesis that long working hours might result in higher injury rates. METHODS: A questionnaire study of injury on the latest tour of duty was carried out among seafarers in 11 countries with 6461 participants. The seafarers were asked if they were injured during the latest tour of duty and what was the number of hours worked. RESULTS: During the latest tour of duty, 9.1% of all seafarers were injured and 4.3% had an injury with at least 1 day of incapacity. The injury incidence rates for cargo ships and tankers: 39.5 per 1 million work hours and 37.6 per 100,000 days. Multivariate analyses: incidence rate ratios (IRR) for >70 working hours per week compared with <57 h: 0.90 [95% confidence interval (95% CI) = 0.61-1.32]; non-officers compared with officers: IRR = 1.57 (95% CI = 1.14-2.15); seafarers <35 years compared with > or =35 years of age: IRR = 2.11 (1.57-2.86); tour lengths > or =117 days compared with <117 days: IRR = 0.27 (0.19-0.39). Main work area on the deck and in the service area compared with work in the engine room: IRR = 0.37 (0.27-0.52) and IRR = 0.49 (0.26-0.91), respectively. CONCLUSIONS: There was no evidence that long working hours alone resulted in higher injury rates. Low self-perceived health, lack of use of personal protection and lack of occupational safety on board were significantly related to an increase in the injury risk.     

Physicians as clinical directors: working conditions, psychosocial resources and self-rated health

BACKGROUND: Physicians in clinical directors' positions fulfil their commitments in demanding work environments characterized by organizational changes and economic cutbacks. Little is known about the self-rated health of this group. AIM: To investigate whether self-rated health was associated with psychosocial working conditions, professional networks, job support, social networks and social support, sick leave and salary in Swedish physicians working as clinical directors. METHODS: A self-reported questionnaire was sent to 373 clinical directors. Odds ratios (ORs) were used for estimating the bivariate association between self-rated health and psychosocial resources. RESULTS: A total of 274 clinical directors agreed to participate in the study. The response rate was 73%. The clinical directors exposed to high job demands had a significantly higher probability of low self-rated health [OR = 3.4 and 95% confidence interval (CI) = 1.6-7.0] than those who were not in this situation. Furthermore, participants who were exposed to high job demands had an increased risk of low self-rated health (OR = 3.8 and 95% CI = 1.8-8.1) irrespective of available social support inside or outside work. High average working hours more than doubled the risk of low self-rated health (OR = 2.2 and 95% CI = 1.1-4.4). CONCLUSION: The job demands on physicians in clinical directors' positions may exceed ordinary means of support with consequent adverse effects on self-rated health. More research is needed to investigate the interaction between job demands and support systems in this group of health care workers.     

Self-rated health in a population of expatriate workers and partners in Riyadh, Saudi Arabia

BACKGROUND: Anthropological theory suggests that expatriate workers progress through a sequence of adaptive stages during their adjustment to a new environment. The psychological and physiological effects of this adaptation process may be reflected in changes in self-rated general health. AIMS: To explore the relationship between self-rated general health, duration of expatriate assignment and two health-related behaviours: physical exercise and cigarette smoking. METHOD: A self-administered questionnaire recorded the demographics, self-rated general health, exercise and smoking behaviours of the adult non-Saudi residents of an expatriate compound in Riyadh, Saudi Arabia. RESULTS: The mean self-rated general health of the study group was better than comparable UK and New Zealand population norms. Self-rated general health was not associated with duration of assignment, but was associated with physical exercise, including a dose-response effect. Middle Eastern expatriates had lower self-rated health scores and a higher prevalence of cigarette smoking than other expatriates. CONCLUSIONS: While the sampling frame limits generalization, physical exercise may promote expatriates' general health. Middle Eastern expatriates may be a target group for smoking health education.     

Mapping the knowledge base for maritime health: 2. a framework for analysis

The knowledge base for maritime health has a number of constant features that have become apparent over the last 150 years. These can be used to structure an analysis of the current state of knowledge and to identify where there is sound evidence about the nature and scale of risks and about the effectiveness of intervention to reduce harm. It can also show where there are deficiencies in knowledge and point to the ways in which these could be remedied. Past events, as discussed in the first article, also indicate the dynamics of the political, economic and human interactions that are central to improving knowledge and to its application to improve the health of seafarers. The sources of useful knowledge about seafarer's health range from single case reports of an unusual disease to long-term studies of common chronic disease incidence. The most accessible events to record are clinically apparent illness, injury, or cause of death, but active investigative studies may look at risks in the environment, personal risk factors, or pre-clinical phases of disease. Comparisons between subsets of a population are needed to look rigorously at health risks or at the effectiveness of intervention. This is best done if information on the at risk population can be used as the basis for deriving the incidence or prevalence of illness and if the populations compared are as similar as possible in every way, except that being studied. Sometimes large studies in onshore populations can provide information that it is not feasible to collect on seafarers. Information on seafarers' health can be collected in several settings: at sea, on arrival in port, during leave periods, or after retirement. For acute illness and for injury a single setting can provide the basis for estimating risks, but for chronic conditions cases arising in several settings have to be included and the at risk population calculated to enable the incidence to be studied. Knowledge about the health of seafarers can be used to improve prevention both by attention to the conditions of living and working at sea and by selection of seafarers who are considered 'fit' for work. It is also important for defining the needs for emergency care at sea and in port. The overall patterns of illness and injury in seafarers and how these compare with other workers are important inputs to regulatory decisions on the measures to be taken to reduce harm from illness and injury. Markers of improved seafarer health can confirm the effectiveness of measures taken with this goal in mind. Reducing the contribution of health-related impairment to accidents and other risks at sea requires knowledge of the effects of such impairments on performance and safety in the routine and emergency tasks of a seafarer. This information can then be used to determine whether someone with an impairment can safely work at sea.     

Fatal work-related accidents in UK merchant shipping from 1919 to 2005

BACKGROUND: Historically, merchant seafaring was the most hazardous occupation in Britain. However, fatal accident rates have fallen sharply in the last 30 years. AIMS: To establish the causes of all fatal accidents and their trends among seafarers who were employed in UK merchant shipping from 1919 to 2005 and to compare with those in the general workforce and in other industries. METHODS: A historical study, based on examinations of death inquiry files from 1976 to 2005 and official mortality returns from 1919 to 1975, with a total population of 11.90 million seafarer-years at risk. RESULTS: From 1919 to 2005, there were 17,386 deaths from accidents in UK shipping, 6,074 from shipping disasters and 11,312 from personal accidents. Over time, there were large reductions in mortality rates for all the main types of fatal accident, except accidents on deck. Major causes of mortality from shipping disasters were vessels foundering in typhoons, storms and severe gales, explosions in cargo holds and collisions in poor visibility. Fatal accident rates were higher among British seafarers than among Lascars. The relative risk of an accident in UK shipping-compared with the general British workforce-was similar in 2001 to that in 1961. CONCLUSIONS: There have been major improvements in health and safety that have led to substantial reductions in fatal accident rates in UK merchant shipping throughout most of the last 90 years. This mirrors comparable improvements in the fatal accident rate among the general workforce of Great Britain.     

Prevalence of fatigue among commercial pilots

BACKGROUND: Short-haul pilots have largely been neglected in studies of fatigue, sleep loss and circadian disruption created by flight operations, but anecdotal evidence from pilots suggests that with the increasing amount of low-cost air travel, commercial pilots working short-haul operations may be becoming seriously fatigued. AIMS: This study attempted to ascertain how much subjective fatigue short-haul pilots reported, and makes comparisons between low-cost and scheduled airline pilots. METHODS: Pilots completed anonymous questionnaires (encompassing aviation factors, flight experience and a fatigue scale) posted on the Professional Pilots' Rumours Network website. RESULTS: Data were collected from 162 short-haul pilots and statistical adjustment for operational factors was made. Seventy-five percent reported severe fatigue and 81% reported the fatigue to be worse than 2 years ago. Eighty percent considered their thought processes were reduced while flying. Severe fatigue was reported more frequently by low-cost airline pilots than scheduled airline pilots (P = 0.05) and fatigue ratings were higher in this group (P = 0.03). Pilots who reported regularly flying into their 'discretion' hours had lower physical and psychological health, and overall fatigue scores, and poorer self-rated general health. Flying into discretion time occurred no more frequently in low-cost airline pilots than scheduled airline pilots. CONCLUSIONS: Identifiable fatigue problems are reported by short-haul pilots, but this cannot be attributed solely to the work schedules of low-cost airlines as regular use of discretion time appears to be associated with fatigue regardless of airline.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Work activity analysis of Finnish occupational health professionals

BACKGROUND: Some Finnish studies have dealt with how occupational health nurses divide their working hours but other occupational health professionals have not been evaluated. AIMS: This study describes how occupational health professionals allocate their working hours between main tasks. METHODS: Questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms. The data were analysed by using frequencies, means and one-way analysis of variance test. RESULTS: Employee-oriented tasks accounted for roughly 50% of working hours from all occupational health professionals. The remaining working hours were shared between workplace visits, co-operation with partners, other occupational health care responsibilities and tasks in other health care fields, especially in the health care centres. These working hours varied greatly between the different occupational health professional groups. All units employed full-time occupational health nurses, but the services of physicians, physiotherapists and psychologists were usually provided part-time or even restricted to a few hours each week because these services were difficult to obtain. Occupational health nurses working in the municipal health care centres spent more time on workplace visits than other nurses. Employee-oriented tasks were emphasized more in physicians', physiotherapists' and psychologists' work, especially in private medical health care units and in the jointly owned health care units. CONCLUSIONS: The amount of time occupational health professionals are able to spend on workplace activities appears to be determined by the type of their employer.     

Cardiovascular diseases in modern maritime industry

Acute cardiovascular diseases (CVD) are the main natural causes of death in industrialized countries - both at sea and on land. Seafarers face very specific job-related cardiac risk factors, such as time pressure, long working hours, or high stress factors onboard [1, 2]. Taking into consideration the healthy worker effect of seafarers, cardiac risk factors are shown to occur slightly more frequently in seafarers than in the general population. Owing to the lack of health professionals onboard and the limited treatment options of events at sea, effective cardiopulmonary resuscitation is often delayed and the outcome of cardiac events may be worse compared to that in other occupations ashore. Seafarers' medical surveillance examinations should be used more intensively as an opportunity for education of crews in CVD risks and the possibilities to reduce them. Further, enhancement of treatment options (e.g. by implementation of advanced therapy and diagnostics such as telemedicine or AED onboard) may contribute to improved CVD prognosis at sea.     

Can general cardiovascular risk evaluation facilitate the assessment of fitness for work and contribute to the reduction of cardiovascular incidents among seamen and fishermen? Article for discussion

Apart from accidents and work related injuries caused by external factors, being the primary cause of death at sea and repatriation of seamen and fishermen from ship to hospital on shore, acute cardiovascular incidents are the main internal causes of their death, both at sea and on land, as well as of long lasting sick leave and disability. In the regulations on health requirements for persons working on sea-going ships and in inland navigation (orders of the Ministry of Health 1993, 1996, 2003, guidelines (39), EU directives and other national regulations) and in the register of diseases and conditions disqualifying from such an employment (EU directive, annex to the order of the Ministry of Health 1993, European Commission (32,33), ILO/WHO guidelines, cardiovascular diseases are only generally mentioned. The minimal scope of examinations is recommended for seafarers in age up to 50 years, and for older seafarers, but without the assessment of their occupational risk. This gives rise to ambiguities in interpretation at the time of issuing their health certificates, and also in judicature when analyzing cause-and-effect relationship between the occurrence of an acute cardiovascular incident during the ship's voyage and conditions of the work at sea. Principles, possibilities and benefits are discussed in this paper, which may be expected from the general assessment of cardiovascular diseases risk at the time of the health assessment for the work at sea. The risk forecasting, health certification and the question of choosing primary preventive methods are included in this presentation.     

An international comparison of women's occupational health issues in the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore: the CIDA-SEAGEP study

BACKGROUND: An international comparison study of women's occupational health issues was carried out in 2000 for the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore. The study was funded by the Canadian International Development Agency's Southeast Asia Gender Equity Program. AIM: The objective was to compare the issues, risk factors, social determinants, and challenges in women's occupational health, according to the status of economic development as defined by the World Bank. METHOD: Data were collected through 27 key informant interviews of high-ranking government officials and senior researchers, self-administered questionnaires on country or regional statistics and 16 courtesy calls. RESULTS: Results indicated that women's occupational health problems common in these countries or regions included women's long hours of work (double workday), shift work and a caring role for family and friends. Problems reported in developing countries but not developed countries included poor access to training and protective equipment, and insufficient legislation to protect women's rights. Problems reported in developed countries but not in developing countries included obesity, smoking and not including women in health research. CONCLUSION: This paper provides insights into the changing environment in the workplace, such as increasing participation of women in the paid workforce and changes in gender differences due to the changing country economy, for improving women's occupational health.     

The scale of perceived occupational stress

This article reviews previous research on the scale of occupational stress and describes in detail the Bristol Stress and Health at Work study. This study had three main aims: firstly, to determine the scale and severity of occupational stress in a random population sample; secondly, to distinguish the effects of stress at work from those of stress in general life; and finally, to determine whether objective indicators of health status and performance efficiency were related to perceived occupational stress. These aims were investigated by conducting an epidemiological survey of 17,000 randomly selected people from the Bristol electoral register, a follow-up survey 12 months later, and detailed investigation of a cohort from the original sample. The results revealed that approximately 20% of the sample reported that they had very high or extremely high levels of stress at work. This effect was reliable over time, related to potentially stressful working conditions and associated with impaired physical and mental health. The effects of occupational stress could not be attributed to life stress or negative affectivity. The cohort study also suggested that high levels of occupational stress may influence physiology and mental performance. The prevalence rate obtained in this study suggests that 5 million workers in the UK have very high levels of occupational stress.     

Validity of the HSE stress tool: an investigation within four organizations by the Corporate Health and Performance Group

AIM: To examine the validity and accuracy of the HSE Management Standards Stress Tool. METHODS: A cross-sectional questionnaire was administered to employees of the occupational health and human resource departments of four of the Corporate Health and Performance Group organizations. The relationship between the six first-pass stress filter questions and self-rated health were examined using the General Health Questionnaire (GHQ12) and the Short Form. The relationship between the filter questions and objective work characteristics such as sickness absence, self-rated performance and job satisfaction was also examined. RESULTS: Two hundred and thirty-five employees participated, giving an overall response rate of 68%. The study sample met the proposed HSE of 85 and 65% pass rates and would not normally progress to further analysis. Almost 40% of the group were above threshold on the GHQ12; 19% rated their work as very or extremely stressful. While the filters were highly specific, they were insensitive and at best detected for less than 40% of those with psychological or work stress. All but one of the filters had less than 50% positive predictive value for work stress and the majority of those identified by the filters did not consider themselves stressed, either overall or by work. Five of the filter questions were significantly associated with self-rated performance, three with absence and two with other objective work indicators. CONCLUSIONS: Further developmental work on these filter questions is indicated. Use of work absence as a measure of the impact or 'cost' of stress may lead to a significant underestimation of the 'true cost' of psychosocial hazards in the workplace.     

Knee Pathology among Seafarers: A Review of 299 Patients

A retrospective study was carried out on 1,250 patients whowere referred to the orthopaedic clinic of the Dreadnought Unitduring 1989 and 1990. These included 299 actively serving orretired seafarers (24%) with knee pathology, who form the basisof this study. Fifty-one per cent of these patients had a diagnosisof knee osteoarthritis, with a predominance of medial compartmentdegenerative change (34%). Genu varus or bow legs was presentin 31% of seafarers studied. Osteoarthritis of the knee, particularlygenu varus, among seafarers may result from acute minor traumato the medial compartment upon which is superimposed a lifetimeof working and living in the vertical environment of a movingship. It is proposed that improvement in ship design, such asthe installation of a two lift system, together with sound workingpractices would be effective in reducing the incidence of osteoarthritisof the knee among seafarers.     

Health interventions for the metal working industry: which is the most cost-effective? A study from a developing country

This study ranked the cost-effectiveness of health interventions in the metal working industry in a developing country. Data were based on 82 034 workers of the Northern region of Mexico. Effectiveness was measured through 'healthy life years' (HeaLYs) gained. Costs were estimated per worker according to type and appropriate inputs from selected health interventions. 'Hand' was the anatomical region that yielded the most gain of HeaLYs and amputation was the injury that yielded the most gain of HeaLYs. The most effective health intervention corresponded to training, followed by medical care, education, helmets, safety shoes, lumbar supports, safety goggles, gloves and safety aprons. In dollar terms, education presented the best cost-effectiveness ratio (US$637) and safety aprons presented the worst cost-effectiveness ratio (US$1 147 770). Training proved to be a very expensive intervention, but presented the best effectiveness outcome and the second best cost-effectiveness ratio (US$2084). Cost-effectiveness analyses in developing countries are critical. Corporations might not have the same funds and technology as those in developed countries or multinational companies.     

Low back pain among Iranian industrial workers

BACKGROUND: Most epidemiological data concerning low back pain (LBP) are from high-income countries and there is very little information about LBP in the working population in developing countries. OBJECTIVES: To determine the prevalence of LBP in Iranian industrial workers. To explore associations between LBP and physical and psychosocial factors at work, as well as lifestyle factors. METHODS: Cross-sectional study of the largest car-manufacturing group in Iran. The prevalence of LBP, work exposures and lifestyle factors were recorded using the standardized Nordic questionnaire for analysis of musculoskeletal symptoms. Demographic data and lifestyle factors (age, sex, education, weight, work experience, smoking and fitness training) were also collected. RESULTS: Of the 18,031 employees, 78% participated. The majority of subjects in this study population were young males (<30 years) and a small proportion was female (4%). The 1-year prevalence of self-reported LBP in this Iranian industrial population was 21% (20% males and 27% females). The prevalence rate of absence due to LBP was 5% per annum. The multiple logistic regression models indicated that the following remained risk indicators for LBP in the previous 12 months: increasing age, no regular exercise, heavy lifting, repetitive work and monotonous work. CONCLUSION: LPB is a common problem in the working population even in a developing country. Age and gender as well as certain work-related physical and psychosocial factors influenced the prevalence of LBP but the differences between different categories of workers were small.     

Mapping the knowledge base for maritime health: 3 illness and injury in seafarers

Recent studies of illness and injury in seafarers and of disease risk factors have been mapped. There is a good knowledge base on some aspects of health, especially on causes of death. By contrast there are very few studies on aspects of current importance, such as illness at sea, the scope for its prevention, and its treatment and outcome. Results are presented in terms of the settings in which the investigations were conducted: medical fitness examinations at recruitment and periodically, illness and injury at sea, telemedical advice, evacuation and urgent port referrals, repatriations, illness at other times in serving seafarers, health related cessation of work, and illness after cessation of work. Mortality studies were mapped in a similar way, as were population-based surveys of health and of risk factors. The scope for valid extrapolation of the results from studies in other populations to seafarers is discussed. A more immediate problem of extrapolation relates to the current knowledge base, which is largely derived from own nationality seafarers of the traditional developed world maritime nations. It is uncertain whether this can be validly extrapolated to seafarers from the major crewing countries, who come from populations with very different patterns of illness. Existing studies mirror the priorities of those who commissioned them, in that many of the most valid ones relate to the overall lifetime risks of seafaring in developed countries. These enable comparisons to be made with other occupational groups. The major concerns of many interest groups in the maritime sector about health are now focused on the risks within a single contract period and how these can most efficiently be minimized. Studies on this are limited in scope, are of uncertain validity, and are often used for operational purposes rather than entering the scientific literature. Gaps in knowledge about health risks over a relatively short timescale in seafarers from the major crewing countries have been identified, and the uncertainties about extrapolating from studies in traditional maritime nations to the majority of the world's seafarers means that a major redirection of effort is needed if maritime health practice is to have a sound knowledge base on illness and injury risks in the future.     

The reliability of personal alcohol consumption estimates in a working population

Health and safety problems related to alcohol consumption represent a major concern in many businesses and consequently pre-employment questionnaires and workplace health promotion packages frequently contain questions seeking basic estimates of alcohol consumption. Although individuals with very heavy drinking patterns often attract much attention, on a population basis most morbidity is likely to arise from drinkers consuming above the recommended limits but not sufficient to result in gross occupational or social effects. This study reviews the research on the reliability of questionnaire techniques used to quantify alcohol consumption and compares the most valid retrospective interview based estimate of consumption, the time line follow-back (TLFB), with a prospective daily diary (DD) method in a working population. The DD method was acceptable and produced significantly higher estimates of consumption and for 'normal' subjects gave consistent estimates of +/- 10 units/week over several weeks. Appropriate questionnaire design is discussed and the use of a DD method in health promotion activities recommended.