Working conditions in international seafaring

BACKGROUND: Seafaring is a global profession and seafarers have their second home on board and live there for several months at a time. AIM: To assess self-rated health status and the main characteristics of seafarers' working conditions. METHODS: Questionnaire study concerning the most recent tour of duty. RESULTS: A total of 6,461 seafarers in 11 countries responded. In general, the seafarers' self-rated health was good, but it declined significantly with age. Seafarers from South-East Asian countries spent longer time periods at sea, and had lower numbers of officers and older seafarers than found among seafarers from western countries. Most seafarers worked every day of the week, and on average for 67-70 h a week during periods of 2.5-8.5 months at sea. CONCLUSIONS: Seafarers' self-rated health was generally good but varied significantly by country. Working conditions also differed by country but did not reflect working conditions in general. Further studies are necessary to describe more closely the influence of work schedules on the health and social life of seafarers.     

Morbidity in expatriates--a prospective cohort study

BACKGROUND: Expatriates comprise an important, but rarely studied subset of international travellers. This study was performed to assess the incidence of health events in an expatriate group and to evaluate factors affecting this incidence. METHODS: A cohort of 2020 Foreign and Commonwealth Office (FCO) staff and partners living abroad were followed-up over 1 year. The main outcome measure was incidence of illness or injury serious enough to require consultation with a doctor. Data collection was by means of a self-administered questionnaire. Poisson regression was used to estimate the rates of health events and to test for association between health events and a number of independent variables. RESULTS: The incidence of health events was 21%. Trauma (incidence 5%), musculoskeletal disorders (incidence 4%) and infectious disease (incidence 3%) were the principal causes of morbidity. The incidence of psychological disorders was low (1%). Of significance, employees were at increased risk of morbidity when compared to partners, with a higher incidence of health events [incidence rate ratio (IRR) 1.4, 95% CI 1.1-1.9] and psychological disorders (IRR 5.9, 95% CI 1.0-34.1). Moreover, unaccompanied employees were at increased risk of health events (IRR 1.3, 95% CI 1.0-1.7), and of traumatic injury (IRR 2.3, 95% CI 1.3-4.3) when compared to accompanied employees. CONCLUSION: While the morbidity in FCO personnel is low in comparison to other expatriate groups, the higher risk of morbidity in employees and unaccompanied individuals merits further research, particularly to ascertain whether work demands, isolation or risk-taking behaviour are contributory factors.     

What is the risk associated with being a qualified military parachutist?

Military parachuting has been recognized as a hazardous activity since it was first introduced in World War II. Other risks associated with military service include actual war-fighting, training with weapons and explosives, operating with armoured vehicles or deployment to climatic extremes. These other hazards should be considered in any assessment of the additional risk associated with military parachuting. The aim of this study was to identify the risk attributable to parachuting amongst US Army enlisted soldiers. This study identified a cohort of infantry soldiers who served between 1990-94. They were separated by receipt of parachute hazardous duty pay. There was a total of 329,794 person-years (PY) available for study of which 18% were in the exposed group. The rate of hospitalization was very similar in both groups [123.9 per 1,000 PYs for the exposed group, 127 in the non-exposed group: relative risk (RR) = 0.98, 95% confidence interval (CI) = 0.96-1.00). The exposed group was 1.49 times (CI = 1.42-1.57) more likely to be admitted as a result of an injury as compared with the non-exposed group. Military parachuting was 20 times (CI = 16.6-24.3) more likely to be the cause of an injury. This study has shown that receipt of hazardous duty pay for military parachuting can be used as a marker in identifying significant additional risks to the health of infantry soldiers associated with military parachuting. This was reflected in an increased incidence of admission for acute injury and musculoskeletal trauma (particularly a trauma pattern associated with parachuting) as a result of military parachuting. Other risks, which are associated with parachute pay, are admission for the effects of heat, battle injury and helicopter accidents.     

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.     

Lifestyle and the development of hypertension: a 3-year follow-up study of middle-aged Japanese male office workers.

The association of lifestyle factors with the development of hypertension (blood pressure > or = 140/90 mmHg) over a 3-year follow-up period was studied in 949 hypertension-free Japanese male office workers aged 35 to 54 years. From the Cox proportional hazards model, age, alcohol intake, body mass index (BMI) and hours of work were independent factors associated with the development of hypertension. Adjusted hazard ratios for 5-year increases in age, daily consumption of alcohol, 5-kg/m2 increases in BMI and working 10 hours per day or more were 1.18 [95% confidence interval (CI) = 1.02-1.35]; 1.53 (CI = 1.14-2.05); 1.79 (CI = 1.38-2.33) and 0.58 (CI = 0.41-0.82), respectively. In the analysis using logistic regression, BMI was independently related to working 10 hours per day or more, controlling for other lifestyle factors. Adjusted odds ratio for 5-kg/m2 increase in BMI was 0.66 (CI = 0.49-0.88). These results suggest that the influences of long working hours on blood pressure are likely to be indirectly mediated through less overall obesity.     

Differences in injury rates in child motor vehicle passengers in rural and urban areas in New South Wales, July 2000 to June 2004

OBJECTIVES: To investigate whether the pattern of hospitalised injuries in injured child motor vehicle passengers involved in traffic crashes differs in rural and urban residents of New South Wales (NSW). METHODS: This study compared injuries of hospitalised child motor vehicle passengers resident in rural areas with those from urban areas. The NSW Inpatient Statistics Collection (ISC), a population-based dataset, was used to select cases for the period of July 2000 to June 2004. The hospitalised injury rate was calculated according to urban/rural status using Poisson regression. Injury rate ratios (IRR) comparing rural and urban children were computed overall and for specific injury types. RESULTS: Overall, 1,286 children (aged 0-15 years) residing in NSW were identified from the NSW ISC internally linked datasets as being separated from hospital for injuries resulting from a motor vehicle crash. The overall hospitalised injury incidence rates for child motor vehicle passengers resident in rural and urban NSW areas were 46.75 (95% CI 36.63-59.66) and 20.13 (95% CI 17.94-22.58) per 100,000 children respectively. The rural/urban IRR for comparing the incidence of hospitalisation was significantly elevated (IRR=2.10, 95% CI 1.78-2.48). The IRR was also significantly elevated across most injury types. The largest risk disparity between rural and urban children was in 9-12 year-olds (IRR=2.33, 95% CI 1.73-3.13). CONCLUSION AND IMPLICATIONS: There is an elevated injury incidence rate in rural resident children, compared with their urban counterparts. This differential should be addressed in future road safety initiatives.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

An analysis of the causes of mortality among seafarers in the British merchant fleet (1986-1995) and recommendations for their reduction

This study was designed to establish the manner and causes of all fatalities among seafarers who were serving in British merchant shipping between 1 January 1986 and 31 December 1995. Other main aims were to compare mortality rates with workers in other industries and with seafarers in other merchant fleets, and to discuss recommendations for the prevention of occupational mortality. This study was based upon official mortality files with a population of 253 919 seafarer-years at risk. There was a total of 252 fatalities in British merchant shipping during the study period. One hundred and seven of the 252 deaths were due to natural causes, of which 93 (87%) were caused by cardiovascular disease. The relative risk of mortality due to accidents at work (96 fatalities) was 23.9 times higher than for all workers in Great Britain during the same time period (95% confidence interval = 14.0-40.7). The risk of a fatal accident in merchant shipping was also much higher than in other British industrial sectors, such as agriculture, forestry and fishing (relative risk = 4.5), construction (5.5), and manufacturing (22.0). Seafaring was identified as a dangerous occupation compared with shore-based employment. Many of the fatal accidents at work were caused by hazardous working practices and were often preventable, as were the many off-duty accidents and drowning that were caused by seafarers falling into docks when encountering hazardous access to their ships from the shore. Seafarers are also at special risk from acute illnesses since they lack direct access to specialist medical care.     

The relationship between occupational psychological stress and female fertility

OBJECTIVE: To investigate the association between occupational psychological stress and female fertility. METHODS: This was a case-control study including consecutive working female patients attending fertility and in vitro fertilization clinics in the Soroka University Medical Center. We compared occupational stress between 64 working patients who had attended the clinics due to female infertility (case group) and 106 working patients who had attended the clinics due to their partner's reproductive impairment (control group). RESULTS: Patients from the female infertility group were older (31.9 +/- 6.2 versus 30.2 +/- 4.6, P = 0.047) and tended to participate more in sporting activity [23.4 versus 10.4%, odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.05-6.73, P = 0.022] as compared with patients from the male infertility group. Patients from the case group tended to work more weekly hours as compared with the controls (33.6 +/- 16.8 versus 26.9 +/- 17.4, P = 0.028). High reliability was found, as demonstrated by Cronbach's alpha of 0.81-0.90 for the four burnout parameters. Patients from the female infertility group had significantly lower listlessness scores as compared with the control group, using the Mann-Whitney test (2.6 +/- 1.1 versus 3.1 +/- 1.2, P = 0.013). CONCLUSIONS: Patients admitted due to female infertility tended to have lower listlessness scores as compared with patients admitted due to their partner's infertility problem. No significant association was found between other burnout, job strain and job satisfaction scores and women's fertility status.     

Mandatory use of eye protection prevents eye injuries in the metal industry

BACKGROUND: Eyes are frequently injured in occupational accidents. What is the preventive effect of mandatory eye protection in metalworking? METHODS: The injury incidence was determined before and after eye protection became mandatory in a metalworking yard. RESULTS: The incidence declined from 6.09 to 0.42 injuries per million working hours after eye protection became mandatory. CONCLUSIONS: Mandatory eye protection among metalworkers in Norway has high potential for preventing eye injuries and should be implemented.     

Non-fatal occupational injuries related to slips, trips and falls in seafaring

BACKGROUND: Merchant seafaring often involves hazardous occupational operations and several studies have shown increased overall injury mortality. The aim of this study was to describe the risks involved in slip, trip and fall (STF) injuries in merchant seafaring, in order to point out areas for prevention. METHODS: A questionnaire study was carried out in 11 countries with 6,461 participants. The seafarers gave information on whether they were injured during their latest tour of duty, and whether STF preceded the injury. RESULTS: Of the total reported injuries 43% (n=467) were STF related. Fractures and sprains accounted for 42% of the STF injuries compared with 17% for non-STF injuries. The proportions of STF injuries for different types of ships and areas of the ships varied from < 30% to >60%, particularly work on passenger ship decks, where STF injuries were >60%. The proportions of STF injuries increased by age and by severity of the injury. CONCLUSIONS: Injuries related to STF on merchant ships were more frequent than previous estimates. There is a need for improvements in defining, reporting, and preventing STF injuries in merchant seafaring.     

Evaluation of potential reduction in blood and body fluid exposures by use of alternative instruments

BACKGROUND: Injuries from needlestick, sharps injuries and splashes lead to exposure to blood and body fluids with the potential for transmission of blood-borne viruses. AIMS: To identify alternative instruments, which if used would improve worker safety. METHODS: Retrospective review of 161 injuries with identification of safer alternative products for instruments that caused injury. The proportion of injuries that could be prevented was calculated [with 95% confidence intervals (CI)]. RESULTS: The average rate of injury was 7.8/1000 employees per annum (95% CI, 6.8-9.4/1000). In the 2 years the highest rates of injury occurred in pre-registration house officers (164/1000; 95% CI, 64-264/1000), phlebotomists (154/1000; 95% CI, 15-291/1000) and senior house officers (45/1000; 95% CI, 13-77/1000). An upper estimate of 65% (95% CI, 58-72%) of incidents would have been preventable with a change to alternative devices. CONCLUSIONS: Change to the use of intrinsically safer instrumentation has the potential to prevent injury to healthcare workers.     

Is service with the parachute regiment bad for your health?

Military parachuting is perceived to be a 'high risk' activity. The estimate of risk should be based on a comparison of injury rates between soldiers who are military parachutists and soldiers who are not military parachutists rather than the rate of injury per parachute descent. Since other aspects of military life also have an inherent risk of injury the risk attributable to military parachuting must be assessed in this context. The aim of this paper is to determine whether Parachute Regiment soldiers have a greater risk of injury as compared with non-Parachute Regiment infantry soldiers by comparing rates of hospital admission and medical discharge between the two groups. Records at the Defence Analytical Services Agency were analysed for the 10-year period 1987-96. The mean rate of hospital admission for Parachute Regiment soldiers was 50.1 per 1,000 and for infantry soldiers was 50.8 per 1,000 [relative risk (RR) = 0.98; 95% confidence interval (CI) = 0.92-1.04). The mean rate of medical discharge for Parachute Regiment soldiers was 4.9 per 1,000 and for infantry the mean rate was 2.8 per 1,000 (RR = 1.76; CI = 1.45-2.15). This study has shown a methodology for comparing occupational exposure to risk that could be extended to other groups if they can be separated by appropriate criteria.     

Smoking and injury in Royal Marines' training

BACKGROUND: Training for the Royal Marines (RMs) is considered to be one of the most arduous military training regimes in the world. Approximately 16% of the annual intake of recruits suffer an injury. Smoking has been found to be a predisposition to injury. OBJECTIVE: To examine the relationship between recruits' smoking status on entry to training and subsequent incidence of injury. METHOD: Retrospective, longitudinal analysis of 1 year's intake of RM recruits at Commando Training Centre Royal Marines. RESULTS: A significantly greater proportion of RM recruits who were smokers on entry to training experienced a physical injury during the course than their non-smoking counterparts (chi-square = 8.15, P < 0.01). A recruit who smoked on entry to training was almost twice as likely to acquire an injury during training [relative risk = 1.7 (95% CI = 1.2-2.8)]. CONCLUSION: Smoking status of RM recruits in training was significantly associated with injury.     

Maritime health emergencies

BACKGROUND: Commercial ships flying the US flag must conform to Coast Guard standards and have medical care available onboard. Consultation with a physician is required if medication is to be prescribed. AIM: To evaluate the epidemiology of medical contacts for US ships at sea. METHOD: Retrospective analysis of cases where shipboard caregivers made contact with US emergency medicine physicians for advice. RESULTS: There were 866 cases and 1720 contacts in 48 consecutive months of study. Eighty-eight per cent of cases were men with a mean age of 43.7 years (SD 13.7). Eighty-four per cent of cases were medical, 14% were injuries and 2% were purely psychiatric. Fifty-eight per cent of medical cases, 50% of psychiatric cases and 42% of injury cases were handled with a single contact. Injuries and psychiatric cases required a higher number of contacts per case compared with medical cases (P < 0.01). Five categories of illness accounted for 43% of medical cases (respiratory infections, abdominal problems, genitourinary complaints, rashes and dental issues). Psychiatric cases required the most medication, with 12% requiring four medications. The most common categories of medication given were pain relievers (non-steroidal anti-inflammatory drugs, opiates, heartburn relief) and antibiotics. CONCLUSIONS: Even with pre-screening of seafarers and the potential dangers of life at sea, the majority of cases requiring physician advice are not related to trauma. However, cases of injury or acute psychiatric problems required more physician interaction and medication than medical cases.     

The suicide mortality of working physicians and dentists

BACKGROUND: Some studies have shown that physicians and dentists have elevated risks of suicide, while other studies have not. AIMS: Using all deaths and corresponding census data in 26 US states, we examine the suicide risk for working physicians and dentists. METHODS: Death and census data for working people were obtained from 1984 through 1992. Directly age-standardized suicide rate ratios (SRRs) were calculated for white male and white female physicians and white male dentists. RESULTS: For white female physicians, the suicide rate was elevated compared to the working US population (SRR = 2.39, 95% CI = 1.52-3.77). For white male physicians and dentists, the overall suicide rates were reduced (SRR = 0.80, 95% CI = 0.53-1.20 and 0.68, 95% CI = 0.52-0.89, respectively). For older white male physicians and dentists, however, observed suicide rates were elevated. CONCLUSIONS: White female physicians have an elevated suicide rate. Only older white male physicians and dentists have elevated suicide rates, which partially explains the varied conclusions in the literature.     

Fatigue increases the risk of injury from sharp devices in medical trainees: results from a case-crossover study.

BACKGROUND: Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. DESIGN: Case-crossover study. SETTING: Five academic medical centers in the United States and Canada. PARTICIPANTS: Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. RESULTS: Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P<.001) and slept less the night before an injury (P<.001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P=.001).Conclusions. Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.     

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.     

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.     

Increased risk of asthma among Finnish construction workers

AIM: To determine the risk of asthma among 7891 Finnish construction workers in the Pirkanmaa Region of southern Finland. METHOD: Retrospective cohort study of hospital records of the Tampere University Hospital. A population of Pirkanmaa paper mill workers (n=2686) and the Pirkanmaa working age population (n=252,500) served as reference populations. RESULTS: There were 147 new cases of asthma among the construction workers in 1991-1995. The annual rate was 37 per 10,000 workers and the odds ratio was 2.1 [95% confidence interval (CI)=1.2-3.6] for the women and 1.8 (95% CI=1.5-2.2) for the men when compared with the general working age population. In general, the risk of asthma among the paper mill workers did not differ from the risk of asthma among the general working age population. The construction workers had an increased risk for asthma, although the number of reported cases of occupational asthma was lower for the construction workers than for the paper mill workers or for the working population. CONCLUSION: Construction work, especially dusty tasks, was associated with an elevated risk of asthma. Thus the effect of exposure to irritant agents may have a role in the development of asthma among construction workers. For the most part, these cases of asthma do not meet the criteria for occupational asthma because the specified causal agent can not be defined. The aetiologic agents and mechanisms of asthma in construction work should be clarified for preventive measures.