Knowledge

Although prevention of incidents leading to evacuations at sea is of vital importance, little is known about its causal patterns and demographic determinants. We investigated therefore relationships between age, occupation and nationality and causes of evacuations. The data were obtained from the Telemedical Assistance Service (TMAS) in Denmark between 2004 and 2014 supplemented with data on all seafarers from the Danish Maritime Authority (N = 73,344). These data included information on broad age groups, occupational position and nationality. The outcomes were evacuations from any cause and in four broad categories of causes leading to evacuations. A total of 403 evacuations were reported in the 11-year study period. 27% of the evacuations were due to external causes, 19% due to diseases of the circulatory system, 14% due diseases of the digestive system and 40% from other or undetermined causes. Age-adjusted all-cause evacuation rates varied between 1.4 and 3.4 incidents per 1000 person-years in 2004–2014 for officers and between 3.3 and 20.2 incidents for non-officers. An elevated risk of evacuations was found among both officers and non-officers aged ≥50 years, compared with those aged 30–49 years with odds ratios of 2.73 (95% confidence intervals 1.66, 4.50) and 2.59 (2.03, 3.31), respectively. The odds ratios for non-officers from non-Danish European Union and from non-European Union countries compared with Danish non-officers were 1.51 (1.12, 2.04) and 0.55 (0.42, 0.71), respectively. In conclusion, working as non-officer, older age and non-Danish EU nationality were associated with a higher risk of evacuations irrespective of the cause leading to evacuation.

In this webinar, Adrienne Mannov from Aarhus University and Peter Aske Svendsen from NFA presented their research on autonomous shipping as this relates to seafaring and technology, based on their 2019 report, “Transport 2040: Autonomous ships: A new paradigm for Norwegian shipping - Technology and transformation”.

The event was organized in collaboration with MARLOG

Background: Limited access to medical care can be considered as an occupational risk of seafaring and it may predispose to developing community-acquired pneumonia (CAP) requiring hospital care. We sought to investigate the risk for CAP and other lower respiratory tract infections (LRTI) requiring hospital care among seafarers. We examined the length of hospital stay (LOS) as a proxy for severity of illness. Methods: The study population in this panel data analysis were all seafarers and a 20% random sample of economically active individuals aged 18–65 years who were residing in Denmark in 1997–2016, constituting more than 11 million person-years of follow-up. Annually-registered socio-demographic and work characteristics were linked to data on cause of hospital admissions. We used fixed-effects and zero-truncated Poisson regression to estimate the rate ratios of hospitalization for CAP and other LRTI, and compared LOS across the two populations. Results: The adjusted incident rate ratio (IRR) for CAP in seafarers compared to the economically active population was 1.42 (95% confidence interval [CI]: 1.15–1.77), whereas the IRR was 0.73 (95% CI: 0.38–1.42) for other LRTI. For LOS, the IRRs for CAP and other LRTI in seafarers were 1.08 (95% CI: 1.04–1.12) and 0.92 (95% CI: 0.83–1.01), respectively. Conclusions: Our findings indicate that seafaring was associated with an increased risk for CAP requiring hospital care. Limited access to health care may be an important contributing factor.

Aims and objectives: Seagoing employees must undergo medical examinations every second year. Even though International Organisations issued guidelines for these pre-employment medical examinations there is a lack of an internationally accepted continuous training programme for the maritime doctors who perform these examinations. The aim of this survey was to examine the Danish maritime doctors perceived training needs as part of a planned comprehensive maritime occupational health prevention programme.

Methods: A questionnaire based on international standards was distributed to all the maritime doctors (110) electronically in May 2017. The completed questionnaires were 46.4%. STATA was used for the statistical analysis of the data and correlations among the self-rated needs as dependent variables and the doctors characteristics were performed with Fisher exact test, with significance level at α=0.05%.

Results: The maritime doctors considered very important to receive training in “Fitness evaluation and medical examinations guidelines” (76.47%) followed by “Rules and regulations within maritime medicine” (68.63%) and “Working conditions and health risks on board” (62.75%). The number of examinations influenced their preference with those with more than 20 patients to express a more pressing need for training. Age, gender and years of practice did not have any influence in their self-rated needs. Furthermore, they pointed out flexible ways of training including distance learning and
the establishment of a webpage by the respective Authorities as one stop-shop.

Conclusion: Maritime doctors are in favour of continuous education and training. The survey may help the respective Authorities to organise such short courses on targeted topics in the country.

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.

Background:
The metabolic syndrome (MS) represents a cluster of risk factors related to insulin resistance. Metabolic syndrome is a strong risk factor for chronic metabolic and cardiovascular diseases and is related to nutritional factors, sleep patterns, work-related stress, fatigue, and physical activity — all of which are critical issues at sea. We have previously demonstrated a MS prevalence of 24.2% in Danish seafarers. This study aimed to follow the trend of MS after 2 years’ intervention.

Materials and methods:
Out of 524 Danish seafarers (mean age 37.7 years) who underwent medical fit-for-duty examination by seamen’s doctors at baseline, 141 seafarers (mean age 41.3 years) were tracked and re-examined after 2 years. At baseline all participants received general advice regarding lifestyle issues. Seafarers with MS were additionally given specific advice regarding treatment. The seafarers provided questionnaire information about their workplace on board, about treatment of hyperlipidaemia, hypertension, and about previously diagnosed type 2-diabetes. In order to define MS, we collected data about waist circumference, blood pressure, triglycerides, HDL-cholesterol, and fasting plasma glucose.

Results:
Out of 35 (26.5%) seafarers who fulfilled the criteria for MS at follow-up, 18 had MS at baseline while 9 were incident cases. Two seafarers with MS at baseline ceased to qualify for this condition at follow-up. The prevalence of seafarers with MS at follow-up represents a minimal estimate because a proportion could not be assessed due to missing fasting blood tests. Smoking and alcohol consumption was not reduced.

Conclusions:
In spite of the intervention, the prevalence of MS increased in this group of seafarers. This study indicates the limitations of individual health promotion and the need for corporate actions.

Piracy has unfortunately become a health and safety risk for seafarers in the maritime industry today. However, little do we know about the impact of a pirate hijacking situation and how seafarers cope. Focusing on negotiation communication, the analysis debouches in a discussion of the dynamics of coping strategies, by investigating 173 authentic audio recordings of communication sequences recorded during a pirate hijacking situation that were donated voluntarily by a shipping company. The Captain assessed and reflected on the course of events in the situation, to which the negotiator responded appropriately, with acknowledging brief responses or psychological aid. This is similar to other highly dynamic decision-making settings, where decision-makers tend to continuously reflect and revise their view of the situation (Eraut 2000). The data is also consistent with the “reflection-in-action” concept by Schön (1983) used by van den Heuvel et al. (Cogn Technol Work 16: 25–45, 2014) in their investigation of communication of police officers in hostage situations. However, the coping dynamics changed when the negotiator’s responses became too minimal. This shows how the context and the individual’s cognitive appraisal of the encounter co-shapes the coping dynamics in the situation. It is urged that pre-piracy care and seafarer training involves practical examples and information about roles and coping dynamics in negotiation communication as part of an orchestrated approach to the scourge of piracy.