Maritime Medicine Research Articles

Maritime Medicine, Hyperbaric and Emergency Case in The Future

Maritime Medicine, Hyperbaric and Emergency Case in The Future

Decision Support System Software for Normal Pregnancy, in Maritime Medicine, Setting for Costal Situation, Recommended for Making A Decision Support System for Diving Fishermen

Background: The coastal situation in Indonesia with thousands of islands and its area, the use of Ultra Sono Graph (USG) as a tool for general practitioners will be useful to facilitate examinations, consult with experts, and make referrals easily and quickly. Objective: For ultrasound readings that require decisions, using the Decision Support System makes it easier and there are friends to discuss, indirectly with experts, even machines. Theoretical Basis: DSS is very important to clarify and speed up decision-making with the help of software and computers. Use Process: The ultrasound software will guide and direct the appropriate diagnosis so that decisions can be made or referred and handled quickly and precisely. DSS will be very useful in preventing accidents among diving fishermen, by using the P02 benchmark which is easy to use. Conclusion: The use of the Decision Support System for normal and abnormal pregnancy ultrasound is beneficial for coastal area support for early diagnosis and implementation of a referral system. By looking at examples of use like this, it is recommended to create a Decision Support System for Diving Fishermen.

Exploring the integration of artificial intelligence (AI) and augmented reality (AR) in maritime medicine

This narrative literature review has analyzed the integration of artificial intelligence (AI) and augmented reality (AR) in the field of maritime medicine. A comprehensive search was conducted in academic databases using relevant search terms, resulting in the identification of 257 records. After screening for relevance and quality, a final review was conducted on 17 papers. This review highlights the potential applications and benefits of AI and AR in enhancing medical practices and safety measures for seafarers. The integration of AI and AR technologies in maritime medicine shows promise in providing real-time medical assistance, remote consultations, augmented training, and improved diagnostic capabilities. Additionally, AI-driven predictive models can aid in early detection of health issues and support proactive health management onboard ships. Challenges related to data privacy, connectivity at sea, and the need for regulatory frameworks are also discussed. The data analysis reported in this review contributes to a better understanding of the current state and future potential of AI and AR in maritime medicine and provide insights into opportunities for further research and implementation in the maritime industry.

Role and place of maritime medicine

The article considers the role and place of maritime medicine as science, as a separate health care industry and as the academic discipline. Maritime medicine is at the crossroads of 2 vast areas of human knowledge – medicine and oceanology. As medical science, maritime medicine explores the impact of Ocean on human health in order to develop means and methods of preserving the Earth’s human potential, first of all, the one of maritime industry and coastal territories. Maritime medicine includes a set of private medical sciences, such as marine hygiene, marine epidemiology, medicine for ships, diving medicine, naval medicine, marine ergonomics, marine physiology and pathophysiology, marine therapy, marine surgery, marine toxicology, marine pharmacy, history of marine medicine, marine health care organizations and some other disciplines. The article discusses the relationship of maritime medicine with other fields of knowledge, sciences and academic disciplines.

INITIAL RESULTS OF TREATING THERMAL BURNS BY HYPERBARIC OXYGEN THERAPY AT THE VIETNAM NATIONAL INSTITUTE OF MARITIME MEDICINE

Background: Burns, especially heat-related ones, are one of the most common injuries in work and daily life. If patients are not treated properly, burns can leave a lot of sequelae which would negatively affect not only daily activities, working ability but also aesthetics and psychology of the patients. Most topical treatments have been reported that they have some adverse effects and unintentionally prolong the length of hospital stay. Therefore, topical treating method is considered as an inefficient and uneconomical therapeutic approach. Hyperbaric oxygen therapy is a new treatment. It is able to help to relieve pain quickly, accelerate wound healing process, and reduce length of hospital stay which would effectively improve the burn treatment process. Objectives:To describe the clinical characteristics right at the time thermal burn patients were admitted to hospital and initial results of treating them by hyperbaric oxygen therapy. Materials and methods:Prospective and retrospective case series report. The study sample was the thermal burn patients who came to the Vietnam National Institute of Maritime Medicine for being treated by hyperbaric oxygen therapy in the period between 2018 and 2022. Results:of the 82 total thermal burned patients, the mean age was 48.4±19.5; the main cause of burns was boiled water which accounted for 74.4% of patients; 51.2% of them had been classified as 3rd degree burns; percentage of patients who had under 10% of total body surface area burned was 80.5%; 84.1% of patients had no pain on the 14th day; the mean length of hospital stay was 8.9±3.0 days which was significantly lower than the expected figures. Conclusions: Hyperbaric oxygen therapy is a new effective treatment for thermal burn patients with a variety of positive impacts on burned tissues. As a result, it should be scaled up, especially in health facilities which is specialized in burn treating.

Requirements, Challenges, and Key Components to Improve Onboard Medical Care Using Maritime Telemedicine: Narrative Review.

Telemedicine has been able to bring healthcare services to all people in far locations such as the sea. Our main objective was to overview the main features, challenges, and requirements of applying telemedicine at sea. The electronic search includes all types of papers published in English. It was performed in four databases with keywords to Feb 2023. Next, main categories were defined to extract major concepts. By mapping extracted themes, maritime telemedicine concepts were represented in two conceptual models. After screening the papers based on title and abstract, 18 articles remained. They can be divided into 13 categories based on their clinical domains. Out of 18 reviewed articles, six articles were published in 2020. The greatest number of studies with five articles was conducted in France. Evidence showed that maritime telemedicine service can be provided to all kinds of ships. Regarding clinical domains, the greatest demand belonged to primary care problems (5 papers) and general health assessment (4 papers). Challenges were divided into four main categories. Moreover, the required services and equipment in four categories were described too. Finally, a conceptual model is represented for providing telemedicine services at sea using satellite Internet. Despite the existing challenges in providing the required equipment and resources for the implementation of maritime medicine, it has an important role in providing better care for seafarers without time limitations.

Results of acute cerebral infarction treatment with hyperbaric oxygen therapy, 2020-2022.

Cerebral stroke is the third leading cause of death after cardiovascular disease, cancer and the leading cause of disability for patients. Hyperbaric oxygen is a non-drug treatment that has the potential to improve brain function for patients with ischaemic stroke. The objective of this study was to evaluate the results of treatment of acute cerebral infarction with hyperbaric oxygen therapy (HBOT). This was a case-control study. One hundred ninety-five patients diagnosed with cerebral infarction, with signs of onset within 24 hours, were treated at the Centre for Underwater Medicine and Hyperbaric Oxygen of Vietnam National Institute of Maritime Medicine during the period from January 2020 to December 2022. Study group included 100 patients with acute cerebral infarction treated with a combination of HBOT and medication and reference group included 95 patients treated by medication only (antiplatelets drugs, statins, control of associated risks factors) RESULTS: After 7 days of treatment with hyperbaric oxygen (HBO), symptoms such as headache, dizziness, nausea, sensory disturbances, and Glasgow score of the study group improved better than that of the reference group (p < 0.01). Movement recovery in the study group was better than the reference group: the percentage of patients with mild and moderate paralysis in the study group increased higher than that of the reference group (86.0% and 68.4%), the degree of complete paralysis of the study group decreased more than that of the reference group (14.0% and 31.6%). The degree of independence in daily activities in the study group was better than the reference group. In the study group, the percentage of patients with complete independence in daily life increased from 27.0% to 84.0%. In the reference group, the rate of patients who were independent in their daily activities increased from 37.9% to 51.6%. The average number of treatment days of the study group was 10.32 ± 2.41 days and it the reference group 14.51 ± 3.24 days. Hyperbaric oxygen therapy is a non-drug treatment with many good effects in the treatment of cerebral infarction, especially acute cerebral infarction. HBOT reduces and improves functional symptoms, improves mobility, and reduces treatment time for patients.

Current status and future prospects of maritime medicine

Current status and future prospects of maritime medicine

Psychological state of the fishing fleet employees during continued sea voyages: a review

INTRODUCTION:The adaptive human characteristics are time bound, hence an abrupt change of environmental conditions is crucial in adaptation process, specifically relevant maritime medicine.OBJECTIVE OF THE STUDY:Based on literature data, to frame the issue of changes in psychological adaptive process among the fishing industry staff during long sea journeys and to justify the need of their constant medical supervision for early identification of possible health problems in the voyage period as well as during crew readaptation to the shore conditions.MATERIALS AND METHODS:The literature has been searched in the international electronic databases of Web of Science, Scopus, also in the domestic library system eLibrary. The sources with a full-text access to the e-library are used. Time depth of the analysed literature coverage is the last 20–25 years, yet more than half of the sources are less than 5–7 years. The key words in the search engine are maritime labour, adverse occupational factors of maritime activities, the health of fishing transport staff, psychological adaptation of the sailing vessel crew.RESULTS:Specificity of the adaptation problem in maritime medicine is primarily that seamen’s body should adjust to a significant number of adversities in a relatively short time. Time discrepancy between these processes leads to the emergence of disadaptation disorders which might evoke pathological lesion. Psychological status has a pronounced impact on human adaptation to working environment. Individuals with pronounced weakness of nervous processes often experience breakdowns in tense navigation conditions. The literary data analysis of seamen’s psycho-emotional state study in navigation conditions shows that even while short-term journey in the Arctic Basin seas most sailors experience mental tension of the central nervous system by the midterm. At long-term journey during a year-round Arctic navigation the phasal nature of psychological adaptation course is identified. In the first third of the journey the development of orienting response was observed due to the staff change and familiar social environment. By the middle of the journey there was a period of mental stabilization. By the end of the journey signs of psychological disadaptation were detected and intensified. Disadaptation changes include emotional instability, increased lability of the nervous system, particularly reflected in irritation, sleep disturbance, increased neuromuscular excitability, decline in mental and physical performance.CONCLUSION:Seamen require constant psychophysiological monitoring to identify adaptive changes in the journey period and during crew readaptation to the shore conditions. Within the system of medical support to the water transport staff, an integrated manner of adverse conditions in professional environment is required in order to create high-quality and safe working conditions.

The maritime medicine in Morocco: reality and future prospects

INTRODUCTION: The maritime sector in Morocco constitutes an important economic and social lever of the country, in particular with the two maritime facades of the country. If the fishing sector is classically the dominant part of this system, the change experienced by the Moroccan economy over the past two decades and the development of the port infrastructure of the merchant marine have allowed the latter to regain its importance. This development of the marine sector has repercussions on seamen and calls into question the importance of the social issue in this area, particularly in relation to the medical care of this population.OBJECTIVES: To research the scope of medical care issues related to merchant marine workers.MATERIALS AND METHODS: This study was based on the collection of data: legislative texts on occupational health and safety; statistical data from administrations (the Ministry of Health and the Ministry of Marine Fisheries), the General Medical Council of Morocco, scientific societies and associations for occupational health and marine medicine. The analysis included socio-demographic and professional characteristics, training, evaluation of activities, limitations in its implementation and priority recommendations for improving the situation.RESULTS AND DISCUSSION: Morocco’s health system includes two areas: the commercial and fishing sectors. The study showed that there are no specialized medical centers in any of the sectors, and medical care for this population is at a low level. There is no Moroccan telemedicine system. Currently, Morocco has already defined a legal framework for this practice.CONCLUSION: This article sheds light on the health system of seamen in Morocco while highlighting its strengths and weaknesses as well as avenues for reflection for the improvement of existing anomalies.

Magellan's circumnavigation: what lessons 500 years later for maritime medicine?

Magellan's circumnavigation: what lessons 500 years later for maritime medicine?

Restrictions of VC and DLCO in relation to asbestos-related computed tomographic findings quantified by ICOERD-based parameters

BackgroundEven almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes.MethodsData from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen’s κ, and accuracy.ResultsVital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (DLCO) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (DLCO/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = − 0.273, P < 0.05), and DLCO measures show a better correlation with fibrosis score (ρ = − 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and DLCO (ρ = − 0.283, − 0.274, resp.; both P < 0.05).DiscussionThe importance of spirometry (VC) and diffusion capacity measurement (DLCO) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and DLCO) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.

The acute odontogenic infection in maritime medicine: clinical and radiological parallels

Relevance. The main thing in the prevention of acute odontogenic infection in sailors during long voyages is the full implementation of the pre-voyage sanitation of the oral cavity, which provides for the elimination of chronic foci of odontogenic infection.The aimof the study was to identify chronic foci of odontogenic infection in sailors after the completion of their prevoyage sanitation of the oral cavity and before going sailing.Material and methods. Dental and X-ray (orthopantomography) examination of 169 men aged 22 to 52 years after completion of dental treatment (oral cavity sanitation) before a long sea voyage was carried out, followed by analysis of clinical and radiological parallels to identify chronic odontogenic foci of infection, which can be a potential source of microorganisms for the development of acute odontogenic infection during swimming.Results and discussion.It was found that, despite the ongoing treatment and prophylactic work on the rehabilitation of the oral cavity with the sailors in the pre-voyage period, in 30.4-77.2% of cases they retain chronic foci of odontogenic infection during a long sea voyage, which can become the cause of the development of acute odontogenic infection. For the qualitative detection of chronic odontogenic foci of infection, it is necessary to supplement the dental examination of sailors in the pre-voyage period with an X-ray examination, which will allow timely identification and elimination of chronic odontogenic inflammation of the maxillary sinuses, as well as chronic periapical and periodontal foci of odontogenic infection.

Promoting psychological adaptation among navy sailors

The mandate of the Institute for Maritime Medicine (IMM) is to support and enhancethe operational performance of sailors of the South African Navy during maritimeoperations, while also ensuring positive long-term mental health outcomes of sailorswho serve their country at sea. To achieve this, the IMM proposes to re-orientate themobilisation and demobilisation programmes used for ship-based maritime operationstowards a predict-and-promote (P&amp;P) approach, to enhance the psychological adaptationof sailors to the emotional demands of deployment as well as to support more adaptiveforms of mental health resilience, both before and after sea-going operations.First, this article aims to present the proposed P&amp;P approach for enhancingpsychological adaptation during and after seaward deployments, with a specific focuson assessing personal emotional regulation (ER). For effective implementation, thisapproach is contingent on several clinical assumptions about ER in the operationalenvironment, namely: the absence of significant psychopathology; the stability ofthe ER measure; the role of dispositional factors in operational adaptation; and theavailability of population-specific normative data, which act as an interpretative guideof ER profiles for sailors. The second aim is to consider support for these assumptions,using previous experience during the mobilisation and/or demobilisation of shipsinvolved in maritime operations. Support was found for all four assumptions, indicatingthe clinical and operational utility of the P&amp;P approach at the IMM broadly, and theassessment of ER for sailors in particular.

Determinants of the Implementation of Telemedicine in the German Navy-A Mixed Methods Study.

ABSTRACTIntroductionThe history of the use of telemedicine in maritime medicine dates back to the 1930s. In the early 2000s, the German Navy built up a telemedicine network which today is installed in all ships and provides a connection to the medical infrastructure ashore. The objective of this study was to optimize the implementation of telemedicine based on the experience gained in the German Navy. For this purpose, qualitative and quantitative methods were used to identify determinants which affect the use of telemedicine in order to determine whether there is any need for optimization.MethodsThe study was conducted using a mixed methods design. First, guideline-based interviews were conducted with Navy medical officers who had been recruited via various email distribution lists. The interviews were then transcribed and coded. In an analysis, deductive and inductive categories were derived from the codes. Hypotheses were deduced from the interviews, too, and used to develop a questionnaire.Besides the medical officers, other Navy medical personnel with experience in the field of telemedicine took part in the survey. The study was concluded by a descriptive analysis of the quantitative data.ResultsThe analysis of the interviews revealed that a regular use of telemedicine workstations increased the users’ confidence and, in their opinion, improved medical treatment. Technical and organizational problems posed obstacles, which increased the use of partly insecure alternatives. A proper technical support was regarded as a precondition for effectively using telemedicine.The results of the quantitative analysis showed that consultation was mainly sought for dermatological (46%), surgical (24%), and internal (22%) conditions.ConclusionThe study revealed determinants for the use of telemedicine in the German Navy. Factors improving the motivation of the users should be strengthened in order to optimize the use of telemedicine. Furthermore, it can be assumed that a successful implementation will be supported by reducing or eliminating obstacles. The findings on the main reasons for seeking medical advice could be taken into account in the further planning of specific training.

Letter to the Editor, 'Occupational Asthma and Its Causation in the UK Seafood Processing Industry'. Do Not Forget Preservatives and Endotoxins.

Letter to the Editor, ‘Occupational Asthma and Its Causation in the UK Seafood Processing Industry’. Do Not Forget Preservatives and Endotoxins David Lucas, David Lucas ORPHY Laboratory, University Brest, BREST Cedex, FranceOccupational and Environmental Diseases Center, Teaching Hospital, Brest, FranceFrench Society of Maritime Medicine Brest, Brest cedex, France Author to whom correspondence should be addressed. Tel: +33-298223509; e-mail: david.lucas@chu-brest.fr https://orcid.org/0000-0001-8201-0808 Search for other works by this author on: Oxford Academic PubMed Google Scholar Greta Gourier, Greta Gourier Occupational and Environmental Diseases Center, Teaching Hospital, Brest, FranceFrench Society of Maritime Medicine Brest, Brest cedex, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Richard Pougnet, Richard Pougnet Occupational and Environmental Diseases Center, Teaching Hospital, Brest, FranceFrench Society of Maritime Medicine Brest, Brest cedex, FranceLaboratoire d’Etude et de Recherche en Sociologie (EA 3149), Université de Brest–Bretagne Occidentale, Brest cedex, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Jean-Dominique Dewitte, Jean-Dominique Dewitte Occupational and Environmental Diseases Center, Teaching Hospital, Brest, FranceFrench Society of Maritime Medicine Brest, Brest cedex, FranceLaboratoire d’Etude et de Recherche en Sociologie (EA 3149), Université de Brest–Bretagne Occidentale, Brest cedex, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Brice Loddé Brice Loddé ORPHY Laboratory, University Brest, BREST Cedex, FranceOccupational and Environmental Diseases Center, Teaching Hospital, Brest, FranceFrench Society of Maritime Medicine Brest, Brest cedex, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Annals of Work Exposures and Health, Volume 65, Issue 6, July 2021, Pages 738–739, https://doi.org/10.1093/annweh/wxaa137 Published: 22 February 2021

Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study

BackgroundAsbestos-related lung diseases are one of the leading diagnoses of the recognized occupational diseases in Germany, both in terms of their number and their socio-economic costs. The aim of this study was to determine whether pulmonary function testing (spirometry and CO diffusion measurement (DLCO)) and computed tomography of the thorax (TCT) are relevant for the early detection of asbestos-related pleural and pulmonary fibrosis and the assessment of the functional deficiency.MethodsThe records of 111 formerly asbestos-exposed workers who had been examined at the Institute for Occupational and Maritime Medicine, Hamburg, Germany, with data on spirometry, DLCO and TCT were reviewed. Workers with substantial comorbidities (cardiac, malignant, silicosis) and/or pulmonary emphysema (pulmonary hyperinflation and/or TCT findings), which, like asbestosis, can lead to a diffusion disorder were excluded. The remaining data of 41 male workers (mean 69.8 years ±6.9) were evaluated. The TCT changes were coded according to the International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) by radiologists and ICOERD-scores for pleural and pulmonary changes were determined. Correlations (ρ), Cohens κ and accuracy were calculated.ResultsIn all 41 males the vital capacity (VC in % of the predicted value (% pred.)) showed only minor limitations (mean 96.5 ± 18.0%). The DLCO (in % pred.) was slightly reduced (mean 76.4 ± 16.6%; median 80.1%); the alveolar volume related value (DLCO/VA) was within reference value (mean 102 ± 22%). In the TCT of 27 workers pleural asbestos-related findings were diagnosed whereof 24 were classified as pulmonary fibrosis (only one case with honey-combing). Statistical analysis provided low correlations of VC (ρ = − 0.12) and moderate correlations of DLCO (− 0.25) with pleural plaque extension. The ICOERD-score for pulmonary fibrosis correlated low with VC (0.10) and moderate with DLCO (− 0.23); DLCO had the highest accuracy with 73.2% and Cohens κ with 0.45. DLCO/VA showed no correlations to the ICOERD-score. The newly developed score, which takes into account the diffuse pleural thickening, shows a moderate correlation with the DLCO (ρ = − 0.35, p < 0.05).ConclusionsIn formerly asbestos-exposed workers, lung function alterations and TCT findings correlated moderate, but significant using DLCO and ICOERD-score considering parenchymal ligaments, subpleural curvilinear lines, round atelectases and pleural effusion in addition to pleural plaque extension. DLCO also showed highest accuracy in regard to pulmonary findings. However, VC showed only weaker correlations although being well established for early detection. Besides TCT the determination of both lung function parameters (VC and DLCO) is mandatory for the early detection and assessment of functional deficiencies in workers formerly exposed to asbestos.

ФГУП НИИ ПММ: эволюция приборов для контроля радона и его ДПР

Preparation and implementation of measures to reduce radiation doses to personnel of enterprises engaged in the extraction and processing of uranium-containing ores, and the population of the territories adjacent to uranium deposits, require an increase in the accuracy of estimates of absorbed and effective doses to the personnel of enterprises and the population with the inhalation of radon and its progeny. This can only be done by taking into account the contribution of the aerosol-unattached fraction of the radon decay progeny to the effective and absorbed radiation doses, which are evaluated on the basis of direct measurements. Alpha spectrometer SAT-03 – a means of measurement of the third generation, has been developed in the Research Institute of Industry and Maritime Medicine for these purposes. Widespread domestic radiometers of the previous generation (RAA-10, RRA-01M) do not have the technical capabilities to perform such studies.

Temporary and permanent unfitness of occupational divers. Brest Cohort 2002-2019 from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P).

In France, the monitoring of professional divers is regulated. Several learned societies (French Occupational Medicine Society, French Hyperbaric Medicine Society and French Maritime Medicine Society) have issued follow-up recommendations for professional divers, including medical follow-up. Medical decisions could be temporary unfitness for diving, temporary fitness with monitoring, a restriction of fitness, or permanent unfitness. The aim of study was to point out the causes of unfitness in our centre. The divers' files were selected from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Only files with a special medical decision were selected, between 2002 and 2019. Three hundred and ninety-six professional divers are followed-up in our centre and 1371 medical decisions were delivered. There were 29 (7.3%) divers with a special medical decision, during 42 (3.1%) medical visit. Twelve (3.0%) had a permanent unfitness. The leading cause of unfitness was pulmonary diseases: emphysema (3), chronic obstructive pulmonary disorder (2), asthma (2). Sixteen (4.0%) divers had temporary unfitness. The leading causes were cardiovascular (4 times) and neurological (6 times). Twelve (3.0%) divers had had at least one decompression sickness. Judgments of permanent unfitness for diving were rare (3.0% of divers), but were because of life-threatening disease. Medical follow-up of occupational divers was justified to decrease the risk of fatal event during occupational dives.

Maritime doctors’ skills and competencies: A review for policy analysis

Maritime medicine deals with the health of seafarers, fishermen, and offshore employees and, more specifically, with their employment, working and living conditions, and their health and safety at sea. Maritime doctors should have the appropriate training and competencies to provide the equivalent service as would be found on land. This review discusses a) the required skills and competencies of maritime doctors and b) explores the associated ongoing discussions for the establishment of a global accredited Masters programme in maritime health. A literature review was conducted using 2 databases: PubMed and Google scholar. Search terms included: maritime doctors, maritime medicine, occupational health, and skills and competencies. Literature published between 1990 and 2018 was prioritised. Thirty-five articles that discussed the skills, competencies, and education of maritime doctors and health professionals were retrieved, reviewed, and discussed, plus 8 reports and documents from relevant International Organisations webpages. We explored policies in relation to training using i) the health triangle and ii) the Kingdon model. Doctors who serve in the sector should have extensive knowledge about medical practice, but also about the environment of seafaring. The complexity of their roles, coupled with the provision of a high quality of services in global shipping, call for high quality accredited training and harmonisation of maritime health practices. The analysis of policy, using 2 policy models, showed that a window of opportunity appears to be in favour of a policy regarding the recognition of maritime medicine as a medical specialisation. International stakeholders, together with the International Maritime Health Association, should actively advocate such a perspective which will be in favour of seafarers, who will enjoy better health and wellbeing, with higher income while avoiding ill-health, as well as the shipping industry, which will employ satisfied and loyal employees, and will enjoy a higher reputation.