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Seafarers are exposed to several physical and psychosocial stressors. Recent studies highlighted specific disorders as fatigue, boredom and diseases as depression. Seafarers are also commonly exposed to post-traumatic stress disorder (piracy, accidents, threats). Coronavirus disease 2019 (COVID-19) impacts seafarers with an estimated 400,000 of whom are stranded on vessels around the world, with extended time on board, repatriation's difficulties and the financial concerns of the unexpectedly unemployed. International Maritime Organization has established the Seafarer Crisis Action Team to help them. In France, in last 10 months a dedicated call centre received 142 calls from 32 seafarers for psychological phone consultations mostly linked to this era. With the increase of duration of the COVID-19 crisis, psychological health care, repatriations and financial solutions are needed for seafarers.

The midwifery profession varies greatly from one country to another. There are, however, a number of common features such as exposure to biological risks through contact with pregnant women and women in labor, exposure to postural stresses during examinations and medical acts, but also, increasingly, exposure to organizational constraints (work schedules, shift work, etc.). This article aims to give an overview of what is known about the occupational health risks of midwives (MWs). A review of the literature on Medline, from January 1, 2006 to December 31, 2017, was carried out. Articles focused principally on burnout (BO) and post-traumatic stress disorder. Several BO questionnaires were used. For the Copenhagen Burnout Inventory , the prevalence of personal BO ranged 20-57%; the percentage of work-related BO fell between 15-57%; and the prevalence of client-related BO ranged 5-15%. For the Maslach Burnout Inventory , the prevalence of emotional exhaustion varied between 23-60.7%; the prevalence of depersonalization ranged 3.3-30.3%; and the pervasiveness of personal accomplishment varied between 5-30.3%. There was little data concerning musculoskeletal problems or accidental exposure to biological fluids. The literature review on occupational pathologies demonstrates high levels of BO. Several gaps exist on the evolution of the impact of their work on the health of MWs, like the effect of shift work, postural stresses, etc. This review will make it possible to better focus future research on the occupational health of this population. Med Pr. 2020;71(4):473-81., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: 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., Materials and Methods: 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., Results: 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., Conclusions: 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.

This is the first case report about a transgender professional diver. The purpose of this article is to show the professional adaptations to help him to continue occupational dive and to raise the question of the impact on diving risks of hormonal treatment in this case. He was a 39-year-old man when he began his transition. He had worked as a diver for 9 years before his transition. When he changed to look like a woman, there were a few difficulties in continuing his professional activity. The main difficulty was that he looked like a woman while working with men. Modesty was a crucial issue in the enterprise. There were other problems such as the organisation of premises, the physical workload and the interaction between treatments and diving. There is a lack of a law to guide the employer. French legislation does not address the issue of transsexuals for this profession. The medical recommendations do not specify contraindications or adaptations for diving safely. Because of his transition, he lost muscle mass. The occupational physician helped to adjust his activity: decreasing the weight of his diving suit, creating a female-like locker room etc. Finally, the question of the risk of decompression illness arose. Legal hormonal medication seems not to significantly increase the risk of decompression illness, but this diver was taking illicit treatment to speed up the transition. The occupational physician recommended taking the legal hormonal medication.

Background: The aim of this study was to assess changes in lung function of professional divers., Materials and Methods: This is a review of the literature. Only studies about professional divers were included. All published studies between 01.01.1984 and 07.01.2014 were systematically searched. The search was performed in Medline and Embase databases and in the "Medicina Maritima" journal. The results of pulmonary function tests were extracted from each study., Results: Fifteen articles were found. Four studies showed a significant decrease in forced vital capacity (FVC). Five studies demonstrated a significant decrease in forced expiratory flows (FEF) at 75% and 50% of FVC expired (FEF75% and FEF50%) after 3 years of diving. Seven studies demonstrated a significant decrease in forced expiratory volume in 1 second (FEV1) after 3 years of diving. But only 2 studies did an age-standardisation so that only 1 study demonstrated a significant decrease in FEV1 after age-standardisation. Three articles showed a decrease in transfer factor for carbon monoxide (TLCO) after 5 years. Dives parameters (like depth, number by year) were not always related to variations on the different lung variables., Conclusions: This literature review showed a decrease in TLCO, FEF75% and FEF25-75%. One wonders whether these variations are due to the age or to diving. The results of such a long-term study would be interesting and might help to guide fundamental research.