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At the University of Nebraska Medical Center College of Pharmacy, a longitudinal project is underway to assess how the college is functioning in terms of keeping Justice, Equity, Diversity, and Inclusion (JEDI) at the forefront of the institution. This study is intended to showcase areas of excellence within the college and as a quality improvement exercise to show the institution potential areas in need of improvement. This process was also initiated because such assessments may soon become a requirement for colleges of pharmacy to earn full accreditation. Upon analyzing the Justice component of JEDI and the 32 justice-related ideas that were recommended for exploration and discussion, and further sub-categorized under the terms representation, curriculum and education, policies and procedures, support and resources, and college climate, useful data were discovered. Overall, the information found on representation, policy and procedure, and college climate was difficult to quantify as much of the information was subjective; however, this does not automatically discount this information from being useful. Information relating to curriculum and education was more quantifiable but may be underrepresented. Analyzing information found relating to resources was made possible by identifying readily available support offered at the college for faculty, staff, and students. In identifying these resources, the college was able to take note of any missing support that needed to be implemented to ensure justice was being maintained. This longitudinal process not only allows the college to see areas where they thrive, but it also highlights any shortcomings of the college while providing the institution with information to spark innovative ideas to strengthen and further promote justice.

Problem description\The University of Nebraska College of Pharmacy is interested in conducting and learning from an inventory of Justice, Equity, Diversity, and Inclusion (JEDI) within the college., Quality Improvement Methods: An extensive literature review was undertaken to define the terms included in JEDI and to craft a listing of ideal inventory components., Results of Cqi Inquiry: The terms used in JEDI were defined and a list of 148 ideal inventory components was created. This list is further segmented by the JEDI components themselves and by five assessment factors including: representation, curriculum & education, policies & procedures, support & resources, and college climate., Interpretation and Discussion: The attempt to create an ideal listing of JEDI inventory components resulted in an unusably large number of potential items. This occurred intentionally to allow the next steps in the longitudinal creation of a workable, quantifiable, and evaluative JEDI inventory process. Describing these preliminary efforts are important in the ultimate acceptance of the results of the JEDI inventory., Conclusion: Deliberate and extensive listing of initial aspirations for a JEDI inventory of a College of Pharmacy or any institution allows for sufficient input and breadth to help assure that no significant factor is overlooked as the process is refined., Competing Interests: Declaration of competing interest None of our authors declares any conflict of interest., (Copyright © 2023. Published by Elsevier Inc.)

Metabolic reprogramming, including increased glucose uptake and lactic acid excretion, is a hallmark of cancer. The glycolytic 'gatekeeper' enzyme phosphofructokinase-1 (PFK1), which catalyzes the step committing glucose to breakdown, is dysregulated in cancers. While altered PFK1 activity and expression in tumors have been demonstrated, little is known about the effects of cancer-associated somatic mutations. Somatic mutations in PFK1 inform our understanding of allosteric regulation by identifying key amino acid residues involved in the regulation of enzyme activity. Here, we characterized mutations disrupting an evolutionarily conserved salt bridge between aspartic acid and arginine in human platelet (PFKP) and liver (PFKL) isoforms. Using purified recombinant proteins, we showed that disruption of the Asp-Arg pair in two PFK1 isoforms decreased enzyme activity and altered allosteric regulation. We determined the crystal structure of PFK1 to 3.6 Å resolution and used molecular dynamic simulations to understand molecular mechanisms of altered allosteric regulation. We showed that PFKP-D564N had a decreased total system energy and changes in the electrostatic surface potential of the effector site. Cells expressing PFKP-D564N demonstrated a decreased rate of glycolysis, while their ability to induce glycolytic flux under conditions of low cellular energy was enhanced compared with cells expressing wild-type PFKP. Taken together, these results suggest that mutations in Arg-Asp pair at the interface of the catalytic-regulatory domains stabilizes the t-state and presents novel mechanistic insight for therapeutic development in cancer., (© 2023 The Author(s).)

BackgroundThe COVID-19 pandemic was of major concern in Greenland. There was a high possibility of rapid transmission in settlements, and an increased risk of morbidity and mortality because of comorbidities in the population and limited access to specialised healthcare in remote areas.AimTo describe the epidemiology of the COVID-19 pandemic in Greenland and evaluate the effects of a strict COVID-19 strategy until risk groups were immunised.MethodsWe studied the epidemiology during March 2020 to June 2022. We describe the non-pharmaceutical interventions (NPIs), PCR-confirmed COVID-19 cases and vaccination coverage with data from the registries of the Greenlandic health authority.ResultsWe found 21,419 confirmed cases per 100,000 inhabitants (54% female, 46% male), 342 per 100,000 were hospitalised and 16 per 100,000 were admitted to the intensive care unit. The COVID-19 mortality rate was 39 per 100,000, all those affected were aged above 65 years. No excess overall mortality was observed. The vaccination coverage by June 2022 was 71.67 and 41% for one, two and three doses, respectively.ConclusionSARS-CoV-2 circulation in Greenland was low, given strict restrictions until all eligible inhabitants had been offered immunisation. The main impact of the pandemic was from May 2021 onwards with increasing numbers of confirmed cases. This occurred after introduction of the vaccine programme, which may have had an influence on the severity of the associated morbidity and mortality experienced. Halting community transmission of SARS-CoV-2 with NPIs until the majority of the population had been immunised was a successful strategy in Greenland.

Antimicrobial resistance in Neisseria gonorrhoeae (GC) has made gonorrhoea control and treatment more complex globally. In Greenland, the incidence of gonorrhoea is high and there is a need for continued surveillance of antimicrobial susceptibility.This study investigated gonococcal isolates obtained in Greenland's capital Nuuk between January 2015 and June 2018. Subsequent to collection, isolates were tested for ciprofloxacin and ceftriaxone susceptibility in order to monitor the resistance pattern among GC strains. 150 GC strains were isolated in Nuuk during the observation period (139 males, 93%; 11 females, 7%). All strains were fully susceptible to ceftriaxone. 49% of the GC strains were susceptible to ciprofloxacin. The median minimal inhibitory concentration (MIC) for ceftriaxone among GC strains resistant to ciprofloxacin was higher than among GC strains susceptible to ciprofloxacin. No differences in ciprofloxacin susceptibility and median MICs for ceftriaxone were observed by collection year. In conclusion no ceftriaxone resistance has been found in Nuuk to date. Continued easy access to diagnostics and treatment combined with increased and more systematic surveillance of antimicrobial susceptibility in Nuuk is recommended. Further, it is advisable to investigate the possibilities for intermittent sampling in Greenland outside of Nuuk, if obstacles in relation to sending sampling material to Nuuk can be bypassed.

Background: Seafarers in international trade are today recruited world-wide based on qualifications and costs. Health is another aspect. In this study, two cohorts of seafarers from the Philippines and Denmark undergoing pre-employment health examinations were compared. The purpose is to investigate differences in the outcome of the examinations and compare basic parameters., Materials and Methods: Two cohorts of equal number of seafarers from the Philippines and Denmark were established. A total of 9,654 consecutive health examinations at a large clinic in the Philippines were compared with a group with the same size examined in a number of clinics in Denmark. The Filipino seafarers were screened according to different company standards whereas the Danish seafarers were examined according to statutory standards., Results: The age structure was different. Only 18% of seafarers from the Philippines were 45 years of age or above whereas almost 43% of the Danish seafarers were in this age category. Obesity was frequent in both cohorts although depending on the standard used as reference. Extreme obesity (body mass index, above 35) was 10 times more frequent among the Danish seafarers. A total of 4.4% of the Filipino seafarers were declared unfit whereas only 0.5% were found unfit among the Danish seafarers. Among the latter, 5.2% were found fit with limitations, which is a category not used in the Philippines., Conclusions: The two groups are inhomogeneous and the health examinations the seafarers underwent differ. Comparisons should be done with caution. The difference in the age distribution of the two groups of seafarers is important factor due to the strong impact of age on health. Obesity was of major concern in both groups, although there were more with severe overweight and especially with extreme overweight among the Danish seafarers. Smoking frequency seems to be on the same level.

Background: This study aimed to review Danish register-studies on seafarers' and fishermen's health and safety., Methods: Register-based or register-linked studies from 1970 until 2012 were identified and reviewed. Four categories of studies were included: mortality, hospitalization, specific diagnoses and conditions and accidents. Standardized risks estimates were typically calculated by comparison with the total Danish working population., Results: Elevated rates were found in all four categories. For mortality male seafarers had excess rates of accidents, cirrhosis of the liver, cancer, and suicides, and fishermen of accidents and cardiovascular disorders. Female seafarers in male-dominated occupations also had increased mortality rates. Elevated hospitalization rates for male seafarers were particularly prominent for endocrine/nutritional conditions, cervical discopathy, gastrointestinal and cardiovascular diseases, cancers, hearing impairment, and injuries, and for female seafarers cancers, circulatory and genitourinary diseases and injuries. Fishermen had increased hospitalization rates for cardiovascular diseases, bronchitis, emphysema, lung cancer, gonarthrosis, thoracolumbar discopathy, rotator cuff syndrome, carpal tunnel syndrome, injuries and hearing impairment. Specific diagnoses and conditions: There was an elevated risk of tuberculosis, hepatitis B and certain cancers for male seafarers, and of obesity and occupational accidents for both fishermen and seafarers., Conclusions: In spite of safety measures and significant structural changes in the Danish merchant and fishing fleet, the spectrum of health indicators continues to indicate considerable risk factors in the maritime environment and/or the lifestyle of seafarers and fishermen. Future monitoring of fishermen's and seafarers' health will remain essential for implementing appropriate preventive measures., (© 2014 the Nordic Societies of Public Health.)

Background: A previous study demonstrated a high death rate among seafarers signed on Danish ships during the years 1986-1993. This study aimed to examine and analyse the subsequent development until 2009., Material and Methods: A total of 356 fatalities were identified from data supplied from the Danish Maritime Authority, an insurance company, and other sources. Maritime deaths among seafarers signed on Danish ships comprise deaths from 1) accidents, suicides and homicides; and 2) disease on board. Deaths due to 2) occurring ashore within 30 days after signing off were included. The overall and mode-specific death rates were calculated for three eight-year observation periods. The rates for work-related fatal accidents were compared with the rates for land-based trades., Results: All categories of maritime deaths were significantly reduced from 1986 to 2009 - in particular during the last eight-year period (Accidents 1986-1993: 66.6 per 100,000 person years, 2002-2009: 27.0 per 100,000 person years, diseases 49.5-26.1, suicides 14.4-7.8). In spite of the remarkable improvement since 1986, seafarers remain in 2002-2009 more than six times more likely to die from occupational accidents (including shipwrecks) than do workers ashore., Conclusions: The favourable trend of maritime deaths in the Danish merchant fleet may be due to 1) preventive measures - e.g. interventions relating to vessel safety, work environment, and improved medical care on board - and to 2) technological and organizational changes - e.g. newer and larger vessels in the Danish merchant fleet, changed composition of the workforce, and reduced shore leaves. The persisting excess risk warrants further preventive actions.

BACKGROUND. In addition to the well-known medical consequences of overweight, severe obesity may also constitute a safety problem on board a ship in case of an emergency. The purpose of this study was to determine the current extent of the problem of overweight among Danish seafarers and fishermen and to follow-up the situation since a previous survey. The aim was to identify the main target groups and determine the need for continuous intervention. MATERIAL AND METHODS. Data on height and weight were obtained from the mandatory health examinations of seafarers and fishermen. A total of 2,101 seafarers were included in the study. Body Mass Index (BMI) was calculated for each individual seafarer. Data from two other surveys were used as reference. RESULTS. A total of 1,379 (66%) of all tested subjects were overweight. Among the male officers and ratings, the relative risk of being overweight was 1.33 (1.25-1.38) and 1.30 (1.22-1.38), respectively. The relative risk for fishermen was 1.45 (1.25-1.66) and for maritime students and trainees 1.44 (1.25-1.66). The female seafarers had a relative risk of being overweight of 1.42 (1.23-1.65). There were a statistical significantly increased number of overweight merchant seafarers since 2001/2002. DISCUSSION. The study shows that Danish merchant seafarers have a major and significantly increasing overweight problem. Among fishermen, overweight was even more frequent. Overweight constitutes a threat not only to their health, but also to their career at sea. The larger than expected incidence of overweight among new employees in the industry provides particular cause for concern. The causes of the problem are complex and interventions need to be broad.

A great deal of research into the determinants of bone strength has unequivocally demonstrated that variation in bone strength is highly subject to genetic factors. Increasing attention in skeletal genetic studies is being paid to indicators of bone quality that complement studies of BMD, including studies of the genetic control of bone geometry. The aim of this study is to investigate the degree to which normal population-level variation in femoral midshaft geometry in a population of pedigreed baboons (Papio hamadryas spp.) can be attributed to the additive effect of genes. Using 110 baboons (80 females, 30 males), we 1) characterize normal variation in midshaft geometry of the femur with regard to age and sex, and 2) determine the degree to which the residual variation is attributable to additive genetic effects. Cross-sectional area (CSA), minimum (I(MIN)) and maximum (I(MAX)) principal moments of inertia, and polar moment of inertia (J) were calculated from digitized images of transverse midshaft sections. Maximum likelihood-based variance decomposition methods were used to estimate the mean effects of age, sex, and genes. Together age and sex effects account for approximately 56% of the variance in each property. In each case the effect of female sex is negative and that of age is positive, although of a lower magnitude than the effect of female sex. Increased age is associated with decreased mean cross-sectional geometry measures in the oldest females. Residual h(2) values range from 0.36 to 0.50, reflecting genetic effects accounting for 15% to 23% of the total phenotypic variance in individual properties. This study establishes the potential of the baboon model for the identification of genes that regulate bone geometric properties in primates. This model is particularly valuable because it allows for experimental designs, environmental consistency, availability of tissues, and comprehensive assessments of multiple integrated bone phenotypes that are not possible in human populations. The baboon is of particular importance in genetic studies, because it provides results that are likely highly relevant to the human condition due to the phylogenetic proximity of baboons to humans.

The purpose of the study was to study the circumstances and incidence rates of fatal accidents in inspection obligated and non-inspection obligated Danish fishing vessels to identify areas for prevention. Information about the fatalities came from maritime authority reports, including vessel disaster reports, post mortem reports, maritime inquiries and police reports. The person- and vessel years at risk came from the Danish Directorate of Fisheries. During the period 1989-2005, 114 fatalities occurred. Sixty-one of the fatalities occurred in 36 vessel disasters mainly caused by foundering/capsizing due to stability changes in rough weather and collisions; 39 fatal occupational accidents mainly occurred on the larger inspection obligated trawlers during fishing. In the remaining 14 other fatal accidents, the main causal factors were difficult embarking/disembarking conditions by darkness in foreign ports and alcohol intoxication. In the period 1995-2005, the overall incidence rate was 10 per 10,000 fishermen per year with no down-going trend during that period. The fatal accident rates are still too high, despite the efforts to reduce the risk. Increased focus on regular and repeated safety training for all fishermen and improved safety measures are needed, especially in the underscored areas of sea disasters concerning small vessels and occupational accidents on big vessels. Better registration of time at risk for fishermen is needed to validate the effect of the safety measures.

Objectives: Earlier studies and statistics have shown that merchant seafarers from the South East Asia had considerable lower accident rates when compared with seafarers from Western Europe. The purposes of the study were to investigate whether the earlier observations were sustained if further sources on occurrence of accidents were used and to identify specific causes of excess accident rates among certain nationalities., Methods: Occupational accidents aboard Danish merchant ships during one year were identified from four different sources. These included accidents reported to the maritime authorities, accidents reported to a mutual insurance company, files on medical costs reimbursed by the government and finally, accidents in which there has been contact to the radio medical service. Time at risk aboard was obtained from a register on all employment periods aboard merchant ships., Results: A total of 943 accidents causing personal injury to a seafarer directly caused by work aboard were identified. Among these accidents, 499 had taken place aboard cargo ships in international trade. Only these were used in the detailed analysis. The accident rate for all identified accidents aboard cargo ships were 84 accidents per 1,000 years aboard. The crude incidence rate ratio (IRR) for East European seafarers was 0.88 and for South East Asians 0.38 using West European seafarers as reference. In a Poisson regression analysis, the IRR for South East Asians was 0.29 (0.22-0.38). In an analysis including only more serious accidents, IRR for South East Asians rose to 0.36 (0.26-0.48)., Discussion: This study indicates that seafarers from South East Asia, mainly the Philippines, may have a genuine lower risk of occupational accidents in comparison with seafarers from Western and Eastern Europe. Differences in approach to safety and risk taking between South East Asian and European seafarers should be identified and positives attitudes included in accident preventing programmes. Main messages Seafarers from South East Asia, mainly the Philippines, seem to have a genuine lower risk of occupational accidents in comparison with seafarers from Western and Eastern Europe., Policy Implications: Differences in approach to safety and risk taking between South East Asian and European seafarers should be identified and positives attitudes included in accident preventing programmes.

For centuries, tuberculosis has been identified as a burden to seafarers. In this study, we assessed the magnitude of tuberculosis among merchant seafarers today. Furthermore, we identified the most likely routes of M. tuberculosis transmission by the use of DNA fingerprinting. A database containing all culture-positive tuberculosis cases in Denmark in 1992-2003 was combined with a register on all seafarers and their employment periods aboard Danish ships. All strains of M. tuberculosis were analysed using DNA-subtyping. 64 cases of culture positive tuberculosis among seafarers were identified. The risk of tuberculosis among males was 1.51 (1.10-2.01) compared with the general population. Two of the 64 cases were likely to be shipping-related, 5 were possibly shipping-related, and 10 were less likely to be shipping-related. The remaining 47 cases were very unlikely to be shipping related. Including the 2 first categories, the incidence was 0.09 cases per 1000 y at sea. The excess risk of tuberculosis among active and former Danish seafarers is most probably due to infections acquired in Denmark. Despite multi-cultural crews aboard, including many from high-incidence countries, our study indicates that only limited transmission of M. tuberculosis takes place among crew aboard modern ships or during shore leaves.

Aims: Seafarers aboard oil and chemical tankers may be exposed to many chemicals, including substances like benzene that are known to be carcinogenic. Other seafarers are exposed to engine exhaust, different oil products, and chemicals used aboard and some years ago asbestos was also used extensively in ships. The aim of this study was to study cancer morbidity among Danish seafarers in relation to type of ship and job title., Methods: A cohort of all Danish seafarers during 1986-1999 (33,340 men; 11,291 women) registered by the Danish Maritime Authority with an employment history was linked with the nationwide Danish Cancer Registry and followed up for cancer until the end of 2002. The number of person years at risk was 517,518. Standardised incidence ratios (SIR) were estimated by use of the corresponding national rates., Results: The SIR of all cancers combined was higher than expected: 1.26 (95% CI 1.19 to 1.32) for men and 1.07 (95% CI 0.95 to 1.20) for women. This was mainly due to an excess of cancer of the larynx, lung, tongue, mouth, pharynx, oesophagus, pancreas, kidney, urinary bladder, colon, and bone as well as skin melanomas among men (the three latter borderline significantly increased), and an excess of cancer of the lung, rectum, and cervix uteri among women. The differences in risk pattern for lung cancer between the different job categories among men ranged in terms of SIR from 1.2 (95% CI 0.9 to 1.7) (engine officers) to 2.3 (1.6 to 3.3) (engine room crew), and 4.1 (2.1 to 7.4) among maintenance crew. Non-officers had a 1.5 times higher lung cancer risk than officers. No increased occurrence of all lymphatic and haematopoietic malignancies combined was found for employees on tankers, but the number of cases was limited to a total of 7., Conclusions: Danish seafarers, especially men, face an increased overall cancer risk, in particular a risk for lung cancer and other tobacco associated cancers.

Aims: To study morbidity among active seafarers in the merchant navy in order to clarify possible work related morbidity and the morbidity related to work and lifestyle where possible preventive measures may be initiated., Methods: From a register in the Danish Maritime Authority a cohort of Danish merchant seafarers who had been actively employed at sea in 1995 was identified. For each seafarer, information on all employment periods at sea, charge aboard, and ship was available. The cohort was linked with the National In-patient Register in Denmark. Standardised hospitalisation ratios (SHRs) were calculated for all major diagnostic groups using all gainfully employed as reference., Results: Seafarers were shown to be inhomogeneous, with significant differences in SHRs for the same disease groups between different groups of seafarers depending on charge and ship type. SHRs for lifestyle related diseases were high, although rates for acute conditions, such as acute myocardial infarction, were low, probably due to referral bias, as acute conditions are likely to cause hospitalisation abroad, and thus are not included in the study. SHRs for injury and poisoning were high, especially for ratings and officers aboard small ships., Conclusion: Despite pre-employment selection, a large proportion of the seafarers constitute a group of workers with evidence of poor health probably caused by lifestyle. The subgroups with high risk of hospitalisation due to lifestyle related diseases also had an increased risk of hospitalisation due to injury and poisoning.

Background: Danish seafarers have an excess of life style related diseases where obesity may be a factor. Obesity may in itself be a safety issue at sea., Objectives: The purpose was to study overweight among male seafarers and determine the consequences if a maximum Body Mass Index (BMI) for seafarers is decided., Methods: As part of the mandatory pre-employment health examination, height and weight of the seafarers are recorded and BMI calculated. From a register comprising all seafarers, basic information on each individual seafarer was obtained from the last employment period before the health examination. In this study, normal weight is defined as a BMI from 20 and up to 25, moderate overweight from 25 up to 30 and obesity from 30 and above., Results: The study comprised 1257 male seafarers. There were statistically significant more overweight seafarers in all age groups compared to a reference group ashore. Among those between 45 and 66 years of age 0.7% had a weight below normal, 22.7% had normal weight and 76.6% had a weight above normal, while 30.9% of this age group was obese., Conclusion: The method is applicable as a tool for an objective description of seafarers' health profile in a national and an international perspective. Overweight is found to be common and may influence the health of the seafarers and shipboard safety. Fixed BMI limits for seafarers on Danish ships would result in loss of license and that would have major implications even if the limit is set high.

In environmental health research there is a recognized need to develop improved epidemiologic and statistical methods for rapid assessment of relationships between environment and health. Exposure assessment is identified as a major challenge needing attention. In this study an exposure simulation model was used to delimit almost exactly in space and time an urban population exposed to airborne dioxin. A geographic information system (GIS) was used as the electronic environment in which to link the exposure model with the demographic, migration, and cancer data of the exposed population. This information is available in Denmark on an individual basis. Standardized incidence ratios (SIRs) for both men and women in 10-year age bands were calculated for three different exposure areas. Migration patterns were outlined. SIRs showed no excess of cancer incidences during the time span chosen (13 years; 1986-1998) in the whole exposed area or in the medium or higher polluted areas. The exposure model appeared very useful in selection of the appropriate exposure areas. The integration of the model in a GIS together with individual data on addresses, sex, age, migration, and information from routine health statistics (Danish Cancer Registry) proved its usefulness in demarking the exposed population and identifying the cancers related to that population. Less than one-third of the study population lived at the same address after 13 years of observation, and only half were still residing in the area, indicating migration of people as a major misclassification.

Background: The highly recurrent nature of major depression in the young and the elderly warrants long-term antidepressant treatment., Aims: To compare the prophylactic efficacy of citalopram and placebo in elderly patients; to evaluate long-term tolerability of citalopram., Method: Out-patients, > or =65 years, with unipolar major depression (DSM-IV: 296.2 x or 296.3 x) and Montgomery-Asberg Depression Rating Scale score > or =22 were treated with citalopram 20-40 mg for 8 weeks. Responders continued on their final fixed dose of citalopram for 16 weeks before randomisation to double-blind treatment with citalopram or placebo for at least 48 weeks., Results: Nineteen of the 60 patients using citalopram v. 41 of the 61 patients using placebo had recurrence. Time to recurrence was significantly different between citalopram- and placebo-patients, in favour of citalopram (log-rank test, P<0.0001). Long-term treatment was well tolerated., Conclusions: Long-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated.

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.

Objectives: To investigate the frequency, circumstances, and causes of occupational accidents aboard merchant ships in international trade, and to identify risk factors for the occurrence of occupational accidents as well as dangerous working situations where possible preventive measures may be initiated., Methods: The study is a historical follow up on occupational accidents among crew aboard Danish merchant ships in the period 1993-7. Data were extracted from the Danish Maritime Authority and insurance data. Exact data on time at risk were available., Results: A total of 1993 accidents were identified during a total of 31 140 years at sea. Among these, 209 accidents resulted in permanent disability of 5% or more, and 27 were fatal. The mean risk of having an occupational accident was 6.4/100 years at sea and the risk of an accident causing a permanent disability of 5% or more was 0.67/100 years aboard. Relative risks for notified accidents and accidents causing permanent disability of 5% or more were calculated in a multivariate analysis including ship type, occupation, age, time on board, change of ship since last employment period, and nationality. Foreigners had a considerably lower recorded rate of accidents than Danish citizens. Age was a major risk factor for accidents causing permanent disability. Change of ship and the first period aboard a particular ship were identified as risk factors. Walking from one place to another aboard the ship caused serious accidents. The most serious accidents happened on deck., Conclusions: It was possible to clearly identify work situations and specific risk factors for accidents aboard merchant ships. Most accidents happened while performing daily routine duties. Preventive measures should focus on workplace instructions for all important functions aboard and also on the prevention of accidents caused by walking around aboard the ship.

Introduction: Injuries involving chemicals occur aboard merchant ships, since such agents are carried commonly on board either as cargo or as needed for running the ship. In case of events involving chemicals, the crew may seek advice from the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods published by the International Maritime Organization. The Guide is currently under revision. To improve knowledge of what is relevant in such a guide, a study was undertaken to identify all intoxications and corrosive incidents occurring aboard Danish merchant ships., Methods: A retrospective study of all intoxications and corrosive incidents reported to the Danish Maritime authorities between 1988 and 1996., Results: A total of 177 injuries were identified, of which 66 were systemic poisonings and 111 were due to corrosive damage to the eyes and skin. Thirteen of 66 systemic poisonings were fatal and almost three out of four corrosive injuries involved the eyes., Conclusions: This study and others show that the majority of injuries aboard merchant ships involving dangerous goods are amenable to first aid and symptomatic measures. Specific antidotes seem to have a limited role aboard merchant ships.

Based on records kept in the Singapore Mercantile Marine Office, the paper presents the results of a study on deaths due to disease of seafarers on board Singapore ships. Out of a total of 373 deaths, altogether 69 fatalities were attributed to diseases. More than 65% (n=45) of theses deaths were due to circulatory diseases commonly associated with life-style factors, but only 24 cases had a specific and 9 cases had an unspecific diagnosis confirmed by a medical, practitioner. A total of 32 seafarers (46.4%) died of a sudden death and were found dead by their shipmates whereas 17 seafarers (24.6%) died on board after a short illness. In only two cases was it reported that Radio Medical advice had been sought indicating either a lack of interest of the ship's management or a lack of knowledge or information on the availability of such services. Eight of the fatalities who died on board had seen a doctor and been declared fit to stay on board, pointing to deficiencies in the port medical services or pressures on port doctors to avoid a costly repatriation. The mean annual mortality rate for deaths due to all causes was 26.5 per 10,000 seafarers and due to disease was 4.9 per 10,000 seafarers.

Insufficient conserved home-made products are the main cause of botulism in Denmark. We present a case of botulism caused by a commercially produced vegetable pie conserved by traditional bottling without addition of preservatives. Clostridium botulinum was grown from faeces of the index case indicating an intestinal infection. An action plan set up by the medical and veterinarian authorities functioned well and further spread of the disease was avoided. More cases of botulism may be seen in the future, if procedures ensuring proper conservation in food production are not adhered to.

Objective: To study the mortality of women in an occupation known to have a high mortality among men., Methods: A total of 6788 female seafarers of all job categories who had been employed on Danish merchant ships, passenger ships, and privately owned ferries between 1986 and 1993, were followed up until the end of 1993., Results: Standardised mortality ratio (SMR) was 1.20 (95% confidence interval (95% CI) 0.89 to 1.58) for all causes of death and job categories together. For women in traditionally male jobs, SMR was 2.82 (1.41-5.05), whereas galley and catering staff had SMRs close to the general female population. The high mortality among women in traditional male jobs could be explained by a high risk of fatal accidents including occupational accidents. In the whole cohort, there were fewer deaths from natural causes than expected but an excess risk of death due to lung cancer, heart diseases, and non-natural deaths., Conclusion: The increased mortality could primarily be explained by an excess risk of fatal accidents and suicide. Especially, female seafarers entering traditional male jobs had a high risk of fatal accidents, not only at sea but also ashore. An excess risk of dying of lung cancer and heart diseases probably reflects a high tobacco consumption. Female seafarers are probably influenced by their occupation towards hazardous behaviour and a high risk lifestyle but people with a high risk lifestyle may also be attracted by or forced into high risk jobs such as traditional male jobs at sea.

Objectives: The aim of the present historical cohort study was to enhance the understanding of the unusual mortality pattern seen among seafarers. The main object was to describe the mortality pattern of Danish seafarers in recent years with special reference to the influence of accidents in the maritime workplace and ashore and the influence of diseases related to lifestyle., Subjects: A cohort of 24,132 male seafarers of all job categories employed on a Danish merchant ship between 1986 and 1993, was followed up. Mortality among those who left the occupation before the end of the follow-up period was analysed separately., Results: The standardized mortality ratio was 1.43 (95% CI: 1.33-1.54) from all causes and 3.05 (95% CI: 2.62-3.52) from accidents. An excess mortality from natural causes was attributable mostly to an excess among deck and engine room crew and was mainly caused by diseases related to lifestyle. While active as seafarers, the SMR for accidents was 2.62 (95% CI: 2.12-3.20), accidents at the workplace explaining almost half the deaths. Among those who left shipping, the risk of fatal accidents increased. All categories of seafarers continued to have a high risk of fatal accidents into older age., Conclusion: Merchant seafarers were shown to have a higher mortality than the general population. Despite a very high risk of fatal accidents in the workplace, these accidents could only explain a proportion of the observed excess mortality. Accidents ashore and diseases related to lifestyle factors such as drinking and smoking made a major contribution to the observed excess mortality. The results indicate that people in occupations with a high risk of fatal accidents at the workplace also seem to have a high risk of accidents away from the workplace after leaving the occupation. The high risk lifestyle seems to be linked to lifestyle in general and hence the related diseases and high risk of death.

Objective: To describe and analyse the types and circumstances of all natural and non-natural deaths among seamen on board Danish merchant ships., Methods: Data on 147 cases were obtained from maritime authorities, an insurance company, shipping companies, hospitals, death registers, and death certificates in the period from 1986-93., Results: The 53 natural deaths were dominated by cardiovascular diseases and infectious diseases. Insufficient treatment on board was identified as a contributing factor for death in some cases. Medical advice was not always sought and the advice given was in some cases insufficient. 73 fatal accidents were identified. The incidence of accidents of 5.29/10,000 person-years was 11.5 times higher than the incidence of 0.46/10,000 for the Danish male workforce ashore. 23 accidents (31%) were due to maritime casualties and 26 (36%) were occupational accidents. The remaining 24 (33%) were accidents during off duty hours including six self intoxications. Rough weather, inadequate awareness of safety, lack of use of personal protection devices, and inexperience were associated with many of the fatal injuries directly related to work. Alcohol played a major part in 12 out of 18 fatal injuries occurring during off duty hours., Conclusions: The maritime workplace was identified as a high risk workplace and in many aspects differs from the conditions ashore. Acute diseases and serious injuries pose special risks to seamen because of a lack of direct access to professional medical care at sea. Primary prevention of certain diseases is needed and possible. Improved training, improved systems of work, improved safety awareness, and greater use of personal protection devices are needed to prevent fatal injuries. Medical training of ships' officers providing medical care on board and specific training of doctors giving medical advise to ships should be improved to meet the needs.

The purpose of the study was to assess the incidence and relative risk of hepatitis A and B and tuberculosis among Danish merchant seamen. We also assessed the occurrence of malaria. The study was based on record linkage of a research database containing data on 24,132 Danish male seamen and the Registry for Notifiable Infectious Diseases in Denmark, supplemented by data from other sources. The standardized incidence ratio (SIR) for hepatitis A for male seamen was 1.77 (0.91-3.10) as compared with the incidence in the general population. The incidence was 0.9 notified cases/10,000 years. The SIR for hepatitis B for male seamen was 3.02 (1.79-4.78), the main risk factors being intravenous drug use and casual sex abroad. Tuberculosis was not more common among seamen than in non-seamen. The results have implications for vaccination strategies in this occupational group. Malaria occurred frequently in the seamen, especially among those involved in West African trade. Irregular use of malaria prophylaxis and probably chloroquine resistance were of importance in some cases. To detect further cases of hepatitis A and B and malaria, other sources were reviewed. Only a few extra cases were identified. The registry of notifiable infectious diseases was thus found to be rather complete.

Seamen constitute a special group of international travellers who may run an increased risk of contracting hepatitis, because of visits to foreign ports and the particular environment on board ship. The purpose of the survey was to assess the prevalence of serological markers for hepatitis A, B and C virus infection among seamen and to identify present and previous risk factors for infection. 515 seamen were studied. The prevalence of antibodies against hepatitis A was 0.3% in subjects below 40 years of age, increasing with age above 40 years, and highest among those who had sailed in international trade. The prevalence of antibodies against hepatitis B was 2.7% in subjects below 40 years of age, increasing to 35.7% in the group above 60 years of age. Hepatitis C antibodies occurred in 1.2%. Vaccination of sailors against hepatitis A should follow the same recommendations as to other travellers. The prevalence of hepatitis B was higher than in reference groups of non-seamen but, because hepatitis B is only one of many blood-borne diseases, prevention should be directed towards changes in behaviour rather than vaccination, except for special groups. Young seamen in international trade were found to be most at risk of contracting sexually transmitted diseases.

A retrospective cohort study was performed to analyze the mortality patterns of Danish merchant seamen in the period 1970-1985. The population census in 1970 in Denmark was the source of information on individual occupation, age, and marital status. All men aged 20-64 years and economically active in 1970 were included. Computerized linkage with the Danish Mortality Register gave information about the deceased persons' date and cause of death. An increased overall mortality among all groups of seamen was found, being highest for deck and engine crew members. The overall mortality was strongly dependent on age and marital status. The highest mortality rate ratios (MRR) were found among young seamen and unmarried seamen. MRRs of 1.90 and 2.47 for cancer of the respiratory system were found among engine officers and crew. The MRRs for accidents and suicide were increased for all seamen, and were highest for crew members, among whom the MRR from accidents was stable within age groups but fell for suicide with increasing age. The same pattern was found with cirrhosis of the liver, although this was positively associated with increasing age. Excess mortality from ischemic heart disease was only found among engine crew (MRR = 1.43). This study confirms earlier findings of high mortality among seafarers. Negative selection into the occupation, occupational environmental factors, and lack of health and safety promotion programs and education could be causes of the high mortality.

The purpose of this study was to estimate the minimal magnitude of the HIV problem among seafarers in Denmark. The material is based on case records from the 6 medical departments in Denmark that undertake treatment of HIV patients. Retrospectively, all case records of HIV infection among seafarers--and of their sexual contacts--have been identified. 33 seafarers with HIV infection or AIDS were identified; 17 had no other known risk factor than heterosexual contacts in high-endemic areas. These results show that HIV infections have entered into the heterosexual group of seafarers. HIV-infected seafarers are a risk group for carrying HIV infection into the heterosexual population in non-endemic areas. In 5 known cases, this has actually taken place in Denmark. The majority of the heterosexually infected seafarers were probably infected early in the AIDS era. We do not know if Danish seafarers are still acquiring HIV abroad.

A population-based survey of the use of different types of examination procedures and treatments of stroke is presented. The study area was a rural district with one local hospital. During a period of 2 1/2 years, 125 cases of first strokes and 29 recurrences were identified. The incidence of hospitalized first strokes in a population of 33,769 was 1.48 per 1000. The three week mortality was 27%. 30% of the patients were submitted to CT-scanning, and 25% were transferred to a specialist department. Two patients (1.6%) had surgery and 4.8% started anti-coagulation treatment. The survival data are compared with a 50 year-old Danish survey. Better survival is seen among patients who are initially awake or drowsy. Initially semicomatose or comatose patients still have poor prognoses. 5% of all bed-days used by the population surveyed were used for the treatment of acute stroke.

The utilization and effectiveness of a pre-operative autologous blood donation programme were analyzed at a small, 40-bed, general hospital with subspecialization in orthopaedic surgery. Over a period of 8 months, 13 patients who were all to undergo total knee or hip replacement were evaluated. Twelve patients were found suitable and they donated in mean 1.9 units of blood. At discharge the patients who had donated blood pre-operatively had the same mean hemoglobin value as a comparable group of patients who only received blood from the ordinary blood bank service in spite of the total transfusion demand being the same in the two groups. The pre-donated blood covered 54% of the total demand of the group evaluated. The method is found especially applicable at small hospitals, where the administrative problems concerned with the method are easy to manage.

In order to determine the prevalence of Cryptosporidium and other intestinal parasites, a household sample survey of children under 5 years old was carried out during the late dry season in 8 rural villages in southern Guinea-Bissau, West Africa. Cryptosporidium oocysts were found in 10 of 270 stool samples (3.7%), using a safranin-methylene blue staining method. Of these 10 children (age range 5-16 months), all non-Muslims, 6 had diarrhoea, giving a prevalence of 12.5% in 48 children with diarrhoea, compared with 1.8% in children without diarrhoea (P less than 0.001). The ethnic group with the highest prevalence (9.2%) also kept most domestic animals, and was the only group to keep cattle. Giardia lamblia was found in 16 children, and the overall prevalences of other enteric parasites were: hookworm, 21.7%; Strongyloides stercoralis, 7.4%; Ascaris lumbricoides, 6.9%; Trichuris trichiura, 4.4%; Entamoeba histolytica, 1.5%; and Taenia sp., 0.5%. The prevalence of cryptosporidiosis was highest in the age group 7-12 months, while for the other parasites it was highest in the oldest children. The prevalence of hookworm was highest (c. 50%) in the southernmost villages. No significant relationship was found between hookworm infection and anaemia.

In a randomised study of 558 children in an urban African community, the protective effect of the Edmonston-Zagreb (EZ) measles vaccine given in a dose of 40,000 plaque forming units from the age of 4 months was compared with the effects of a standard dose (6000 tissue culture infectious units) of Schwarz measles vaccine given from the age of 9 months. During two years of follow-up, all 14 clinical cases of measles occurred in the Schwarz group; 10 of the children contracted measles before vaccination and 4 after measles vaccination. Thus the EZ vaccine provided significant protection against measles both before and after the usual age of vaccination. Among the children who were exposed to measles at home, those given EZ vaccine were better protected than either unvaccinated children or those given the Schwarz vaccine.