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The Bulletin of the Institute of Maritime and Tropical Medicine (IMTM) was published first time in 1948 as a preliminary publication. Since then it has developed and from 1999 it is known as International Maritime Health (IMH). Initially it was published by the Institute of Maritime and Tropical Medicine (IMTM) in Gdynia. From 2009 it was published by the Polish Society of Maritime, Tropical and Travel Medicine (PSMTTM) in cooperation with the International Maritime Health Association (IMHA) and the Norwegian Centre for Maritime Medicine (NCMM), later the Norwegian Centre for Maritime and Diving Medicine (NCMDM) at the Department of Occupational Medicine, Haukeland University Hospital, Bergen. After a couple of years of planning and discussions on how to take the journal forward, the International Maritime Health Foundation (IMHF) was established under Polish Law, 21st June 2018. This article discusses the process from the very beginning of the journal, until the establishment of the IMHF as well as the foundation's objectives and way forward.

Background Formulation of a medical preparedness plan for treating severely bleeding casualties during naval deployment is a significant challenge because of territory covered during most missions. The aim of this study was to evaluate the concept of "walking blood bank" as a supportable plan for supplying safe blood and blood products. Methods In 2013, the Royal Norwegian Navy conducted antipiracy operations from a frigate, beginning in the Gulf of Aden and ending in the Indian Ocean. Crews were on 24-hour emergency alert in preparation for an enemy assault on the frigate. Under an approved command protocol, a "walking blood bank," using crew blood donations, was established for use on board and on missions conducted in rigid-hulled inflatable boats, during which freeze-dried plasma and leukoreduced, group O low anti-A/anti-B titer, cold-stored whole blood were stored in Golden Hour Boxes. Data demonstrating the ability to collect, store, and provide whole blood were collected to establish feasibility of implementing a whole blood-focused remote damage-control resuscitation program aboard a naval vessel. In addition, ROTEM data were collected to demonstrate feasibility of performing this analysis on a large naval vessel and to also measure hemostatic efficacy of cold-stored leukoreduced whole blood (CWB) stored during a period of 14 days. ROTEM data on CWB was compared with reconstituted whole blood. Results Drills simulating massive transfusion activation were conducted, in which 2 U of warm fresh whole blood with platelet sparing leukoreduction were produced in 40 minutes, followed by collection of two additional units at 15-minute increments. The ROTEM machine performed well during ship-rolling, as shown by the overlapping calculated and measured mechanical piston movements measured by the ROTEM device. Error messages were recorded in 4 (1.5%) of 267 tests. CWB yielded reproducible ROTEM results demonstrating preserved fibrinogen function and platelet function for at least 3.5 weeks and 2 weeks, respectively. The frequency of ROTEM tests were as follows: EXTEM (n = 88), INTEM (n = 85), FIBTEM (n = 82), and APTEM (n = 12). CWB results were grouped. Compared with Days 0 to 2, EXTEM maximum clot firmness was significantly reduced, beginning on Days 10 to 14; however, results through that date remained within reference ranges and were comparable with the EXTEM maximum clot firmness for the reconstituted whole blood samples containing Day 5 room temperature-stored platelets. Conclusion A "walking blood bank" can provide a balanced transfusion product to support damage-control resuscitation/remote damage-control resuscitation aboard a frigate in the absence of conventional blood bank products. ROTEM analysis is feasible to monitor damage-control resuscitation and blood product quality. ROTEM analysis was possible in challenging operational conditions. Level of evidence Therapeutic study, level V.

Background Little is known about the occurrence of Legionella pneumophila in water supply systems on board ships. Our aim was to study the occurrence of L. pneumophila in the water supply system on board Norwegian naval vessels as the basis for framing preventive strategies against Legionella infection. Material and method Water samples were collected from technical installations and from the water distribution network on board 41 vessels and from ten water filling (bunkering) stations, the sampling taking place in two rounds separated by a one-year interval. The samples were subjected to analysis, including serotyping and genotyping, with a view to identifying the presence of L. pneumophila and of free-living amoebae. Results L. pneumophila was found in 20 out of a total of 41 vessels in the first round of sampling, and live L. pneumophila serogroup 1 was isolated in seven of the 20 vessels. Free-living amoebae were found in the water supply system in most of the vessels, including all the vessels with L. pneumophila. The same genotype of L. pneumophila was identified in the water in bunkering stations and in the water on board the vessels. Interpretation L. pneumophila was not present in all the vessels, but all the vessels where the bacterium was found were also contaminated with free-living amoebae. We have demonstrated the probability of the fresh water from bunkering stations being the source of the contamination. In framing preventive strategies, importance should therefore be attached to identifying the source of contamination and the presence of free-living amoebae, as a premise for the establishment and growth of L. pneumophila in onboard water supply systems.

Seafarer’s mental health is vital for a well-functioning organisation. Neglecting mental health status on board could be extremely costly for both the crew affected as well as the company. The present article outlines an extensive programme implemented in the Royal Norwegian Navy for personnel deployed in international operations. The challenges involved in international operations bare similarities to onboard personnel in civilian maritime operations. The program utilised by the Royal Norwegian Navy is extensive and not immediately applicable to civilian maritime companies. However, elements of this program could be used with limited resources. Questionnaire based screening, before, during and at the end of a contract period could result in early detections of mental health problems and increased retaining of personnel. This should be done by health professionals. Early targeting of at risk personnel could prevent serious costs for the individual as well as the company. publishedVersion

The current research investigated cultural differences in emotional intelligence among top officers on board vessels of multicultural maritime companies. We found that Southeast Asian officers scored higher than European officers on the total Emotional Intelligence scale. When separating the EQ scale in its facets, higher scores for Asian officers were found on "Utilization of emotions", "Handling relationships", and on "Self-control". Another finding was that Chief officers/Second engineers scored higher than Masters/Chief Officers on "Self-control". Finally, we found a negative correlation between age and scores on the facet of "Self-control". These crosscultural differences may have implications for interpersonal relations and ship management.

The frigate His Norwegian Majesty's ship (HNoMS) Fridtjof Nansen was participating in operations in the Gulf of Aden in support of the EU mission tasked with protecting vessels from the threat of piracy. The crew was therefore prioritized and given the first batch of Influenza A (H1N1) vaccine (Pandemrix(®)).To investigate the type, frequency, and intensity of side effects after whole-crew vaccination with Pandemrix vaccine in healthy subjects in a controlled environment.A hundred and thirty-three members of the crew were vaccinated, and then they participated in the study. The side effects of the vaccination were evaluated through a survey.Seventy-five per cent of the vaccinated sailors reported adverse reactions to the vaccine, with 9% not being able to perform their daily duties for one day. Muscle pain, headaches, malaise, and fatigue were the most frequent symptoms reported.The vaccination program using Pandemrix H1N1 vaccine resulted in a high rate of side effects, which were generally mild and resolved within a few days. No serious lasting side effects of the vaccination were reported or registered. The adverse effects of the vaccination did not affect the operational capacity of the vessel.

Objectives The aim of this study was to examine mortality and cancer incidence in a cohort of 28 300 military servicemen known, from personnel files, to have served in the Royal Norwegian Navy during 1950–2004. Methods The cohort was followed from 1951–2007 for mortality and from 1953–2008 for cancer. Standardized mortality ratios (SMR) and incidence ratios (SIR) for cancer were calculated from national rates. Internal comparisons [rate ratios (RR)] were made using Poisson regression. Results Mortality for all Navy personnel was lower than expected for all causes combined (SMR 0.84) and for most disease groups and violent causes, but not for cancer mortality (SMR 1.02). Vessel crews had consistently higher SMR than land-based personnel, still with rates lower than – or close to – national ones. The relative risk between the two subgroups was in the same direction for mortality from alcohol abuse and non-malignant alcohol-related diseases (RR 1.56) and for the incidence of alcohol-related cancers (RR 1.58) and lung cancer (RR 1.65). An overall small excess in the incidence of all cancers combined for the entire cohort (SIR 1.06) was caused by prostate cancer, malignant melanoma, and non-melanoma skin cancer. An excess of bladder cancer was observed among submariners (SIR 1.53). Conclusion The low all-cause mortality was in line with a “healthy soldier effect”. Navy personnel had a lower-than-expected mortality from accidents and suicide. Alcohol-related diseases were more frequent among vessel crews than among land-based personnel, but largely comparable to the rates among all Norwegian men.

The thesis covers the establishment and quality controls of two cohorts of civilian and military personnel serving in the Royal Norwegian Navy (RNoN) after January 1, 1950, and two studies among male members of the military cohort. For the civilian cohort, the criterion for inclusion was all civilians who have served at any time during 1950–2005 in the Navy, while the military cohort was limited to officers and enlisted personnel. All branches of the Navy were covered, hereunder the Fleet, the Coast Guard and the Coastal Artillery. By 1950, the Norwegian Fleet was either destroyed during the Second World War (WWII) or out-dated. The rebuilding of the Navy was yet to begin, and Norway had just become a member of the North Atlantic Treaty Organisation (NATO) at the Treaty foundation in 1949. With its border with the Soviet Union in the north Norway became of strategic importance, and the Cold War shaped the design of the Norwegian Defence. The present work started in 2002 with establishment of the cohorts. The registration work resulted in a military cohort of 29 056 persons (2.5% women) with an average of 6.2 years service in the Navy. The cohort of 8 378 civilians (39% women) had an average of 11 years in the Navy. Both cohorts were regarded as virtually complete. The first cohort study dealt with asbestos related cancers among Navy vessels crews. Asbestos has been commonly used in shipbuilding for heat and sound insulation, and for fireproofing. Until 1987, asbestos aboard the Navy vessels potentially caused exposure to 11 500 crew members. Engine room crews were considered to experience higher exposure intensity than other crews aboard. Asbestos is the only environmental factor known to cause malignant mesothelioma, and an elevated incidence of this disease served as an indicator of asbestos exposure. The incidence of other potentially asbestos related cancers (lung, laryngeal, pharyngeal, stomach and colorectal cancers) was evaluated according to duty station and mesothelioma incidence. Elevated incidence of mesothelioma was found among engine room crews only, and the time from first exposure to date of diagnosis ranged from 28 to 48 years (median 41). The mesothelioma incidence offered no consistent explanation to the variation in incidence of other potentially asbestos-related cancers. The second cohort study examined the cause-specific mortality and cancer incidence compared to the national rates. Internal comparisons between vessel crews and land-based personnel were performed. A military career implies adaptation to a rigid disciplinary system, handling of weaponry, and a life at remote locations causing separation from family members. In foreign navies, a higher than average alcohol consumption with a negative impact on occupational efficiency and adverse health outcome, has been reported. Special attention was thus given towards deaths from violent causes, alcohol related diseases (mental and behavioural disorders due to use of alcohol, liver cirrhosis) and incidence of alcohol-related cancers (mouth, pharynx, larynx, oesophagus and liver cancer). For the cohort as a whole, the overall mortality was 16% lower than in the general Norwegian male population. The physical and psychological screenings for military service and the demand for “keeping up” during service imply that the Navy personnel were highly selected and expected to be healthier than the general population. This phenomenon has been termed “healthy soldier effect”. Overall cancer incidence was 6% higher, mostly due to excess prostate cancer and malignant melanoma and non-melanoma skin cancers. Death from violent causes (accidents and suicide) was 36% lower than expected. Both overall mortality and cancer were higher among sailors than among land-based personnel. No increased risk of alcohol related cancers or mortality was found for the cohort as a whole, but a higher risk was found among those serving aboard the vessels than for land based personnel.

Tuberculosis became a great problem in the Royal Norwegian Navy during the first years of the Second World War (when it operated in allied services mainly from the UK); with the highest incidence (9.6 per 1 000) during the first half of 1943. Main reasons were insufficient medical examination of recruits, crowded living conditions on board (favoured the contagion) and the physical and psychological pressure during sea operations, which may have reduced the immune defence. Prophylactic measures in terms of tuberculin testing of all personnel, chest X-rays of the positives, vaccination of the negatives, environment investigation when disease was discovered, and isolation of those infected, gave control from the second half of 1943 and onwards. The article also mentions treatment, repatriation and the incidence of tuberculosis in the Norwegian Navy before and after the war as well as in the Royal Canadian Naval Services (where the incidence was low) during the war. Today, the tuberculosis situation in Norway is so favourable that routine chest X-ray of the recruits is no longer performed in the armed forces.

Little attention was paid to lead poisoning in Norway before 1930. In 1931-33, however, Dr Harald Engelsen, a naval surgeon, reported to the National Insurance Administration more than 40 cases among shipyard workers. The first worker in which he diagnosed lead poisoning had consulted other doctors, but only got a symptomatic diagnosis. Dr Engelsen was then consulted by several others with similar symptoms. At the outset his diagnosis was doubted and a considerable disagreement ensued with colleagues and yard representatives; he was compared with Dr Stockmann in Henrik Ibsen's play An Enemy of the People. The controversy escalated. A commission appointed by the government to examine the matter concluded that there had been cases of lead poisoning in the shipyard, that mandatory requirements had not been strictly complied with, and that monitoring of working conditions had been fragmentary. Most of the workers were granted compensation and pensions. For a publication on lead poisoning, Dr Engelsen was awarded the University of Oslo's gold medal, and for his work for improving seamen's health and welfare he was awarded the St. Olav Order. In 1938 he was appointed head of medical services in the Royal Norwegian Navy.

When the Norwegian corvette Nordstjernen was in the North Sea bound for Port Said to be present at the opening of the Suez Canal on 17 November 1869, an officer suffered a rupture of m. triceps brachii when he was drawn into the machinery during a storm. He was put ashore in Harwich; four days after the injury he was hospitalized in Colchester. The voyage was eventful in other ways too. Another officer died from typhoid fever in Ismailia. On the Swedish frigate Vanadis, also present at the opening of the Suez Canal, one of the doctors died from lung infection and was buried in Smyrna; a twelve-feet high column of white marble was taken from the ruins of Aesculap's temple and put on his grave. Denmark was represented by the frigate Sjaelland. During a storm in the North Sea, one seaman fell down on the deck from the foresail yard and suffered contusions and a fracture of the left clavicle. These cases illustrate challenges that faced our ancestors. The accident happened when the ship was in the Netherlands sector of the North Sea as we know it today. Today the Coast Guard could have arranged transport by helicopter and hospitalized the patient in about two hours.