Marcus Oldenburg

Severe Cobalt Intoxication Due to Prosthesis Wear in Repeated Total Hip Arthroplasty

Our study describes a 55-year-old man with a total hip prosthesis (ceramic femoral head and polyethylene [PE] inlay). After a fall, the ceramic head broke into several pieces, and a subsequent revision surgery with metal femoral head and PE inlay was performed. Three months later, the so far healthy patient complained of multiorgan symptoms. The subsequent clinical examinations revealed hypothyroidism, peripheral neuropathy, and cardiomyopathy for the first time. In a second revision surgery, a massive deterioration of the metal femoral head by overlooked particles of the broken ceramic head was found. The cobalt concentration in blood exceeded a never before observed level. After replacement of the scraped femoral head, the cobalt concentration decreased considerably, and most of the symptoms disappeared.

Systematic review of maritime field studies about stress and strain in seafaring

PurposeThe aim of this study was to summarize and evaluate the current scientific literature on stress and strain on seafarers on board as defined by maritime field surveys.MethodsUsing a systematic review, 109 studies on the stress and strain experienced by seafarers were identified for the period January 1990 to January 2012.ResultsOnly 13 of the identified maritime studies were conducted as field studies, and in 10 of these studies, the focus was on the watch system and/or on fatigue. According to the study results, sleepiness tends to be stronger in the 2-watch system than in the 3-watch system (particularly between 4:00 and 6:00 a.m.). Occasional short sleep episodes appear to provide adequate recovery. Fatigue does not appear to depend on the seafarers’ age and is often associated with poor sleep quality; noise and night shifts are also considered to contribute to fatigue. Stress among the seafarers was primarily recorded in sleep diaries (9 times) and with devices for measuring physical activity (4 times). As a rule, a questionnaire was used to assess the strain on the crew on board; 7 studies also additionally recorded biometrical parameters. Only in 6 cases were several groups with different ranks on board investigated.ConclusionThe conducted literature review makes it clear that most maritime field studies have focused on fatigue and watch systems in the shipping industry—in each case as univariate parameters. Thus, scientific field studies with comprehensive multivariate stress and strain analyses on board are required.

Endotoxin exposure and respiratory symptoms in the cotton textile industry

Abstract One hundred fourteen male employees of a cotton spinning mill in western Germany participated in a cross-sectional study, the purpose of which was to clarify the dose effect of endotoxin exposure on respiratory symptoms. Airborne endotoxin exposures were classified as low (≤ 100 endotoxin units [EU]/m3), medium (> 100–450 EU/m3), or high (> 450 EU/m3), on the basis of endotoxin activity in the Limulus amoebocyte lysate assay. Age- and smoking-adjusted odds ratios (ORs) and confidence intervals (Cls) were estimated. The dose-response relationship between current endotoxin exposure and prevalence of wheezing (medium: OR = 2.15, 95% Cl = 0.48–9.62; high: OR = 5.49, 95% Cl = 1.17–25.81) and cough (medium: OR = 2.11; 95% Cl = 0.59–7.56; high: OR = 3.93; 95% Cl = 1.02–15.12) was significant (test for linear trend: p values = 0.020 and 0.040, respectively). The association between exposure and wheezing was stronger among atopic workers. The higher prevalence of chest tightness and shortness of breath among workers with medium and high current endotoxin exposure did not reach statistical significance. The results suggested that there was a dose-dependent increase in bronchial symptoms, with significant effects occurring at exposures that exceeded 450 EU/m3.

Merchant seafaring: a changing and hazardous occupation

### What this paper addsnnCurrently, the worlds merchant fleet encompasses more than 50u2008000 vessels.1 Approximately 90% of the goods traded worldwide are transported by sea; international transport is the basis for the global division of labour. The goods are transported on container ships, bulk carriers and oil tankers, chemical tankers, reefer ships, general cargo ships and other specialised ships (eg, vessels for the transport of cars, livestock carriers and off-shore supply vessels). This manuscript focuses mainly on merchant seafaring, particularly on the situation on board container ships, the most important ship type in the merchant maritime industry. In recent years, seafaring has undergone economic and technological change.2 This change has been characterised by:

Overview and prospect: food and nutrition of seafarers on merchant ships.

During stay on board, seafarers have limited influence on quality and quantity of food over several months. Furthermore, the nutrition on board is characterised by different dietary habits in the multi-ethnic crews, differential food supply in crews and officers mess room and irregular mealtimes due to the shifts on board. Internationally, nutritional situation on board is not standardised, but reflects the flag-state standard. Up to date, there is only little comprehensive research published concerning food patterns of seafarers; these studies often lack in objective examination methods to estimate the actual food intake and activity-related energy requirements. Therefore, to examine the food and nutrition of seafarers, shipping companies should be interviewed about food provisions on board, and seafarers about eating habits in consideration of possible socio-cultural and psychological backgrounds for malnutrition. These studies should also encompass seafarers health parameters related to nutrition on board (energy consumption, bioelectrical impedance analysis, ergospirometry and blood analysis). In total, further research directly on board is needed to know more about seafarers food and nutrition situation at sea.

Burnout syndrome in seafarers in the merchant marine service.

PurposeAs seafarers face a wide range of psychosocial stressors on board, they may be endangered to develop burnout syndrome. This study aims to investigate respective indicators.MethodsIn a cross-sectional study, 251 seafarers were asked about demographic data and job-related stressors. Particularly, the subscale emotional exhaustion (EE) of the Maslach Burnout Inventory and the Epworth Sleepiness Scale were used to assess the respective risks of job-related burnout and daytime sleepiness among seafarers. The statistical analysis was carried out using multiple logistic regression.ResultsWithin the whole study group, the EE score was elevated in 10.8xa0%. A higher EE score was found in 10.7xa0% of officers, in 4.5xa0% of lower crew ranks and in 25.0xa0% of the galley staff (pxa0=xa00.05). Furthermore, long working days were associated with an elevated EE score [OR 3.83 (CI 1.46–10.03)]. Emotional exhaustion was associated with a subjective perception of enough sleep on board [OR 3.33 (CI 1.17–9.46)], lack of care taken by the shipboard superiors and/or the shipping company [OR 1.19 (CI 1.04–1.36)], with high responsibility for work organisation of those involved in leadership [OR 1.46 (CI 1.20–1.78)] and with social problems due to the long periods of separation from their families [OR 1.19 (CI 1.02–1.39)], taking into account relevant demographic parameters.ConclusionsCompared with the majority of on-shore occupations, the burnout risk in seafaring seems to be moderate. To reduce the EE among seafarers, it is recommended to extend the sleeping time, to avoid long working hours, to improve the superiors’ communication and leadership skills, to diminish the superiors’ stress load caused by organisational duties and to support low-price telecommunication possibilities at home.

Maize pollen is an important allergen in occupationally exposed workers

BackgroundThe work- or environmental-related type I sensitization to maize pollen is hardly investigated. We sought to determine the prevalence of sensitization to maize pollen among exposed workers and to identify the eliciting allergens.MethodsIn July 2010, 8 out of 11 subjects were examined who were repeatedly exposed to maize pollen by pollinating maize during their work in a biological research department. All 8 filled in a questionnaire and underwent skin prick testing (SPT) and immune-specific analyses.Results5 out of the 8 exposed subjects had repeatedly suffered for at least several weeks from rhinitis, 4 from conjunctivitis, 4 from urticaria, and 2 from shortness of breath upon occupational exposure to maize pollen. All symptomatic workers had specific IgE antibodies against maize pollen (CAP class ≥ 1). Interestingly, 4 of the 5 maize pollen-allergic subjects, but none of the 3 asymptomatic exposed workers had IgE antibodies specific for grass pollen. All but one of the maize pollen-allergic subjects had suffered from allergic grass pollen-related symptoms for 6 to 11 years before job-related exposure to maize pollen. Lung function testing was normal in all cases. In immunoblot analyses, the allergenic components could be identified as Zea m 1 and Zea m 13. The reactivity is mostly caused by cross-reactivity to the homologous allergens in temperate grass pollen. Two sera responded to Zea m 3, but interestingly not to the corresponding timothy allergen indicating maize-specific IgE reactivity.ConclusionThe present data suggest that subjects pollinating maize are at high risk of developing an allergy to maize pollen as a so far underestimated source of occupational allergens. For the screening of patients with suspected maize pollen sensitization, the determination of IgE antibodies specific for maize pollen is suitable.

Risk of cardiovascular diseases in seafarers.

Seafarers experience a lot of job-related risk factors for cardiovascular diseases (CVD). Considering the healthy-worker effect due to the biennial pre-employment examination and the periodical medical fitness tests, a (slightly) elevated risk for CVD among seafarers is assumed compared to the reference population ashore. In seafaring, the most important, influenceable risk factors for CVD refer to the ship-specific stress situation, the malnutrition and the lack of exercises on board. Furthermore, the prognosis of acute severe CVD often depends on the measures taken in the first few hours after occurrence of the symptoms. Owing to the lack of health professionals on board and the limited treatment options of events at sea, effective cardio-pulmonary resuscitation is often delayed and the outcome of cardiac events is worse compared to that ashore.

Nautical officers at sea: emergency experience and need for medical training

BackgroundOn merchant ships, the medical treatment including emergency interventions on the high seas are carried out by nautical officers who have to pass a forty hours medical refresher course every five years in order to meet international requirements. This study aims to show the most frequent kinds of medical emergencies on the high seas and to assess the seafarers’ knowledge about their treatment.Methods465 nautical officers who participated in the medical refresher course at the Institute for Occupational and Maritime Medicine in Hamburg, within the period from 2006 to 2013, were interviewed about their experience of serious diseases and accidents on board, which had led to an emergency port call, a course deviation or an evacuation. Furthermore, prior to the course the officers were asked to answer 18 basic medical questions about common medical issues on board.Results133 seafarers (28.6%) reported that they had been confronted with at least one serious medical emergency at sea. These emergencies encompassed trauma (37.9%), cardiovascular diseases (18.2%), severe gastrointestinal diseases (15.9%), serious skin or pulmonary infections (9.8%), neurological (9.1%) and urological diseases (4.5%) as well as burns (4.5%). With regards to the basic medical questions, an average of 70.7% of the total score had been achieved (from 26.8% to 100%). On average, 65.5% of internal and 65.6% of surgical questions had been answered correctly. Proper answers to toxicological and infectious questions had been given by 93.3% and 94.1% respectively and to topics of hypothermia and medical treatment by 59.4% and 61.0%. In total, a significant number of younger seafarers answered the questions correctly (pu2009=u20090.001).ConclusionsAccording to this study, serious emergencies on board are most frequently related to trauma or cardiovascular diseases. Taking into account the acquired medical knowledge, there seems to be a need to train deck officers within these fields more intensively. Considering the knowledge of seafarers about medical issues directly before attending their medical refresher course, the 5xa0years interval without any form of refresher course appears to be too long to guarantee adequate medical treatment by the lay persons on board.

Mortality of German travellers on passenger vessels

BACKGROUNDnIn the past two decades, more and more Germans decided to spend their holidays on a passenger vessel. This study examined the frequencies and causes of deaths of German travellers aboard passenger vessels of all flags.nnnMETHODSnThe shipboard deaths of all German travellers within the time period from 1998 to 2008 were counted using the German civil central register in Berlin. The available documentation in this register provides information on frequencies, circumstances and causes of deaths on ships. In the above-mentioned period of time, the total cohort of German travellers on cruise ships is estimated to be 5.97 million persons.nnnRESULTSnDuring the 11-year examination period, 135 shipboard deaths of German passengers [102 males (75.6%) and 33 females (24.4%)] were recorded. Out of these travellers, 110 died on cruise ships. When considering only the passengers on cruise ships (without those on ferries) an average crude mortality rate of 1.8 per 100,000 German passengers was calculated. The crude mortality rate of shipboard death for males and females was 2.5 and 0.8 per 100,000 German passengers with a mean age of 71.2 years [standard deviation (SD) 16.0 years] and 73.3 years (SD 16.0 years), respectively. Significantly, more deceased travellers older than 70 years were observed on traditional cruise ships and resort vessels than on passenger ferries (Pu2009=u20090.001). The causes of death were documented in 85 cases (63.0%). Out of these documented deaths, 82 (96.5%) cases were regarded to be natural causes (particularly circulatory diseases) and 3 (3.5%) as unnatural causes (twice drowning and once an accidental fall).nnnCONCLUSIONSnIn spite of the large proportion of unknown causes of death, this study argues for a high significance of internal causes of deaths among German passengers. Thus, ships doctors-particularly those on traditional cruise ships-should be well experienced in internal and geriatric medicines.