# Occupational Epidemiology/Clinical epidemiology
## Background

The development of the sciences in a modern society includes among other issues, research training, research-based teaching in universities and the establishment of research centers and scientific journals. This center is part of this trilogy in order to develop research in health and to develop the society. A recent literature review revealed that the research on maritime health in Latin America is very scarce. Only a total of 54 published articles in peer-reviewed journals, mainly from Brazil, were found. The earliest publications are from the 1980ies and all publications are related solely to professional fishing (1). The health of seafarers and fatalities among seafarers and fishermen haven’t been studied at all. Some of the health problems are specific for the tropical and subtropical regions; still many of the maritime health problems are comparable to the colder areas of the globe. There is obviously a strong need for health research for seafarers and fishermen among all countries in Latin America and research form this area will also add benefit to the global maritime health. The Department of Occupational and Environmental Health Science at the Faculty of Medicine in the University of Panama has been established in 2018 (Goto here

## Aims and visions

The aims of the Department are to offer research training for pmedical students, other students and postgraduate health professionals to work systematically, scientifically with an evidence-based approach. We will try to give them the most needed tools for clinical work and for prevention in the population and for research. Clinical studies will be related to the population where the patient comes from with an epidemiological approach to cause search, prevention and prognosis. In the presentation of clinical problems, we will inspire the students to see each patient in the big picture. That is to use modern methods of systematic, scientific work, identifying and solving health problems in the evidence-based. Both in clinical work and working with the population health problems include diagnostics, search for etiology, treatment, prevention and prognosis. Prevention is included in all health work, corresponding to the WHO definitions of primary secondary and tertiary prevention. These principles are useful in occupational medicine, public health and all clinical specialties. We hope that these methods will stimulate students to work systematically, scientifically in all areas where they will be working graduates. And most important to be inspired to start their own research project, ideally to do their thesis as a scientific work presented in the same style as a scientific article.

## Dropbox Archives

* User:medi1234@gmail.com code 1234medi

## Steps to develop the center

* December 2016: Draft description of the center objectives
* March 2017, Clinica Einstein offered rooms for office and meetings
* March 2017 Meeting with the Dean and the professors from occupational medicine in the Faculty of health at the public university University of Panama to discuss strategy for teaching schemes and thesis offers to the medical students

## Research programs

The Occupational Health Survey Program aims to investigate working and living conditions in all forms of occupational activity and to study the health and living conditions of the population. The goal is to produce scientific evidence for the primary, secondary and tertiary health prevention in all health aspects. All members of the Research Unit can get permission to re-use the data for further analysis and publications. There are 5 proposals for research at the moment:
1. Clinical data monitoring
The routine data from pre-embarkation health examinations are monitored in different countries. The proportions of pre-hypertension, pre-diabetes, and obesity in the seafaring population will be monitored and the seafarers will be offered early diagnostic and prevention. This monitoring and the analysis of the data will help to point out the most important areas for prevention, see example: Google Forms Clinical data monitoring
2. Study of the seafarers´ repatriations
In case of illness, the seafarers are repatriated to heir home country, which is normally very costly. Very little is known how to reduce the number of these repatriations. The research question is to identify clinical indicators with high predictive value for +/- repatriation, including mental health problems. The objectives are to study the etiological, predictive variables that can be used to reduce the number of repatriations.
3. Maritime Mental Health Program
The seafaring employees face more difficult working conditions in the sea than the employees working on land. Their mental health is affected by the environment in which they live, often coupled with long working hours that contribute to stress, anxiety, loneliness, depression and suicide. This proposal seeks to improve the seafarers' mental health by introducing a comprehensive, evidence-based global maritime mental health promotion program that attracts the youngest seafarers to choose and to stay in the job. Methods: The theories on empowerment, life-long and problem-oriented learning with inclusion of all stakeholders form the theoretical background. A joint action among the unions, the ship owners, the maritime authorities and a network of universities' research centers in suicide prevention, public health and maritime health departments.
4. Dock workers health and safety intervention program
The employers have the full responsibility for health and safety in the ports but the unions also take initiatives for better health and safety together with the university occupational health research departments. The strength is that the workers know the workplace hazards by own experiences better than the owners and the administrators and therefore are the best to propose how to do the prevention.
5. Work related diseases in the clinics
6. Perceived training needs of maritime health professionals
Patient records in clinics are unique resources that can provide knowledge for better patient diagnostics, treatment and prevention of the working conditions. All types of clinics can participate in collection of data for research. By using the forms the physicians will identify complaints that are work related and the prevention should be done at work. For a start to complete and analyse 100 schemes would be a great contribution to better knowledge and prevention. The schemes are prepared for General Medicine, Psychiatry, Dermatology and Maritime medicine but other specialties like Rheumatology, Cardiology, Respiratory- and Neurological clinics can benefit by using these schemes.
* Medicina Maritima encuesta sobre enfermedades del trabajo
* Encuesta enfermedades dermatologia del trabajo
* Medico familiar Encuesta sobre enfermedades del trabajo
* Encuesta enfermedades psychiatria del trabajo

## Standard agenda for research meetings

* Status of ongoing research projects
* Scientific literature readings, ppt from conferences
* Lectures on research methodology, epidemiology, biostatistics

## Research training 1

The introductory training module, self-learning is needed to be member of the Learning Center. After an interview and evaluation the applicants are admitted to start with her/his selected research work, that must be within the running research programs. Diplomas will be given after self—study and an interview to assure familiarity with the following issues in Research training 1:
* The Occupational Medicine Wikibook
* Draft a research protocol with: problems, objectives, methods and expected results in 100-200 words
* Present the protocol literature search, reference list in Vancouver format by use of Zotero

## Research training 2

* Curso en medicina ocupacional in ingles Universidad de Panama
* Research tools 1

## Research training 3

Epidemiologia User cahe09 code canalview
EPI-Investigacion User cahe09 code canalview

## Learning principles

* "We stand on the shoulders of giants" meaning that we use the scientific literature as start point equipped to solve real-life complex health problems. To solve a problem you need to learn to ask the right questions. In projects you work deeply and exploratory with a problem chosen by you and your fellow members of the project group.
* Throughout the research process talented researchers will guide the students. They will learn how to identify and frame a problem through problem-oriented projects and get a methodological and theoretical toolbox.
* The project groups will ideally consist of students who are passionate about the same issues and findings as you. Every module consists of reading and lectures, group work with 1 selected research theme during the whole course and minor group works in each of the lectures. The students elaborate a main research project over the whole course (months/years) and minor review project on articles per module/week.

## Key words

* Learn to become a problem solver
* Prevention and promotion
* Learn to ask the right questions
* Problem oriented projects
* Research methodology
* Epidemiology
* Group work
* IMRAD structure
* Evidence based medicine/health