# IMHAR Guidelines for integrated early diagnosis, prognosis, follow-up and prevention

Seafarers travel across the globe, and very often it is difficult to seek timely health services. In this sense they are hard to reach population group. This makes pre-service examinations fundamental, as they need to comply with specific requirements in order to get their work fitness certificate. Good health is a prerequisite for seafarers to serve at sea. Though the medical clinical guidelines are developed globally for decennia, it hasn´t been developed and adapted to a high degree in the maritime medicine. The overall aim is to improve health and safety for seafarers and fishermen by adapting the best possible clinical evidence based early diagnosis, prevention and personal advice to the seafarers and the ship-owners. The aim is also to make some preliminary steps to create the maritime medical speciality. The guidelines are intended to be gradually developed in the Network of IMHA members and many others. It is intended to be created in collaboration with other maritime health clinics in order to develop the guidelines gradually to the highest quality. In Denmark, maritime doctors designated by the DMA to provide fit-for work certificates. They are mainly general practitioners (GPs). The seafarers every second year need to renew their health certificate but in the meantime they could visit the same doctor for having consultations. This allows doctors exercising a full range of service provision including diagnostics and management of diseases as the seafarers are regularly enrolled on their list of customers. However this is not the case for flag states, in which the specific seafarers´ health clinics do not serve as the seafarer´s family practice. This serious problem was never questionned in the WHO/ILO guidelines for routine pre-entry health examinations! This means that the detection of for example prediabetes will not be further controlled and prevented until the diabetes is fully developed. Clinica Einstein in Panama is the first clinic that has taken up regular staff colloquia to develop guidelines for seafarers emerging chronically diseases together with all other health conditions to be taken in consideration at the regular health examination. The early diagnosis and follow-up with prevention of the chronic non-contagious diseases are not included in the seafarers ‘international fit for duty guidelines. However, the emerging global epidemic of obesity, diabetes, hypertension and cardiovascular diseases calls for attention to this important problem for seafarers. Moreover the early diagnosis and plan for integrated prevention has not yet been included in the WHO/ILO Guidelines for pre-entry health examinations for seafarers. Therefore IMHA Research has taken the initiative to develop such integrated clinical and public/occupational health guidelines and we invite all interested health professionals to contribute to the development of these guidelines. The global inter-clinical-collaboration will be facilitated by the use of the Maritime Clinical Colloquial Network To be discussed how a continued education on how to have early diagnosis and prevent the chronic diseases for seafarers and fishermen and the whole industry can be established

## Pre-diabetes

In medical examinations it is important with an adequate clinical history, with the primary goal of early diagnosis of diseases that may be exacerbated by the maritime labor. Early diagnosis and start of prevention at home and at sea through the detection of modifiable risk factors to prevent the development of diseases that undermine the health of people sea. A clinical condition that deserves compulsory care in medical examinations of seafarers because of their importance are the changes in blood glucose levels that do not correspond with diabetes but neither is considered normal, this intermediate stage of metabolic relevance today called prediabetes.

## Pre-hypertension

Blood pressure readings are given as two numbers. The systolic blood pressure (the top number) equals the pressure in the arteries as the heart contracts. The diastolic pressure (the bottom number) is the pressure in the arteries as the heart relaxes. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension," and a blood pressure of 140/90 or above is considered high while a systolic blood pressure of about 90 to 100 is considered low blood pressure.

## Overweight and Obsesity

Over time, when people eat and drink more calories than they burn, the energy balance tips toward weight gain, overweight, and obesity. Overweight and obesity are risk factors for type 2 diabetes, heart disease, high blood pressure, and other health problems. Seafarers and fishermen are like all other professional groups at risk and so its important, that the growing weight should be taken care of in the health examinations. Another very important issue is that the obese often come from an obese family, so the culture is strongly related to the family. This should probably be included in the anamnesis because it might be useful for the prevention in the whole family. To be continued later.

## Vaccination guide

To be discussed to choose the best clinical practice

## Finding Melanoma Early: Warning Signs & Photos

"Seafarers and fishermen are often massive exposed to sunlight and at risk to develop cancer of the skin and other diseases related to sunlight exposure. Therefore early detection of should be mentioned/included in the health examinations. included in sunlight aIn most cases, melanoma is easy to self-detect at an early stage while it is curable by simple surgical excision. Although the visual appearance of a skin lesion (a growth or mark) is often an indication of melanoma, you cannot always rely on this alone. You should also be aware of the history of your skin lesions—any changes that occur in them, as well the onset of any new ones. The only way to develop this awareness is by regular self-examination of your skin. We recommend a complete self-skin exam once every month"

## Remarks about quality programs

In this context we have the current national quality programs in the health sectors in different countries in mind. They have proposed to introduce training and quality teams to help lift the quality in selected areas. It appears that the aim is that good results and knowledge about what works best, disseminated as soon as possible for the benefit of patients. The national quality programs emphasizes that there should be greater visibility of results and quality, a visibility that will create a focus on health care outcomes.