BACKGROUND: In a working environment that is predominantly male, very tough physically, with a difficult working environment, occupational exposures and working, verbal and physical aggression can be more frequent than in other sectors. Fishing, merchant shipping and yachting are all sectors where fitness to sail is reassessed every year by doctors in the Seafarers\' Health Service. Seafarers are increasingly reporting insulting, violent or sexist behaviour. The main types of abuse seen on board can be verbal and/or physical aggression, humiliation, whether in private or in front of others. Sexual harassment of women is a very worrying subject.
METHODS: It was a retrospective observational study which is part of the professional monitoring of seafarers. The target population was adult seafarers coming for a fitness to sail visit. The group was recruited from seafarers aged over 18 who were being monitored by one of the seafarers\' health services (or local centres). The inclusion period was 4 months between January and April 2023. All the information was collected using a self-questionnaire developed from the questionnaires of the Surveillance Médicale des Expositions des Salariés au Risques Professionnels (SUMER) for health status, job satisfaction and the European mini-module, verbal and physical aggression and psychological violence at work (based on the Leymann questionnaire), sexual violence and aggression based on the sexual harassment questionnaire and the PCLS-5 scale validated and translated into French to assess post-traumatic stress. The population studied was therefore 788 sailors.
RESULTS: The study population was predominantly male (82.3%). The average age was 41.4 years (standard deviation = 11.7). 46.7% of seafarers estimate being in very good health. During the past 12 months, overall, 24.5% of seafarers disclaimed having been victim in work-related context of a verbal aggression, with a significant difference according to the gender (21.1% for men and 41.0% for women). During the last 12 months, overall, 3.2% of seafarers have been victim in work-related context of a physical aggression (2.6% for men and 5.8% for women, NS), whereas 10.9% of seafarers reported hostile behaviour at present. Twenty per cent of seafarers reported sexual harassment in the last 12 months. During the entire working life of seafarers, 65.5% of women and 38.2% of men reported sexual harassment, and 38.8% of seafarers stated that they had experienced at least one traumatic event in the last 12 months.
CONCLUSIONS: A quarter of seafarers say they have been the victim of verbal or physical aggression at work in the last twelve months. These figures are high, and higher than those of the global survey on violence and harassment at work carried out by the International Labour Organization. One of the most alarming results of our study is the overexposure of women working in the maritime industry to the risk of physical, verbal or sexual assault of any kind. Indeed, in all the questions concerning the experience of verbal and physical aggression, the number of women victims is twice as high as that of their male colleagues, and this difference is statistically significant. As far as prevention is concerned, it seems that an effort is needed in terms of information, since only one seafarer in two knows the procedure to follow in the event of aggression within their shipyard. Communication between shipowners and seafarers needs to be stepped up to ensure that everyone is familiar with the procedures.

BACKGROUND: Seafarers\' diets are often high in fat, sugar and calories, thus contributing to an increased risk of obesity, metabolic syndrome and cardiovascular disease. The multitude of obstacles to healthy eating in the on-board environment on merchant ships makes it essential to find new approaches for health promotion. This study explored seafarers\' attitudes, the status quo of support measures and chances to improve nutrition on merchant ships from the perspective of crews and cooks.
METHODS: In the course of the EU-funded project \"e-healthy ship\", European and Southeast Asian seafarers (N = 810) and ship cooks (N = 62) were examined by using two questionnaires on 68 ships of two German shipping companies.
RESULTS: Almost all seafarers (98.8%) considered a healthy diet important for their well-being and the majority of seafarers reported being open-minded about changing their eating habits (88.4%). However, European seafarers were less likely to respond that they are willing to eat less meat [OR 0.11; 95%CI (0.07-0.17); p < .001], more vegetables [OR 0.10; 95%CI (0.02-0.49); p = .005] and more fruits [OR 0.11; 95%CI (0.02-0.61); p = .011] than their Southeast Asian colleagues. On the one hand, 82.3% of the ship cooks reported having taken part in at least one cooking course organized by their employer (1: 33.9%, 2: 25.8%, 3: 14.5%, 4 or more: 8.1%), on the other hand, slightly above half stated that the last of these courses had taken place more than 2 years ago. Furthermore, the ship cooks showed a positive attitude towards the use of a tablet-based digital platform that supports the ship cooks in daily and complex tasks (> 85% agreement).
CONCLUSIONS: To improve nutrition on board merchant ships, various parameters need to be adjusted, such as ensuring a demand-oriented food supply on board or supporting seafarers\' healthy food choices through target group-specific nutrition education. Ship cooks would be able to play a crucial role if they receive support. The development of a tablet-based digital platform that supports the ship cooks in their daily tasks, offers training and empowers them to implement health-promoting measures themselves seems to be an accepted and promising approach.

It is important to explore causal relationships in functional magnetic resonance imaging study. However, the traditional effective connectivity analysis method is easy to produce false causality, and the detection accuracy needs to be improved. In this paper, we introduce a novel functional magnetic resonance imaging effective connectivity method based on the asymmetry detection of transfer entropy, which quantifies the disparity in predictive information between forward and backward time, subsequently normalizing this disparity to establish a more precise criterion for detecting causal relationships while concurrently reducing computational complexity. Then, we evaluate the effectiveness of this method on the simulated data with different level of nonlinearity, and the results demonstrated that the proposed method outperforms others methods on the detection of both linear and nonlinear causal relationships, including Granger Causality, Partial Granger Causality, Kernel Granger Causality, Copula Granger Causality, and traditional transfer entropy. Furthermore, we applied it to study the effective connectivity of brain functional activities in seafarers. The results showed that there are significantly different causal relationships between different brain regions in seafarers compared with non-seafarers, such as Temporal lobe related to sound and auditory information processing, Hippocampus related to spatial navigation, Precuneus related to emotion processing as well as Supp_Motor_Area associated with motor control and coordination, which reflects the occupational specificity of brain function of seafarers.

Prevalence of depressive symptoms among seafarers is higher than the general population because of their unique work conditions. Factors that can be changed must be considered and promptly addressed in order to decrease the prevalence of depression. This study aims to clarify the prevalence of depressive symptoms and its related factors among Thai seafarers in an effort to contribute to policies and to prevent depression among Thai seafarers.
This cross-sectional study was conducted among 381 male seafarers working onboard ocean-going vessels of five Thai shipping companies. The questionnaire items comprised of personal factors, working factors and depressive symptoms. Depressive symptoms were assessed using the Thai version of the Patient Health Questionnaire-9. First, the chi-square test was used for univariate analysis. Then, variables significantly associated by the chi-square test were used for multivariate logistic regression analysis (employing the stepwise method) as independent variables.
The average age of participants in this study was 36.4 years. Prevalence of depressive symptoms was 19.5%. One half of the participants (58.3%) reported subjective sleep problems, and most (75.1%) experienced poor coping behaviors. Two thirds (67.5%) were officers, and 10.1% of participants reported that they sometimes or never performed occupational safety behaviors. Regarding work environments, 62.2% reported that their work was disturbed from performing repetitive tasks. Multivariate logistic regression analysis showed two personal factors; sleep problems (Adjusted Odds Ratio (AOR) = 7.97, 95% Confidence interval (CI) = 3.52-18.05) and poor coping behaviors (AOR = 4.46, 95%CI = 1.61-12.34), and three working factors; job assignment (AOR = 2.50, 95%CI = 1.33-4.70), inadequate occupational safety behaviors (AOR = 4.51, 95%CI = 1.85-11.01) and performing repetitive task (AOR = 2.27, 95%CI = 1.16-4.45), were significantly associated with depression.
During COVID-19 pandemic, 19.5% of Thai male seafarers had depressive symptoms. Personal and working factors including subjective sleep problems, poor coping behaviors, job assignment, performing inadequate occupational safety behaviors and performing repetitive tasks were risk factors of depressive symptoms among Thai male seafarers. Monitoring work environment rigorously and coping with work-related stress of the occupational safety behaviors program should be suggested.

A variety of factors influence seafarers\' health. Such factors might affect their satisfaction with life.
To examine the relationships between seafarers\' mental health status and satisfaction with life by using a structural equation method.
In this survey, 470 seafarers were selected via convenience sampling method from two shipping companies. Validated questionnaires including Satisfaction with Life Scale (SWLS), generalized anxiety disorder-7 (GAD-7), Post-traumatic Stress Disorder-8 (PTSD-8), Patient Health Questionnaire-9 (PHQ-9), General Health Questionnaire-12 (GHQ-12), Perceived Health status and Depression-Anxiety-Stress scale-21 (DASS-21) were used to assess different aspects of well-being and life satisfaction. The stratified path analysis method was applied to analyze the data.
439 seafarers (200 officers and 237 non-officers) with a mean age of 34.5 (SD: 8.05) participated in the current study. The GHQ score directly affected satisfaction with life in both officers (β = 0.35) and non-officers (β = 0.40). Also, perceived health status directly and indirectly affected satisfaction with life among officers (β = 0.19) and non-officers (β = 0.06). While officers working days per month indirectly impacted satisfaction with life through the general anxiety disorder, perceived health status, depression, anxiety, stress and current mental health. In non-officers, generalized anxiety disorder had the most potent indirect effects on satisfaction with life through perceived health status and current mental health.
Perceived health status, directly and indirectly, affected seafarers\' satisfaction with life. Measures should be taken in order to improve seafarers\' perceived health status and its effects on satisfaction with life.

Seafaring shares many characteristics with contemporary working life ashore. However, a major difference is that seafarers can spend up to 12 months aboard a ship that constitutes a work, living and recreational environment. Onboard work includes many stressors that can potentially contribute to workplace bullying and harassment, which in turn can affect safety critical operations. The aim of this study was to identify underlying causes in the organizational and social work environment that can cause workplace bullying and harassment at sea, and to suggest appropriate preventive and promotive strategies and measures. Data were collected mainly through World Café workshops with 56 participants from the Swedish maritime industry. Seafarer occupational health, safety, and wellbeing is largely determined by interdependent factors at micro, meso, and macro levels, where different stakeholders play various roles. Strategies and measures starting at the individual seafarer, and gradually expanding outwards toward the maritime industry are suggested. It is important that a victim of bullying or harassment receives adequate support. Creating crew courage enables employees to both recognize troubling situations and know how to act and respond to a situation. To bridge the gap between policy and practice, the legislative framework needs translating into practical procedures to make sense to the middle manager at the sharp end, with limited knowledge, time, resources, and decision latitude. Future research should evaluate the effectiveness of work environment interventions - what works, for whom, and under which circumstances.

Quality of shipboard life plays a significant role, as for a seafarer the ship is both his workplace and home for extended periods. Physical, psychological, social and environmental factors have a substantial impact on the seafarers\' quality of life and work. The aim of the study was to analyse the domains determining the factors associated with the seafarers\' quality of life at Kochi Port, India.
This was a cross-sectional study in which 302 Indian seafarers took part in the research and was conducted in January-February, 2020. WHOQOL-BREF scale was used to explore the four domains of quality of life, and the participants had to rate their perceived satisfaction in each of the domains. The trained researcher conducted a face-to-face interview session using a structured questionnaire. Bivariate and multivariate analysis was used to determine associations and predictors for quality of life, respectively.
The majority (80%) of the seafarers were married and were from a rural area (74%). The mean score (standard deviation) was highest for the psychological domain 70.9 (10.5), followed by environmental domain 69.9 (13.2), social relations domain 68.5 (16.9) and physical domain 61.2 (12.8), respectively. A significant association was found between age and the psychological domain (p < 0.05). At the same time, the area of residence had a significant association with physical and psychological domains whereas marital status with physical, psychological and environmental domains (p < 0.05). Daily working hours had a significant association with psychological domains and work experience with the physical and psychological domains (p < 0.05).
The findings of this study are an indication for the health policy makers to focus on interventions for improving the quality of life among the seafarers and would also help in enhancing healthy work environments for them.

BACKGROUND: The quality of radiotherapy delivery has been shown to significantly impact clinical outcomes including patient survival. To identify errors, institutions perform Patient Specific Quality Assurance (PSQA) assessing each individual radiotherapy plan prior to starting patient treatments. Externally administered Dosimetry Audits have found problems despite institutions passing their own PSQA. Hence a new audit concept which assesses the institution\'s ability to detect errors with their routine PSQA is needed.
METHODS: Purposefully introduced edits which simulated treatment delivery errors were embedded into radiation treatment plans of participating institutions. These were designed to produce clinically significant changes yet were mostly within treatment delivery specifications. Actual impact was centrally assessed for each plan. Institutions performed PSQA on each plan, without knowing which contained errors.
RESULTS: Seventeen institutions using six radiation treatment planning systems and two delivery systems performed PSQA on twelve plans each. Seventeen erroneous plans (across seven institutions) passed PSQA despite causing >5% increase in spinal cord dose relative to the original plans. Six plans (from four institutions) passed despite a >10% increase.
CONCLUSIONS: This novel audit concept evolves beyond testing an institution\'s ability to deliver a single test case, to increasing the number of errors caught by institutions themselves, thus increasing quality of radiation therapy and impacting every patient treated. Administered remotely this audit also provides advantages in cost, environmental impact, and logistics.

UNASSIGNED: Fatigue is an important factor for the safety of ships. In order to alleviate fatigue of the seafarers, the STCW Convention (International Convention on Standards of Training, Certification, and Watchkeeping for Seafarers) has made many regulations on the working time of seafarers. At present, if a crew member takes only one day off at home before returning to work on the ship, the working time on the ship must be re-calculated again. If the time spent at home is not sufficient to allow the crew to recover, the regulations of only stipulating the working time, not stipulating the home vacation time, cannot guarantee the crew\'s fatigue been well controlled. The aim of present study is to explore the relationship between vacation schedule and fatigue of the seafarers.
UNASSIGNED: In present study, a simplified stress scale developed by the Ministry of Labor of Japan has been used as a measurement tool. The method of stratified sampling was adopted. Data collection mainly came from domestic ocean-going seafarers (n = 165). Analysis was conducted using the Cross (chi-square) analysis and hierarchical multiple regression analysis methods.
UNASSIGNED: We found that there was no difference between crew members of different positions in terms of average vacation time and on-board service time (p > 0.05). The length of last vacation time and this service time for seafarers of different positions showed obvious differences (p < 0.01). The rank has a significant effect on the length of the last vacation (χ2 = 101.560, p = 0.000 < 0.01) and the length of this service time (χ2 = 75.624, p = 0.000 < 0.01). Also, the results showed that there was a significant negative correlation between the duration of vacation and overall fatigue (t = -7.160, p = 0.000 < 0.01), while there was a significant positive correlation between the length of service time on board and overall fatigue (t = 3.474, p = 0.001 < 0.01).
UNASSIGNED: The results indicated that a reasonable vacation schedule was crucial for the relief of the seafarers\' fatigue, and also played a positive role in the state of working on the ship again.

The complexity derived from resting-state functional magnetic resonance imaging (rs-fMRI) data has been applied for exploring cognitive states and occupational neuroplasticity. However, there is little information about the influence of occupational factors on dynamic complexity and topological properties of the connectivity networks. In this paper, we proposed a novel dynamical brain complexity analysis (DBCA) framework to explore the changes in dynamical complexity of brain activity at the voxel level and complexity topology for professional seafarers caused by long-term working experience. The proposed DBCA is made up of dynamical brain entropy mapping analysis and complex network analysis based on brain entropy sequences, which generate the dynamical complexity of local brain areas and the topological complexity across brain areas, respectively. First, the transient complexity of voxel-wise brain map was calculated; compared with non-seafarers, seafarers showed decreased dynamic entropy values in the cerebellum and increased values in the left fusiform gyrus (BA20). Further, the complex network analysis based on brain entropy sequences revealed small-worldness in terms of topological complexity in both seafarers and non-seafarers, indicating that it is an inherent attribute of human the brain. In addition, seafarers showed a higher average path length and lower average clustering coefficient than non-seafarers, suggesting that the information processing ability is reduced in seafarers. Moreover, the reduction in efficiency of seafarers suggests that they have a less efficient processing network. To sum up, the proposed DBCA is effective for exploring the dynamic complexity changes in voxel-wise activity and region-wise connectivity, showing that occupational experience can reshape seafarers\' dynamic brain complexity fingerprints.