1. Epidemiological research in maritime health and safety - why and how ? 1 Olaf C Jensen, MD, MPH, Senior researcher at the Centre for Maritime Health and Safety, Institute of Public Health at the Faculty of Health Sciences, University of Southern Denmark

2.  To learn how the epidemiological research in general constitutes a core element of occupational risk prevention.  To understand the objectives of the 3 main study design types: 1) descriptive studies 2) causal analytical studies and 3) intervention analytical studies.  To understand how the 3 design types correspond to the logical diagnostic procedures in the medical clinic.  To understand how the objectives of the design types correspond to the basic elements of the evidence based medicine logical structure 2

3. 3 Why research? Because we need scientific knowledge for the risk prevention

4. 4 Risk prevention– knowledge needed from research Step 1: Which hazards are there? Step 2: Who can be harmed ? Step 3: What is the best prevention? Step 4: Implement Step 5: Evaluate

5. Example: The Spanish treasure fleets from the 1700ies were large Galleons ships. The problem was that many seafarers died of scurvy or other diseases. 5

6. The first maritime medical experimental study 6

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8. 8 Different fruits, foods, drinks were given and citrus fruts was helpful

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11. 11 HOW is research done?

12. 12 Research types Descriptive Research Causal Research Intervention research

13. 13 ”gnosis” for health practice and health research DIA- GNOSIS ETIO- GNOSIS PRO- GNOSIS

14. 14 Evidence based medicine Define the questions Collect evidence to answer the question Critical evaluation of the evidence Decide and Implement the treatment Follow - prognosis ?

15. 15 ”Quality circle” or general ”problem solving circle” ProblemCausation? Find remedy Implement Remidy Evaluate (prognosis)

16. 16 Problems with the car – mono- causal! Problem: Cannot start Cause: Low battery Remedy: Find new battery Implement Evaluate – does it work?

17. 17 Health and safety risk prevention – multiple causes

18. 18 Prevention of hypertension The problem? Pre-hypertension Evidence? Non-pharm Critical appraisal Implement Non-pharm Evaluate Does it work?

19.  Risk of fatal and non-fatal injuries  Risk of occupational diseases  Risk of injuries and errors caused by fatigue,  Risk of HIV for seafarers  Risk of other infectious diseases  Risk of burn-out and stress  Risk of non communicable diseases 19 Some examples of research needs in seafaring:

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21. GovernmentProvide laws and funding for health research Health FacultiesUniversity degrees in maritime occupational health Maritime UniversitiesImplement health risk prevention modules StudentsMaritime risk prevention research projects Maritime AuthoritiesCollaboration + provide data Seafarers´ organisationsCollaboration + provide data + funding Shipowners organisationsCollaborations + provide data + funding Insurance companiesCollaborations+ provide data + funding Occup. health servicesCollaboration + data collection Seafarers´s doctorsCollaboration + data collection + own studies 21 Contribution to more research from:

22. Resumé : 22 The problemCausesRemedyImplementEvaluate Risk prevention includes Practice and Research

23. Thank you for your attention 23