open access
Decision aid for the use of additional tests during the pre-employment medical examination (PEME) of seafarers
Affiliations- Haukeland University Hospital, Department of Occupational Medicine, Norwegian Centre for Maritime and Diving Medicine, Bergen, Norway, Norway
open access
Abstract
No laboratory tests and imaging techniques are recommended for routine use in the ILO/IMO Guidelines on the Pre-Employment Medical Examination (PEME) of Seafarers that form the basis for statutory certification. However, they are widely used as components of the PEME protocols developed by insurers, employers and national maritime authorities in an attempt to predict and reduce the risks from illness whilst working at sea. This may be justified on scientific, safety, economic or professional grounds. We propose a rational approach for deciding if and when tests can be justified for routine use in assessing a seafarer’s fitness for work at sea. This is based on well-established methods for determining the validity of screening tests in public health as well as the seafarer demographics. We do not address the well-established use of similar tests where illness is suspected but only when they are used for routine PEME screening of all seafarers.
Abstract
No laboratory tests and imaging techniques are recommended for routine use in the ILO/IMO Guidelines on the Pre-Employment Medical Examination (PEME) of Seafarers that form the basis for statutory certification. However, they are widely used as components of the PEME protocols developed by insurers, employers and national maritime authorities in an attempt to predict and reduce the risks from illness whilst working at sea. This may be justified on scientific, safety, economic or professional grounds. We propose a rational approach for deciding if and when tests can be justified for routine use in assessing a seafarer’s fitness for work at sea. This is based on well-established methods for determining the validity of screening tests in public health as well as the seafarer demographics. We do not address the well-established use of similar tests where illness is suspected but only when they are used for routine PEME screening of all seafarers.
Keywords
laboratory tests, imaging techniques, pre-employment medical examination, seafarers
About this articleTitle
Decision aid for the use of additional tests during the pre-employment medical examination (PEME) of seafarers
Journal
Issue
Pages
90-98
Published online
2017-06-27
Page views
1911
Article views/downloads
2667
DOI
Pubmed
Bibliographic record
IMH 2017;68(2):90-98.
Keywords
laboratory tests
imaging techniques
pre-employment medical examination
seafarers
Authors
Alf Magne Horneland
Suzanne Louise Stannard
References (21)- Guidelines on the medical examination of seafarers, Ch. XII, Paragraph (x). International Labour Office, Geneva, 2013. ISBN 9 789221 274629. http://www ilo org/wcmsp5/groups/public/@ed_dialogue/@sector/documents/normativeinstrument/wcms.
- Personal review of PEME protocols from Panama, Marshall Islands, Malta, Liberia, Norway, the Netherlands, Philippines DOH, Steamship, The Standard, The American Club, UK P&I Club, The Swedish Club 2016.
- Carter T. Seafarer medicals: population health or private gain? Int Marit Health. 2016; 67(1): 1–2.
- https://www.nice.org.uk/guidance/cg127.
- https://www.gov.uk/government/publications/the-approved-doctors-manual.
- https://handbook.ncmm.no.
- Universal Declaration of Human Rights, adopted by the United Nationas General Assembly 10th December 1948, Article. ; 23: 1.
- ILO/IMO Guidelines on the medical examination of seafarers. Appendix E. Introduction. ISBN 978-92-2-127463-6.
- Herman C. What makes a screening exam. Virtual Mentor. 2006; 8(1): 34–37.
- Akobeng AK. Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta Paediatr. 2007; 96(3): 338–341.
- Graham J, Barker A. Reference Intervals. Clin Biochem Rev. 2008 Aug(Suppl 1): 93–97.
- Principles of Epidemiology in Public Health Practice, Third Edition, An introduction to Applied Epidemiology and Biostatistics. http://www.cdc.gov/ophss/csels/dsepd/SS1978/Lesson3/Section2.html Accessed 2016-09-23. (Accessed 2016-09-23.).
- Njeze GGE. Niger J Surg. PMC:3899548. 2013; 19(2): 49–55.
- Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989; 42(2): 127–136.
- Thistle JL, Cleary PA, Lachin JM, et al. The natural history of cholelithiasis: the National Cooperative Gallstone Study. Ann Intern Med. 1984; 101(2): 171–175.
- Shabanzadeh DM, Sørensen LT, Jørgensen T. A Prediction Rule for Risk Stratification of Incidentally Discovered Gallstones: Results From a Large Cohort Study. Gastroenterology. 2016; 150(1): 156–167.e1.
- Afdahl, N H: Approach to the patient with incidental gallstones. www.UpToDate.com, literature review current through Sep 2016. https://www.uptodate.com/contents/approach-to-the-patient-with-incidental-gallstones?source=search_result&search=approach%20to%20the%20patient%20with%20incidental%20gallstones&selectedTitle=1~150 (Accessed 2016-10-03).
- Attili AF, De Santis A, Capri R, et al. The natural history of gallstones: the GREPCO experience. The GREPCO Group. PMID: 7875663. Hepatology. 1995; 21(3): 655–660.
- Capocaccia L, the GREPCO group. Clinical symptoms and gallstone disease: Lessons from a population study. In: Epidemiology and prevention of gallstone disease, Capocaccia L, Ricci G, Angelico F, Attili AF (Eds), Lancaster MTP Press, 1984. p.153. http://link.springer.com/chapter/10.1007%2F978-94-009-5606-3_20#page-2.
- Barbara L, Sama C, Morselli Labate AM, et al. A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatology. 1987; 7(5): 913–917.
- Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med 1982; 307:798. http://www.nejm.org/doi/full/10.1056/NEJM198209233071305.
