{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:59:18Z","timestamp":1781265558012,"version":"3.54.1"},"reference-count":19,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Helse Bergen HF"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,18]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate whether seafarers in Norway who were declared unfit for service at sea or received a time-limited health certificate had a higher risk of acute somatic hospital admissions compared with those who received a full health certificate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Registry-based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Seafarers in Norway who presented to a seafarer\u2019s doctor to obtain a health certificate between 2018 and 2019, as required for work aboard Norwegian vessels. The study was conducted within Norway\u2019s publicly funded healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Norwegian seafarers aged 18\u201370 years who underwent medical examinations (n=43\u2009758), including n=5452 females (12.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Acute somatic hospital admission within 2 years of medical examination. HRs were estimated using Cox regression models in two separate time periods (0\u20133 months and 3\u201324 months), with adjustment for possible confounding from age, gender, level of education and centrality of residence (proximity to healthcare services).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The crude risk of acute somatic hospital admissions was higher for individuals who received a declaration of unfitness, as compared with those who received a full health certificate, in both follow-up periods: 0\u20133 months (HR=5.13, 95%\u2009CI: 3.27 to 8.04) and 3\u201324 months (HR=2.63, 95%\u2009CI: 2.07 to 3.34). Similarly, those with time-limited health certificates had a higher risk in both periods: 0\u20133 months (HR=2.02, 95%\u2009CI: 1.39 to 2.93) and 3\u201324 months (HR=2.45, 95%\u2009CI: 2.15 to 2.79). Adjustment of the analyses for socio-demographic factors did not change the effect estimates substantially.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings highlight the importance of comprehensive and continuous health assessments to help prevent adverse health outcomes and ensure safety at sea, particularly among vulnerable subgroups of seafarers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103837","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T14:40:39Z","timestamp":1756824039000},"page":"e103837","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of acute somatic hospital admissions among seafarers: a registry-based study in Norway"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8717-7659","authenticated-orcid":false,"given":"Sahil","family":"Gulati","sequence":"first","affiliation":[{"name":"Norwegian Centre for Maritime And Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway"},{"name":"Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stein H\u00e5kon L\u00e5stad","family":"Lygre","sequence":"additional","affiliation":[{"name":"Norwegian Centre for Maritime And Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit","family":"Gr\u00f8nning","sequence":"additional","affiliation":[{"name":"Norwegian Centre for Maritime And Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon Magnus","family":"Haga","sequence":"additional","affiliation":[{"name":"Norwegian Centre for Maritime And Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway"},{"name":"Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"2026061204351056000_15.9.e103837.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tranpol.2022.04.010"},{"key":"2026061204351056000_15.9.e103837.2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494814534538"},{"key":"2026061204351056000_15.9.e103837.3","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqaa002"},{"key":"2026061204351056000_15.9.e103837.4","first-page":"1","article-title":"The need for international seafarer medical fitness standards","volume":"60","author":"Carter","year":"2009","journal-title":"Int Marit Health"},{"key":"2026061204351056000_15.9.e103837.5","first-page":"78","article-title":"The mental health of seafarers","volume":"63","author":"Iversen","year":"2012","journal-title":"Int Marit Health"},{"key":"2026061204351056000_15.9.e103837.6","first-page":"1","article-title":"Maritime health: a review with suggestions for research","volume":"63","author":"MacLachlan","year":"2012","journal-title":"Int Marit Health"},{"key":"2026061204351056000_15.9.e103837.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-6377-6","article-title":"Overweight among seafarers working on board merchant ships","volume":"19","author":"Nittari","year":"2019","journal-title":"BMC Public Health"},{"key":"2026061204351056000_15.9.e103837.8","doi-asserted-by":"publisher","DOI":"10.5603\/IMH.2016.0037"},{"key":"2026061204351056000_15.9.e103837.9","doi-asserted-by":"crossref","first-page":"461","DOI":"10.5271\/sjweh.3879","article-title":"Cancer incidence among seafarers and fishermen in the Nordic countries","volume":"46","author":"Ugelvig Petersen","year":"2020","journal-title":"Scand J Work Environ Health"},{"key":"2026061204351056000_15.9.e103837.10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.5603\/IMH.2017.0020","article-title":"Seafarers\u2019 depression and suicide","volume":"68","author":"Mellbye","year":"2017","journal-title":"Int Marit Health"},{"key":"2026061204351056000_15.9.e103837.11","unstructured":"Norwegian Maritime Authority . Regulations of 5 June 2014 no.805 on medical examination of employees on Norwegian ships and mobile offshore units, Available: https:\/\/www.sdir.no\/siteassets\/engelske-forskrifter-pdf\/5-june-2014-no.-805-medical-examination-of-employees-on-norwegian-ships-and-mobile-offshore-units.pdf"},{"key":"2026061204351056000_15.9.e103837.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2026061204351056000_15.9.e103837.13","article-title":"Understanding seafarers\u2019 physical and mental health","volume":"8","author":"\u015eenbursa","year":"2024","journal-title":"J Int Marit Saf Environ Affairs Ship"},{"key":"2026061204351056000_15.9.e103837.14","doi-asserted-by":"crossref","first-page":"101819","DOI":"10.1016\/j.jth.2024.101819","article-title":"Impact of distance and\/or travel time on healthcare service access in rural and remote areas: A scoping review","volume":"37","author":"Mseke","year":"2024","journal-title":"J Transp Health"},{"key":"2026061204351056000_15.9.e103837.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.cub.2012.07.024"},{"key":"2026061204351056000_15.9.e103837.16","doi-asserted-by":"crossref","DOI":"10.1186\/s13690-020-00402-5","article-title":"The influence of education on health: an empirical assessment of OECD countries for the period 1995-2015","volume":"78","author":"Raghupathi","year":"2020","journal-title":"Arch Public Health"},{"key":"2026061204351056000_15.9.e103837.17","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmab120"},{"key":"2026061204351056000_15.9.e103837.18","doi-asserted-by":"publisher","DOI":"10.1177\/1403494819859737"},{"key":"2026061204351056000_15.9.e103837.19","unstructured":"International Maritime Organization . International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, Available: https:\/\/www.imo.org\/en\/OurWork\/HumanElement\/Pages\/STCW-Convention.aspx"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-103837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:35:24Z","timestamp":1781264124000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-103837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":19,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,2]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bmjopen-2025-103837"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-103837","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}