{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:00:02Z","timestamp":1790316002801,"version":"4.1.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Underwater habitats represent emerging extreme workplaces in which pressure exposure, immersion, confined living, external underwater tasks, and delayed access to definitive care create combined occupational health and safety demands. Candidate selection establishes baseline suitability. It cannot, on its own, specify which preventive and response capabilities should be taught, practiced, and documented between selection and deployment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a scenario-based, evidence-informed occupational health curriculum for the pre-deployment preparation of non-medical research personnel. The design case was deliberately narrow. It placed three to six crew members in a 15-m habitat for 14\u202fdays, with topside telemedical support and limited immediate specialist care. Peer-reviewed studies and official manuals were mapped to mission phases, occupational and operational risk events, expected actor actions, and feasible non-medical performance. No Delphi round or validation study was undertaken. Internal project documents only defined the scenario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The occupational health curriculum specification contains four domains, ten modules, and 28 observable learning outcomes. Emergency preparedness, physical self-maintenance, psychological and team functioning, and underwater operational safety are separated by immediate performance purpose. Together, the domains connect worker protection across routine prevention, acute response, psychosocial risk management, and task-specific safety. Three modules carry the psychological and team content. Sleep and circadian management, emotional self-regulation, and crew communication with conflict management are each specified on their own.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This article offers a preliminary occupational health curriculum for pre-deployment preparation that underwater habitat programs can adapt. It is evidence-informed and unvalidated. The framework addresses worker protection within a bounded underwater workplace while preserving the authority of diving, clinical, and mission-governance systems. Independent stakeholder review, instructor usability testing, pilot training, and analog-mission observation remain necessary before the framework informs any operational readiness decision.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1962851","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:33:28Z","timestamp":1790314408000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["An evidence-informed occupational health curriculum for pre-deployment preparation of aquanauts in underwater habitats: a scenario-based framework development study"],"prefix":"10.3389","volume":"14","author":[{"given":"Inho","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital","place":["Cheonan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jisuk","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital","place":["Cheonan, Republic of Korea"]},{"name":"Department of Occupational and Environmental Medicine, Chungbuk National University Hospital","place":["Cheongju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongwoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Seoul Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeon-Ah","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Soonchunhyang University Cheonan Hospital","place":["Cheonan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Sun","family":"Min","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital","place":["Cheonan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee-Dong","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital","place":["Cheonan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Jun","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Ajou University Medical Center","place":["Suwon, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gi Woon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital","place":["Bucheon, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwa-Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Soonchunhyang University Cheonan Hospital","place":["Cheonan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"289","DOI":"10.30773\/pi.2024.0335","article-title":"Development of aquanaut selection procedures: establishing psychological evaluation criteria and processes for underwater space inhabitants","volume":"23","author":"Lee","year":"2026","journal-title":"Psychiatry Investig"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"610000","DOI":"10.3389\/fphys.2020.610000","article-title":"Human adaptations to multiday saturation on NASA NEEMO","volume":"11","author":"Koutnik","year":"2021","journal-title":"Front Physiol"},{"key":"ref3","volume-title":"The NEEMO Project: a Report on How NASA Utilizes the Aquarius Undersea Habitat as an Analog for Long-Duration Space Flight","author":"Todd","year":"2003"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1152\/japplphysiol.00928.2015","article-title":"Effects of isolation and confinement on humans\u2014implications for manned space explorations","volume":"120","author":"Pagel","year":"2016","journal-title":"J Appl Physiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.neubiorev.2021.03.032","article-title":"Psychosocial issues in isolated and confined extreme environments","volume":"126","author":"Palinkas","year":"2021","journal-title":"Neurosci Biobehav Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1705","DOI":"10.1002\/cphy.c140018","article-title":"Human physiology in an aquatic environment","volume":"5","author":"Pendergast","year":"2015","journal-title":"Compr Physiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1136\/pgmj.2007.066472","article-title":"Human physiology in extreme environments: lessons from life at the limits?","volume":"84","author":"Grocott","year":"2008","journal-title":"Postgrad Med J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.28920\/dhm54.1.suppl.1-53","article-title":"Decompression illness: a comprehensive overview","volume":"54","author":"Mitchell","year":"2024","journal-title":"Diving Hyperb Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"685","DOI":"10.22462\/10.12.2019.14","article-title":"Hyperbaric treatment for decompression sickness: current recommendations","volume":"46","author":"Moon","year":"2019","journal-title":"Undersea Hyperb Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3389\/fpsyg.2019.00811","article-title":"What we know about team dynamics for long-distance space missions: a systematic review of analog research","volume":"10","author":"Bell","year":"2019","journal-title":"Front Psychol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.reach.2017.03.002","article-title":"Selecting astronauts for long-duration exploration missions: considerations for team performance and functioning","volume":"5","author":"Blackwell Landon","year":"2017","journal-title":"REACH"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1037\/amp0000260","article-title":"Teamwork and collaboration in long-duration space missions: going to extremes","volume":"73","author":"Landon","year":"2018","journal-title":"Am Psychol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1016\/S1474-4422(14)70122-X","article-title":"Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after spaceflight: an observational study","volume":"13","author":"Barger","year":"2014","journal-title":"Lancet Neurol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/0094-5765(92)90191-K","article-title":"Psychological training of German science astronauts","volume":"27","author":"Manzey","year":"1992","journal-title":"Acta Astronaut"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/0094-5765(95)98736-S","article-title":"Psychological countermeasures for extended manned spaceflights","volume":"35","author":"Manzey","year":"1995","journal-title":"Acta Astronaut"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.lssr.2020.12.002","article-title":"A review of astronaut mental health in manned missions: potential interventions for cognitive and mental health challenges","volume":"28","author":"Oluwafemi","year":"2021","journal-title":"Life Sci Space Res"},{"key":"ref17","volume-title":"Consolidated Telemedicine Implementation Guide","year":"2022"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"S337","DOI":"10.1161\/CIR.0000000000000918","article-title":"Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"142","author":"Merchant","year":"2020","journal-title":"Circulation"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"S15","DOI":"10.15441\/ceem.21.024","article-title":"2020 Korean guidelines for cardiopulmonary resuscitation. Part 3. Adult basic life support","volume":"8","author":"Song","year":"2021","journal-title":"Clin Exp Emerg Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"S116","DOI":"10.15441\/ceem.21.029","article-title":"2020 Korean guidelines for cardiopulmonary resuscitation. Part 9. Education and system implementation for enhanced chain of survival","volume":"8","author":"Lee","year":"2021","journal-title":"Clin Exp Emerg Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"45","DOI":"10.28920\/dhm48.1.45-55","article-title":"Pre-hospital management of decompression illness: expert review of key principles and controversies","volume":"48","author":"Mitchell","year":"2018","journal-title":"Diving Hyperb Med"},{"key":"ref22","first-page":"189","article-title":"Telemedicine in the management of diving accidents: correlation of phone-assessed symptom severity with clinical findings","volume":"41","author":"W\u00f6lfel","year":"2011","journal-title":"Diving Hyperb Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1017\/dmp.2014.1","article-title":"Confined space medicine and the medical management of complex rescues: a case series","volume":"8","author":"Petinaux","year":"2014","journal-title":"Disaster Med Public Health Prep"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"765197","DOI":"10.3389\/fpubh.2021.765197","article-title":"A work environment under pressure: psychosocial job demands and resources among saturation divers","volume":"10","author":"Romsbotn","year":"2022","journal-title":"Front Public Health"},{"key":"ref25","volume-title":"NOAA Diving Standards and Safety Manual","year":"2023"},{"key":"ref26","volume-title":"U.S. Navy Diving Manual, Revision 7","year":"2016"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1093\/milmed\/usae058","article-title":"An approach to reduce the incidence of submarine medical evacuations by identifying individual risk characteristics: preliminary findings","volume":"189","author":"Hughes","year":"2024","journal-title":"Mil Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e1675","DOI":"10.7205\/MILMED-D-16-00269","article-title":"Embedded mental health: promotion of psychological hygiene within a submarine squadron","volume":"182","author":"Rapley","year":"2017","journal-title":"Mil Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e029954","DOI":"10.1136\/bmjopen-2019-029954","article-title":"Guidance on how to develop complex interventions to improve health and healthcare","volume":"9","author":"O\u2019Cathain","year":"2019","journal-title":"BMJ Open"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"g1687","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1080\/1364557032000119616","article-title":"Scoping studies: towards a methodological framework","volume":"8","author":"Arksey","year":"2005","journal-title":"Int J Soc Res Methodol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the insomnia severity index as an outcome measure for insomnia research","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1111\/scs.12131","article-title":"Korean versions of the perceived stress scale (PSS-14, 10 and 4): psychometric evaluation in patients with chronic disease","volume":"29","author":"Lee","year":"2015","journal-title":"Scand J Caring Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.comppsych.2007.08.006","article-title":"Validation of the patient health Questionnaire-9 Korean version in the elderly population: the Ansan geriatric study","volume":"49","author":"Han","year":"2008","journal-title":"Compr Psychiatry"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"127","DOI":"10.3389\/fpsyt.2019.00127","article-title":"The psychometric properties and clinical utility of the Korean version of GAD-7 and GAD-2","volume":"10","author":"Ahn","year":"2019","journal-title":"Front Psych"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"210","DOI":"10.3988\/jcn.2014.10.3.210","article-title":"Validation of a Korean version of the insomnia severity index","volume":"10","author":"Cho","year":"2014","journal-title":"J Clin Neurol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1093\/jn\/135.3.437","article-title":"The nutritional status of astronauts is altered after long-term space flight aboard the international Space Station","volume":"135","author":"Smith","year":"2005","journal-title":"J Nutr"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1002\/jbmr.1647","article-title":"Benefits for bone from resistance exercise and nutrition in long-duration spaceflight: evidence from biochemistry and densitometry","volume":"27","author":"Smith","year":"2012","journal-title":"J Bone Miner Res"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.sleh.2015.10.004","article-title":"National Sleep Foundation\u2019s updated sleep duration recommendations: final report","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.smrv.2015.08.009","article-title":"The effects of light therapy on sleep problems: a systematic review and meta-analysis","volume":"29","author":"van Maanen","year":"2016","journal-title":"Sleep Med Rev"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"191","DOI":"10.7326\/M14-2841","article-title":"Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis","volume":"163","author":"Trauer","year":"2015","journal-title":"Ann Intern Med"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.smrv.2015.10.004","article-title":"Efficacy of internet-delivered cognitive-behavioral therapy for insomnia: a systematic review and meta-analysis of randomized controlled trials","volume":"30","author":"Zachariae","year":"2016","journal-title":"Sleep Med Rev"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1001\/jamainternmed.2013.13018","article-title":"Meditation programs for psychological stress and well-being: a systematic review and meta-analysis","volume":"174","author":"Goyal","year":"2014","journal-title":"JAMA Intern Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/j.jpsychores.2015.03.009","article-title":"Mindfulness-based stress reduction for healthy individuals: a meta-analysis","volume":"78","author":"Khoury","year":"2015","journal-title":"J Psychosom Res"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.2196\/jmir.5774","article-title":"The benefit of web- and computer-based interventions for stress: a systematic review and meta-analysis","volume":"19","author":"Heber","year":"2017","journal-title":"J Med Internet Res"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1136\/oemed-2015-103269","article-title":"Self-guided internet-based and mobile-based stress management for employees: results of a randomised controlled trial","volume":"73","author":"Ebert","year":"2016","journal-title":"Occup Environ Med"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e66626","DOI":"10.2196\/66626","article-title":"Supporting the mind in space: psychological tools for long-duration missions","volume":"13","author":"Pagnini","year":"2024","journal-title":"Interact J Med Res"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e58803","DOI":"10.2196\/58803","article-title":"Automated psychotherapy in a spaceflight environment: advantages, drawbacks, and unknowns","volume":"13","author":"Smith","year":"2024","journal-title":"Interact J Med Res"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1962851\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:33:30Z","timestamp":1790314410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1962851\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":54,"alternative-id":["10.3389\/fpubh.2026.1962851"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1962851","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"1962851"}}