title: Outcomes of seafarer work fitness qualifications in the Netherlands.
abstract: BACKGROUND
  Seafaring is a dangerous profession involving high fatality rates and little research has been done to identify conditions that may lead to failing the seafarer's medical qualification (SMQ).
  
  
  OBJECTIVE
  To determine the proportion of seafarers failing to pass the SMQ in the Netherlands during 2012, to analyse the outcomes of the SMQ according to qualification, age, duties and requirements of additional evaluations and to describe the reasons for considering a seafarer unfit for duty.
  
  
  METHODS
  A retrospective descriptive study of SMQs registered in the Netherlands Shipping Inspectorate database.
  
  
  RESULTS
  Less than 1% (46 cases; 0.6%) of the 7617 final SMQ candidates were considered unfit for duty with 53% (24) of these being temporarily unfit. Four per cent (276) of cases were classified 'fit with restrictions' and 1% (66) 'fit by exemption' (FEx). Re-examination was required in 2% (122) of cases. A second opinion from a medical referee was sought in 4% of cases. The highest rate of FEx was found in older seafarers (aged over 55) due to restrictions in hearing and vision in the majority (59%) of cases. The leading causes of unfitness were other medical reasons, mainly associated with cardiovascular conditions and morbid obesity, in 52% of cases and visual impairment in 34%.
  
  
  CONCLUSIONS
  The proportion of seafarers considered unfit in the SMQ carried out in the Netherlands in 2012 is relatively low. The proportion of FEx was higher in older groups, mainly due to hearing or visual impairments.
authors.affiliation: Mateu Orfila Teaching Unit in Occupational Medicine, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Zevallos
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: C T
authors.initials: CT
authors.lastname: Hulshof
authors.affiliation: Netherlands Shipping Inspectorate, The Hague, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Mutsaerts
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, j.sluiter@amc.uva.nl.
authors.forename: J K
authors.initials: JK
authors.lastname: Sluiter
mesh_terms: D000062:Accidents, Occupational / Q000401:mortality / Q000517:prevention & control; D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D006262:Health; D006304:Health Status; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009326:Naval Medicine; D009426:Netherlands / Q000453:epidemiology; D009767:Obesity, Morbid / Q000453:epidemiology; D009790:Occupations; D010809:Physical Fitness; D012189:Retrospective Studies; D012767:Ships; D014786:Vision Disorders / Q000453:epidemiology; D055815:Young Adult
keywords: Fit for work; medical examinations; seafarer.