Anja Leppin

The relationship between parental socio-economic status and episodes of drunkenness among adolescents: findings from a cross-national survey

BackgroundBehavioral factors such as (excessive) alcohol consumption play a major role in the explanation of social inequalities in health. The unequal distribution of health risk behaviors among socio-economic groups has important consequences for both the current and future health status of the younger generation. However, little is known about socio-economic differences in unhealthy lifestyles during adolescence. The purpose of the present study is to investigate socio-economic differences in adolescent drinking behaviour among 11–15 year old adolescents in Europe and North America.MethodsData was obtained from the Health Behaviour in School-aged Children (HBSC) study 2001/02, a cross-national survey conducted in collaboration with the World Health Organization. The present analysis is based on 69249 male and 73619 female students from 28 countries. The effect of parental occupation and family affluence on episodes of drunkenness was assessed using separate logistic regression models controlling for age.ResultsSocio-economic circumstances of the family had only a limited effect on repeated drunkenness in adolescence. For girls only in one out of 28 countries a significant association between family affluence and repeated drunkenness was observed, while boys from low and/or medium affluent families in nine countries faced a lower risk of drunkenness than boys from more affluent families. Regarding parental occupation, significant differences in episodes of drunkenness were found in nine countries for boys and in six countries for girls. Compared to family affluence, which was positively related to risk of drunkenness, a decreasing occupational status predicted an increasing risk of drunkenness. This pattern was identified within a number of countries, most noticeably for boys.ConclusionParental socio-economic status is only of limited importance for episodes of drunkenness in early adolescence, and this very limited role seems to apply for girls more than for boys and for parental occupation more than family affluence. For future studies it might be important to look at the effects of socio-economic status within the context of other peer, family and school related factors in order to assess to what extent those factors might mediate the effects of social class background.

Risk Perceptions Related to SARS and Avian Influenza: Theoretical Foundations of Current Empirical Research

BackgroundThe outbreak of severe acute respiratory syndrome in 2003 and the subsequent emergence of the H5N1 virus have highlighted the threat of a global pandemic influenza outbreak. Planning effective public health control measures for such a case will be highly dependent on sound theory-based research on how people perceive the risks involved in such an event.PurposeThe present article aims to review theoretical models and concepts underlying current empirical research on pandemic influenza risk perception.MethodA review was conducted based on 28 empirical studies from 30 articles which were published between 2003 and 2007.ResultsConcepts of risk perception mostly seemed more pragmatic than theory-based and were highly heterogeneous, for instance, in terms of conceptualizing risk perception as an exclusively cognitive or as a cognitive and emotional phenomenon or whether the concept was dominated by expectancy or expectancy and value components. Similarly, the majority of studies investigating risk perceptions and protective behaviors were not model-based.ConclusionsThe current body of knowledge can only provide preliminary insights. Unlike the reviewed studies, which were mostly launched as a rapid response to outbreak situations, future research will have to invest more strongly into theoretical work to provide sounder evidence.

The influence of VKORC1 and CYP2C9 gene sequence variants on the stability of maintenance phase warfarin treatment.

INTRODUCTION A substantial part of the inter-individual variation in vitamin K-antagonist dose can be explained by certain sequence variants in the genes CYP2C9 (NG_008385.1:g.8633C>T or *1/*2, NG_008385.1:g.47639A>C or *1/*3) and VKORC1 (NG_011564.1:g.6399C>T). Patients possessing these variant alleles require lower doses and have increased risk of overanticoagulation. METHODS We investigated the influence of the above sequence variants on stability of maintenance phase warfarin therapy in a prospective study of 300 consecutive patients followed for one year at an anticoagulant clinic. RESULTS Patients having one VKORC1 variant allele (n=144) had a time in therapeutic range of INR (TTR) of 71.4%, significantly lower (p=0.02) than the 76.7% TTR of patients with none (n=96) or two (n=46) variant alleles. Patients carrying the CYP2C9 *3 allele (n=40) trended towards lower TTR than patients without this variant allele (69.8% vs. 74.7%, p=0.09). Six patients possessed two variant alleles of CYP2C9 (*2/*3 or *3/*3) and had significantly lower TTR (60.5% vs. 74.3%, p=0.012) and higher risk of an INR>4.5 (67% vs. 23%, p=0.03) compared with the remaining patients. CONCLUSIONS We observed modest effects of common gene sequence variants in CYP2C9 and VKORC1 on stability of maintenance phase warfarin therapy. Patients attending an anticoagulant clinic using computer-assisted dosage were safely monitored regardless of these sequence variants, but for the small subgroup of patients with the CYP2C9 genotype *2/*3 or *3/*3, treatment stability was reduced.

Knowledge, attitudes and practices related to avian influenza among poultry workers in Nepal: a cross-sectional study

BackgroundAvian influenza is a considerable threat to global public health. Prevention and control depend on awareness and protective behaviours of the general population as well as high risk-groups. This study aims to explore the knowledge, attitudes and practices related to avian influenza among poultry workers in Nepal.MethodsThe study was based on a cross-sectional study design, using a structured questionnaire administered in face-to-face interviews with 96 poultry workers age 15 and above from the Rupandehi district in Nepal.ResultsThe majority of respondents were male (80%), mean age was 35 (SD = 11.6). Nearly everybody was aware that AI cases had been detected in Nepal and that poultry workers were at risk for infection. The major sources of AI information were radio, TV and newspapers. Knowledge about preventive measures was high with regard to some behaviours (hand washing), but medium to low with regard to others (using cleaning and disinfecting procedures or protective clothing). Poultry workers who got their information from TV and newspapers and those who were more afraid of contracting AI had higher knowledge than those who did not. Being employed as compared to being an owner of a poultry farm as well as having a high level of knowledge was associated with practising more preventive behaviours. While on one hand many specific government control measures found a high degree of acceptance, a majority of study participants also thought that government control and compensation measures as a whole were insufficient.ConclusionsThe study provides information about knowledge and practices regarding avian influenza among poultry workers in Nepal. It highlights the importance of targeting lack of knowledge as well as structural-material barriers to successfully build preparedness for a major outbreak situation.

Genetic, Clinical and Behavioural Determinants of Vitamin K-Antagonist Dose – Explored Through Multivariable Modelling and Visualization

Vitamin K antagonists (VKA) are highly effective anticoagulants but their use is hampered by multiple interactions with food and medicine and a narrow therapeutic range. The large variation in dose requirements has led to the development of several dosing algorithms based on pharmacogenetic and clinical variables. In contrast, evidence about the influence of behavioural (i.e. diet and exercise) and socio-psychological factors is sparse. To investigate the impact of pharmacogenetic, clinical, behavioural and socio-psychological factors on maintenance dose of VKA. In a cross-sectional study, we interviewed 250 consecutive patients from an anticoagulant clinic and subsequently measured pharmacogenetic and anthropometric variables. Statistical analyses were carried out using linear regression and multivariable models with visualization features. In both types of analyses, the strongest determinants of VKA dose were polymorphisms in the VKORC1 and CYP2C9 genes and age. Half of the variation in VKA dose could be explained by a linear regression model including four variables, while a multivariable model with 20 pharmacogenetic and clinical variables explained 60%. A multivariable model including 94 predictor variables was not notably better regarding predictive performance, but visualization of this model offered information about the correlation structure between predictor variables. The strongest determinants of VKA dose are well-known pharmacogenetic variables and age. The variables describing health-related behaviour and socio-psychological factors are strongly inter-correlated and not useful in dosing algorithms.

Perceived stress predicts the stability of vitamin K-antagonist treatment of anticoagulant clinic patients

Perceived stress predicts the stability of vitamin K-antagonist treatment of anticoagulant clinic patients -

Health promotion in the Danish maritime setting: challenges and possibilities for changing lifestyle behavior and health among seafarers

BackgroundSeafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. This trend is partly due to a higher number of accidents but also higher incidence of lifestyle-related diseases like cardiovascular disease and lung cancer. In Denmark, the proportion of smokers as well as of overweight and obese persons is higher among seafarers compared to the general population. This high burden of risk indicates that this occupational group might be a growing challenge at sea in regard to safety and health issues and there is a need to further our understanding of the health promotion approaches that work.MethodsA single-group pre-post design was conducted in 2008–2009 in order to identify changes in lifestyle related behaviors and health risk factors among seafarers (N: 606) in two Danish shipping companies after implementing two structural health promotion interventions (healthy cooking courses for ship cooks and improvement of fitness facilities) as well as health education interventions (smoking cessation courses, individual exercise guidance and extra health check-ups) at the maritime workplace. Baseline and follow-up data were collected with a self-administrated standardized questionnaire and individual health profiling assessing parameters such as physical health and physical fitness. In addition, qualitative interviews with participants and non-participants were conducted in order to gain in-depth information on experiences with the intervention processes.ResultsSignificant changes were identified for levels of fitness, daily sugar intake and metabolic syndrome. However, these results were not associated with participating in the health educational interventions. One possible explanation for the improved fitness rate could be the upgrading of fitness equipment onboard the ships provided by the management level. The decrease in daily sugar intake and prevalence of seafarers with metabolic syndrome might be associated with the cooking course intervention which aimed at providing healthier daily meals on board.ConclusionThe findings suggest that a multicomponent health promotion intervention program has the potential to achieve change in seafarers’ health behavior and health parameters. In the future, studies with more rigorous designs, separately testing the contribution of different types of interventions are needed.

Determinants of seafarers’ fatigue: a systematic review and quality assessment

PurposeFatigue jeopardizes seafarer’s health and safety. Thus, knowledge on determinants of fatigue is of great importance to facilitate its prevention. However, a systematic analysis and quality assessment of all empirical evidence specifically for fatigue are still lacking. The aim of the present article was therefore to systematically detect, analyze and assess the quality of this evidence.MethodsSystematic searches in ten databases were performed. Searches considered articles published in scholarly journals from 1980 to April 15, 2016. Nineteen out of 98 eligible studies were included in the review. The main reason for exclusion was fatigue not being the outcome variable.ResultsMost evidence was available for work time-related factors suggesting that working nights was most fatiguing, that fatigue levels were higher toward the end of watch or shift, and that the 6-h on–6-h off watch system was the most fatiguing. Specific work demands and particularly the psychosocial work environment have received little attention, but preliminary evidence suggests that stress may be an important factor. A majority of 12 studies were evaluated as potentially having a high risk of bias.ConclusionsRealistic countermeasures ought to be established, e.g., in terms of shared or split night shifts. As internal as well as external validity of many study findings was limited, the range of factors investigated was insufficient and few studies investigated more complex interactions between different factors, knowledge derived from studies of high methodological quality investigating different factors, including psychosocial work environments, are needed to support future preventive programs.

Factors associated with condom use for HIV prevention among Nepalese labor migrant couples

Information about factors associated with condom use among Nepalese labor migrant couples that are considered being at high risk of HIV infection is not clearly understood. Therefore, we carried out a cross-sectional study to identify the factors associated with condom use among Nepalese labor migrant couples. A total of 266 wives of Nepalese labor migrants were invited for an interview. Hierarchical logistic regression analysis was performed to analyze data. We found that almost 39% of the women reported having used a condom while having sex with their husbands. Age was the only husband-related factor independently associated with condom use. School education, knowledge about HIV/AIDS, discussion of HIV with peers and sexual negotiation with the husband were the wife-related factors independently associated with condom use. Our findings highlight a clear need to develop effective HIV prevention interventions targeting illiterate labor migrant couples, with a particular emphasis on increasing womens ability to negotiate condom use.