Saliva continine levels of babies and mothers living with smoking fathers under different housing types in Hong Kong: a cross-sectional study

Paper Session 15 - The Challenge of Second-Hand Smoke: PA15-3BACKGROUND: After the Smoking Ordinance enacted in HK since 1/2007, shifting of smoking from outdoor to home was found, home becomes a major source of secondhand smoke (SHS) exposure of nonsmokers. OBJECTIVES: It aimed to assess the SHS exposure of babies and mothers living with smoking fathers of two housing types by using a biomarker. METHODS: Trios of smoking father, non-smoking mother and a baby under 18-months were recruited from Maternal and Child Health Centres (MCHCs) from 6/2008 to 10/2009. Consented couples completed the baseline survey including demographic data, fathers’ household smoking behaviors and mothers’ actions in protecting babies from household SHS exposure. Saliva samples from baby and mother were collected and then sent to the National University of Singapore for cotinine analyses. Log-transformations were used for the saliva cotinine due to skewed data. There were 2 housing types (public/private) and father was asked if they smoked at home (yes/no). MANOVA was used to compare the babies’ and mothers’ cotinine levels when fathers smoked at home under the 2 housing types. RESULTS: 1,158 trios were consented. 1,142 mothers’ and 1,058 babies’ samples were assayed. The mean age of the fathers and mothers was 35.5(±7.0) and 31.2(±4.9). The mean mothers’ cotinine level was 12.15ng/ml (±61.20) while babies’ was 2.38ng/ml (±6.01). 606 and 501 trios were living in public and private housing. Fathers’ smoked at home led to higher mothers’ and babies’ saliva cotininary (mean log of mothers’ cotininary: 0.14±0.62 vs. 0.05±0.55, p=0.06; babies: 0.16±0.38 vs. 0.07±0.34, p=0.003). Housing types influenced babies’ cotinine level (public: 0.17±0.37; private: 0.10±0.36, p=0.01). MANOVA showed that fathers smoked at home (Λ=0.99, p=0.01) and housing types (Λ=0.99, p=0.01) were positively related to the saliva cotinine levels. CONCLUSIONS: Father smoked at home and the housing types have greater impact on babies’ saliva cotininary, showing that they were highly exposed at home and in public housing environment. HK government should promote smoke-free homes and to provide more smoking cessation services to minimize the household SHS exposure to babiespublished_or_final_versio

Long-term sick leave and work rehabilitation - prognostic factors for return to work

The main objective of this thesis is to examine individual prognostic factors for return to work (RTW) after work rehabilitation, for workers on long-term sick leave with common musculoskeletal and mental health complaints. The process of returning to work after long-term sick leave may be complex, and is often influenced by other factors than health complaints and diagnoses alone. The primary hypothesis in this thesis was that individual’s cognitions about health and illness would be central for returning to work or not, after work rehabilitation. A second hypothesis was that socioeconomic status (SES) through education or occupation would predict RTW after work rehabilitation. A third hypothesis was that the process of returning to work would be complex and differ between subgroups of work rehabilitation participants. Cognitions, such as illness perceptions and fear avoidance beliefs may be a matter of beliefs about cure, control, and expectancies, thus of coping. Coping, as defined in the Cognitive activation theory of stress (CATS), was applied in this thesis. In the CATS, coping is defined as positive response outcome expectancies, in contrast to negative response outcome expectancies (hopelessness) or no response outcome expectancies (helplessness). In Norway, comprehensive inpatient work rehabilitation may be offered to individuals on long-term sick leave. Participants in inpatient work rehabilitation programs typically have sick leave diagnoses related to musculoskeletal and mental health complaints, often characterized by non-specific conditions, mostly subjective health complaints, with few objective medical findings. Individuals with subjective health complaints may believe that their complaints are harmful and may therefore try to avoid activities they believe will harm them, such as work. Experiencing distress and poor functional ability may lead to vicious circles of hopelessness and helplessness, i.e. poor coping. Maladaptive illness perceptions and fear avoidance beliefs about work may contribute to prolonged disability and time out of work. The aim of work rehabilitation is to alter such vicious circles through positive experiences and cognitive processes, and facilitate RTW. This is done by interdisciplinary assessments, education, physical activities, and cognitive behavior modifications offered in a combination of individual and group-based sessions. In addition, collaboration with external stakeholders, such as health care providers, the employer, or the local social insurance office (NAV-office) are important elements during work rehabilitation. In this thesis, individual prognostic factors for RTW after work rehabilitation were investigated in three different samples of work rehabilitation participants. Predictive information was extracted from questionnaires and patient journals while information of work and sick leave were measured by self-reports and official register data of The Norwegian labor and welfare administration (NAV). The primary and secondary hypotheses were investigated in the first paper, where the aim was to examine whether health complaints, illness perceptions, fear avoidance beliefs, coping, and education predicted non-working 3 and 12 months after participating in work rehabilitation, and to assess the relative importance and interrelationship of these factors. Logistic regression analysis was conducted. The results showed that fear avoidance beliefs for work were the most important predictor for non-working both at 3 months, and at 12 months follow-up after participating in work rehabilitation. A multiple regression analysis displayed that almost half of the variance in fear avoidance beliefs for work were explained by the amount of musculoskeletal and pseudoneurological health complaints, i.e. tiredness, sadness/depression, and anxiety, and by illness perceptions and education. For illness perceptions, the components concerning perceived duration, consequences, and personal control of the illness were the most important. Coping did not contribute to explain any variance in fear avoidance beliefs for work. In conclusion, high levels of fear avoidance beliefs for work were a strong predictor for non-working after work rehabilitation. However, the intervening mechanisms between fear avoidance beliefs and subsequent avoidance behavior, in terms of avoiding the workplace when sick, are still poorly understood. The primary and secondary hypotheses were investigated in the second paper, where the aim was to test if fear avoidance beliefs for work would mediate the relationships between musculoskeletal and pseudoneurological complaints, functional ability, level of education, and number of days on sickness benefits during 3-year follow-up after work rehabilitation. Structural equation modeling (SEM) was used to test a predefined mediation model for direct and indirect effects between the hypothesized predictors and days on sickness benefits during follow-up. As hypothesized, fear avoidance beliefs for work mediated the effect of musculoskeletal complaints and education on sick leave during follow-up. There was however, no direct effect of musculoskeletal complaints on fear avoidance beliefs, as this relationship was fully mediated by poor physical function, in terms of moving ability and lifting/carrying ability. Fear avoidance beliefs for work did not mediate the relationship between pseudoneurological complaints or mental function, in terms of coping/interaction ability and sick leave during follow-up. Pseudoneurological complaints had a small direct effect, and length of previous sick leave had a strong independent effect on days on sickness benefits after work rehabilitation. In conclusion, the mechanisms involved in the process of returning to work are complex and involve several intervening factors including health and functional ability, education, previous sick leave, and fear avoidance beliefs for work. The second and third hypotheses were investigated in the third paper. Here the aim was to examine if gender, age, diagnosis, occupation, and length of previous sick leave predicted differences in the process of returning to work, in terms of being at work or registered with sickness benefits, and transitions in and out of work and sickness benefits, during a 4-year follow-up after work rehabilitation. Proportional hazard regression analysis was used to explore the probabilities of being at work, or of receiving sickness benefits, or disability pension, and differences in the transitions between any of these states during follow-up. Regression models based on transition intensities detected differences in the risk factors of entering and leaving a given state. For example among women, the lower probability of being at work than men, could be explained by a lower probability of transitions to work, and not by a higher probability of leaving work. In addition, the probabilities of being at work, and of receiving sickness benefits, and disability pension differed between men and women, age groups, diagnostic category, type of work, and previous history of sick leave. Being a female, having diagnoses other that mental and musculoskeletal, having bluecollar work, and receiving long-term sick leave before entering work rehabilitation, increased the risk of not returning to work and of receiving disability pension during follow-up. The use of novel statistical methods made it possible to understand more of the different patterns in or out of work or of receiving sickness benefits, and how the prognosis differed between groups. The results from this thesis show that the process of returning to work after long-term sick leave and work rehabilitation depends on the interplay between multifaceted prognostic factors related to the history of previous sick leave, age, gender, SES, health, function, and cognitions in terms of illness perceptions and fear avoidance beliefs for work. These findings may have implications for selection criteria into work rehabilitation, for tailoring actions during a work rehabilitation program, and may guide follow-up actions aiming at RTW in collaboration with stakeholders outside the work rehabilitation clinic

Salutogenesis for thriving societies

Settings are defined by the World Health Organization (1998) as “the place or social context in which people engage in daily activities in which environmental, organizational, and personal factors interact to affect health and well-being.” Such settings range from small-scale home/family to (international) organizations and large cities and thus differ in size, in their degree of formalized organization and their relationships to society. The chapters in Part V review how salutogenesis has been applied to health promotion research and practice in a broad range of settings: organizations in general, schools, higher education, workplace, military settings, neighborhood/communities, cities, and restorative environments. The following synthesis demonstrates that applying salutogenesis to various settings and linking salutogenesis with other models established in these settings has the great potential to generate ideas on how to advance the general salutogenic model

The Handbook of Salutogenesis

This open access book is a thorough update and expansion of the 2017 edition of The Handbook of Salutogenesis, responding to the rapidly growing salutogenesis research and application arena. Revised and updated from the first edition are background and historical chapters that trace the development of the salutogenic model of health and flesh out the central concepts, most notably generalized resistance resources and the sense of coherence that differentiate salutogenesis from pathogenesis. From there, experts describe a range of real-world applications within and outside health contexts. Many new chapters emphasize intervention research findings. Readers will find numerous practical examples of how to implement salutogenesis to enhance the health and well-being of families, infants and young children, adolescents, unemployed young people, pre-retirement adults, and older people. A dedicated section addresses how salutogenesis helps tackle vulnerability, with chapters on at-risk children, migrants, prisoners, emergency workers, and disaster-stricken communities. Wide-ranging coverage includes new topics beyond health, like intergroup conflict, politics and policy-making, and architecture. The book also focuses on applying salutogenesis in birth and neonatal care clinics, hospitals and primary care, schools and universities, workplaces, and towns and cities. A special section focuses on developments in salutogenesis methods and theory. With its comprehensive coverage, The Handbook of Salutogenesis, 2nd Edition, is the standard reference for researchers, practitioners, and health policy-makers who wish to have a thorough grounding in the topic. It is also written to support post-graduate education courses and self-study in public health, nursing, psychology, medicine, and social sciences

Disconnection Notices: Networks and Power at the Intersection of Technology, Biology, and Finance

This dissertation argues that the concept of the network has brought together technology, economics, biology, and the social under a feigned logic of totality. This study examines the origins and everyday implications of this totalizing network discourse. When networks are taken to describe all relations, the connections and flows of the above four areas define all that exists. But we are not connected thanks to the material structure of new technological and social networks. Instead, we have been made to think of ourselves as connected through the naturalization of an ideology. That which does not connect properly is rendered an aberration from existence. This dissertation is comprised of two parts. The first part argues that the academic theorization of networks emphasizes materiality and nature in such a way as to assume there are no alternatives to networks. Connectivity and flow inevitably ground all possibilities for our contemporary moment, if not all eternity. This reading of networks is ahistorical. When the history of network discourse is acknowledged, it is clear that our understanding of networks has cultural origins that are centuries old. Networks, connectivity, and flow are contingent assumptions about reality, naturalized through technology and discourse. The second part examines how the naturalization of network ideology produces subjects that are compelled to manage connectivity and flow throughout the network as a whole. Connection management does not stop at the individual. Managing the self is equated to the management of the network--and the management of the entire network is impossible. Thus, individual human beings are rendered insignificant or dangerous to the management of connection and flow. The two case studies discussed in this part, which examine various forms of social networks, together present how the empowerment produced through connectivity becomes disempowerment when individuals must manage both their own personal connections and flows along with the connectivity and flow of the networked totality

Tackling complexity in biological systems: Multi-scale approaches to tuberculosis infection

Tuberculosis is an ancient disease responsible for more than a million deaths per year worldwide, whose complex infection cycle involves dynamical processes that take place at different spatial and temporal scales, from single pathogenic cells to entire hosts' populations. In this thesis we study TB disease at different levels of description from the perspective of complex systems sciences. On the one hand, we use complex networks theory for the analysis of cell interactomes of the causative agent of the disease: the bacillus Mycobacterium tuberculosis. Here, we analyze the gene regulatory network of the bacterium, as well as its network of protein interactions and the way in which it is transformed as a consequence of gene expression adaptation to disparate environments. On the other hand, at the level of human societies, we develop new models for the description of TB spreading on complex populations. First, we develop mathematical models aimed at addressing, from a conceptual perspective, the interplay between complexity of hosts' populations and certain dynamical traits characteristic of TB spreading, like long latency periods and syndemic associations with other diseases. On the other hand, we develop a novel data-driven model for TB spreading with the objective of providing faithful impact evaluations for novel TB vaccines of different types