Readiness to Accept Genetic Testing for Personalized Medicine: Survey Findings on the Role of Socio-Demographic Characteristics, Health Vulnerabilities, Perceived Genetic Risk and Personality Factors.

Studies from various countries have shown that majorities would accept genetic testing for personalization of treatment, but little is known about differences among population subgroups. The present study investigated whether readiness to accept a hypothetical cost-free offer of genetic testing to personalize treatment depends on socio-demographic characteristics, health-related vulnerabilities, personal dispositions, and prior awareness about personalized medicine. The study was based on a cross-sectional survey design. Out of a representative initial sample of 50-80-year-old Danish citizens (n = 15,072), n = 6807 returned a fully answered web-based questionnaire. Socio-demographic data were added from a national registry. Data were analyzed by multivariable logistic regression. A large majority of respondents (78.3%) expressed their readiness to be tested. Rates were higher in men, younger persons, and those with higher income. Additionally, ex-smokers and obese persons as well as those less satisfied with their health and respondents who perceived a personal genetic risk were more interested, as were those with higher internal health control, higher extraversion, higher emotional stability, and those who had not heard about this option before. Further research should investigate the specific concerns among population subgroups which need being addressed by systematic communication efforts in a clinical but also a broader public health context.

Reasons for participation and non-participation in colorectal cancer screening.

OBJECTIVES: The aim of the present analysis is to identify the reasons for accepting or rejecting the invitation to be screened by the Faecal Immunochemical Test as part of the free Danish screening programme for colorectal cancer (CRC). STUDY DESIGN: A cross-sectional representative survey of 15,072 Danish citizens aged 50-80 years was collected in 2019 via a Web-based questionnaire administered by Statistics Denmark. Among the net sample of 6807 respondents (45%), 177 were excluded because of current treatment for colorectal disease. METHODS: To determine the reasons for accepting or refusing the invitation to be screened for CRC, a latent class analysis was conducted, which allowed participants to provide several reasons for acceptance or rejection of screening. RESULTS: The most important reason for participating in CRC screening was the active public programme. A further reason for participation was the perceived risk for CRC, mainly in combination with the public programme. The reasons for participation did not differ between individuals who had participated and those who intended to participate when offered. Among participants who declined screening, the most frequent reasons were that they forgot to participate or that they were concerned about the unpleasant test procedure. Among individuals who intended to decline screening, a perceived low risk for CRC was the most frequently cited reason. CONCLUSIONS: Recommendation from a general practitioner (GP) was not given as a frequent reason for CRC screening participation which is discussed as a challenge to participation rates in population based screening program The main reasons reported for non-participation in CRC screening (i.e. forgot to participate or the unpleasant test procedure) might be addressed by a stronger endorsement from GPs.

Policymakers' Research Capacities, Engagement, and Use of Research in Public Health Policymaking.

The use of research in public health policymaking is one of the prerequisites for successfully implemented health policies which have better population health as an outcome. This policy process is influenced by the actors involved under the policy umbrella, with inter-related contextual factors and specific structural and institutional circumstances. Our study investigates how policymakers' research capacities influence the use of research in the health policy process and identify areas where capacity-building interventions give the most meaning and impact. Furthermore, we investigate policymakers' research engagement and use this to inform public health policy in the public sector in Denmark. We collect and report data using Seeking, Engaging with, and Evaluation Research (SEER) methodology. Policymakers are reported to have research capacity, but it is questionable how those competences have actually been used in policymaking. Decision-makers were often not aware or did not know about the existing organizational tools and systems for research engagement and use and two third of respondents had not been part of any research activities or had any collaboration with researchers. Overall, research use in public health policymaking and evaluation was limited. As a conclusion, we propose that capacity-building interventions for increasing research use and collaboration in EIPM should be context-oriented, measurable, and sustainable in developing individual and organizational competences.

Willingness to Use Digital Health Tools in Patient Care Among Health Care Professionals and Students at a University Hospital in Saudi Arabia: Quantitative Cross-sectional Survey.

BACKGROUND: The adoption rate of digital health in the health care sector is low in many countries. A facilitating factor for successful implementation and adoption of digital health is acceptance by current and future health care professionals. OBJECTIVE: This study was conducted to identify factors associated with willingness to use digital health tools in patient care among health care professionals and students. METHODS: This was a quantitative cross-sectional survey study conducted among health care professionals and students at a university hospital in Riyadh, Saudi Arabia. A nonprobability convenience sampling procedure was used to recruit participants. Data were collected using a self-completed e-questionnaire that was distributed by email. Chi-square tests, t tests, and logistic regression were used to analyze the data. RESULTS: We found that 181 out of 218 health care professionals (83.0%; 75.6% [59/78] physicians; 87.1% [122/140] nurses) and 115 out of 154 students (74.7%; 80.0% [76/95] medical students and 66.1% [39/59] nursing students) were willing to use digital tools in patient care. Willingness to use digital tools was significantly associated with attitude (Adjusted Odds Ratios [AOR] 1.96; 95% CI 1.14-3.36) and self-efficacy (AOR 1.64; 95% CI 1.17-2.30) among health care professionals, and with current year of study (AOR 2.08; 95% CI 1.18-3.68) and self-efficacy (AOR 1.77; 95% CI 1.17-2.69) among students. No significant difference in willingness to use digital tools was found between physicians and nurses (P=.113), and between medical and nursing students (P=.079). CONCLUSIONS: The findings of this study should encourage policy makers and hospital managers to implement relevant eHealth interventions within routine health care systems in Saudi Arabia. For successful implementation, digital health education programs should be implemented simultaneously, so that current and future health care professionals are able to develop required positive attitudes as well as practical skills and competencies.

To do or not to do - a survey study on factors associated with participating in the Danish screening program for colorectal cancer.

BACKGROUND: Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. METHODS: We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50-80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. RESULTS: Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. CONCLUSION: The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

Do student social background and school context affect implementation of a school-based physical activity program?

This study examined the relationship between student- and school- characteristics and different implementation parameters of "Active All Year Round", a nationwide Danish school-based physical activity program. The study is based on data from multiple sources: questionnaire data from students from 16 fifth-grade school classes (n = 276) and their teachers (n = 16), in-class observations (n = 15) and register data. Predictors included the student-level characteristics of gender, family affluence, immigration background, and perception of school connectedness as well as the school-level characteristics of school size, school parental education level, school physical activity policy and school's prioritization of health promotion. Implementation was assessed by creating an implementation score from data on program psychological reach, dose delivered, dose received and fidelity. Data were analyzed by multilevel linear regression analysis. Findings indicated that the program was more easily implemented for students with higher school connectedness. To conclude, school-based health promotion programs can be improved by knowing, before the program is implemented, which factors increase the odds of better implementation.

Implementation of interventions targeting the uptake of genetic testing services for breast cancer risk: protocol for a systematic review.

INTRODUCTION: The timely identification of breast cancer-related pathogenic variants can help to identify the risk of potential disease development and determine healthcare choices. However, the uptake rate of genetic testing services for breast cancer risk remains low in many countries. Interventions targeting the uptake of these services among individuals potentially at risk for inherited breast cancer are often complex and have multiple components, and are therefore difficult to implement, replicate and disseminate to new contexts. Our aim is to systematically review studies targeting the uptake of genetic testing services for breast cancer risk and critically assess the quality of implementation outcomes and the reporting of intervention descriptions. METHODS AND ANALYSIS: PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and all Campbell Coordinating Group databases will be searched for intervention studies that target individuals' participation in breast cancer genetic testing programmes. Papers published in English within the time period from January 2005 until October 2019 will be considered for inclusion. Titles, abstracts and full papers will be screened for eligibility by two pairs of reviewers independently. For data analysis and synthesis, study-level and intervention-level characteristics will be abstracted. We will present all implementation outcomes that are mentioned in each of the studies and register the number of studies that do not at all look at or report implementation outcomes. The quality of implementation will be checked using a 5-point rubric item, and the quality and completeness of reporting of intervention description will be evaluated using the 12-item Template for Intervention Description and Replication (TIDieR). ETHICS AND DISSEMINATION: Ethical approval is not required to conduct this review. Review findings will be disseminated to academic and non-specialist audiences via peer-reviewed academic journals and presented at appropriate conferences, workshops and meetings to policymakers, practitioners and organisations that work with our population of interest. PROSPERO REGISTRATION NUMBER: CRD42018105732.

Is physical and psychological work stress associated with fatigue in Danish ferry ship employees?

BACKGROUND: Fatigue is a recognised risk factor for safety in seafaring. While always dangerous, fatigue in ferry shipping is especially hazardous as it may jeopardise passengers' safety. To counteract fatigue, knowledge on its determinants is important. Little, however, is known on the influence from physical and psychosocial work environment factors within ferry shipping. The aim of the study was to investigate the association between work stress in terms of physical stressors, perceived job demands and job control and different dimensions of fatigue among ferry ship employees and to test whether a potential effect of work stress was mediated by sleep satisfaction. MATERIALS AND METHODS: The design was cross-sectional. 193 respondents answered to a self-administered questionnaire including standardised scales, i.e. the Swedish Occupational Fatigue Inventory and the Copenhagen Psychosocial Questionnaire for job demands and control. The association of risk factors with fatigue was determined using hierarchical multiple linear regression analyses. RESULTS: Physical work stressors were positively associated with only one of five fatigue subscales: lack of energy. Higher levels of demands were related to more lack of energy, lack of motivation, physical exertion and sleepiness, while more control was related to lesser lack of energy, lack of motivation and sleepiness. No demand-control interaction was found. Effects of demand and control were partly mediated by sleep satisfaction. CONCLUSIONS: Although limited by its cross-sectional design this study provides support for the independent relevance of demands and control for employee fatigue in ferry shipping and for a mediating role of sleep satisfaction.

Fatigue in ferry shipping employees: the role of work-family conflict and supervisor support.

BACKGROUND: Fatigue is a concern in ferry shipping as it has a negative impact on crew members health and plays a major role in marine incidents and accidents. Research within land-based occupational settings has found that work-family conflict is an important risk factor for fatigue and that support from leaders constitutes a possible resource with the potential to buffer a negative impact from work-family conflict. Though, the working conditions of ferry shipping are likely to interfere with employee's family life those two factors have received little attention in research on seafarers' health. Therefore, the aim of this study was to investigate the direct associations between work-family conflict as well as leaders' support with fatigue in employees of the Danish ferry shipping industry. Further, the study aimed at testing whether support could buffer potential detrimental associations between work-family conflict and fatigue. METHODS: The study design was cross-sectional, and 193 respondents answered to a self-administered questionnaire. Fatigue was measured with the Swedish Occupational Fatigue Inventory. Perceived work-family conflict and perceived supervisor support were assessed with two subscales from the Copenhagen Psychosocial Questionnaire. The association of potential risk factors with fatigue was determined using hierarchical multiple linear regression analyses. RESULTS: After controlling for confounding, work-family conflict was found to be positively associated with four of the five subdimensions of fatigue; lack of energy, physical discomfort, lack of motivation and sleepiness, while more support from supervisors was related to less lack of energy, physical exhaustion and lack of motivation. Further, supervisor support was found to moderate the effect from work-family conflict on the physical subdimensions of fatigue. CONCLUSION: Although restricted by its cross-sectional design and a limited sample, this study provides support for the independent relevance of work family conflict and support from nearest superior for employee fatigue in ferry shipping. Further, there was evidence for a moderating role of such support on the negative impact of work-family conflict on the physical aspects of fatigue. Shipping companies may consider commencing initiatives which reduce conflicts between family life and work obligations, and that leader support may be a relevant component in such initiatives.

Program Reach and Implementation Feasibility of a Physical Activity School Health Program: A Qualitative Study of Teachers' Perception.

BACKGROUND: The reasons for the mixed evidence of the effectiveness of school-based physical activity programs can be many, including implementation challenges. Studying program implementation can potentially contribute to enhancing effectiveness, the design of future interventions, improved implementation, and the interpretation of outcomes. METHODS: For this process evaluation, individual interviews were conducted with 16 teachers who had implemented the program "Active All Year Round" in a fifth-grade school class (students aged 9-11 y) in 2017. Through systematic text condensation feasibility and barriers of program implementation, perceived program reach and the programs' influence on social cohesion were identified and discussed. RESULTS: Teachers described the program as very feasible to implement and identified very few implementation barriers, the most prominent being time constrains. Perceived program reach was very high, and teachers reported that those students who are less confident when it comes to physical activity did not have differential participation than those feeling more confident about physical activity. Finally, the program was perceived to positively affect social cohesion in class. CONCLUSIONS: Active All Year Round is a standardized, flexible, and easily implemented program in Danish schools. Future studies are needed to study implementation from a student's perspective and/or students' role in and experiences with competition-based health programs.

Can the Easter break induce a long-term break of exercise routines? An analysis of Danish gym data using a regression discontinuity design.

OBJECTIVES: Many sedentary individuals are aware of the health benefits of regular physical activity and start becoming more physically active. Yet, despite good intentions, many struggle to keep up initial exercise levels and experience a decline in exercise frequency. A possible explanation is that it is hard to establish habits or routines, and that such routines-once established-might be easy to break. In this paper, we analyse whether a break in habitual/routine behaviour-induced by the Easter holidays-results in individuals exercising less after the break. METHODS: The study included a sample of 1210 members of a Danish chain of fitness centres who were gym members at least since the preceding New Year's Day. Participants granted access to gym attendance data, which were automatically recorded when entering the gym. We use a regression discontinuity design encompassing a time period of 10 weeks prior to and 10 weeks after Easter. RESULTS: We found a significant and relevant discretionary drop in exercise frequency right after the Easter holidays of 0.24 times per week (p=0.001) corresponding to a fall of 12.25% compared with the week prior to the Easter holidays. The effect was especially profound for individuals below retirement age and for individuals who had attended the gym with a higher frequency (twice a week or more) in the 6 weeks prior to the Easter break. DISCUSSION: This information is potentially relevant for helping individuals maintain an exercise habit. Motivational support should focus on the time period after normative breaks, such as Easter or other holidays.

Who perceives a higher personal risk of developing type 2 diabetes? A cross-sectional study on associations between personality traits, health-related behaviours and perceptions of susceptibility among university students in Denmark.

BACKGROUND: Type 2 diabetes (T2D) is on the rise among young adults (aged 20-39 years). A challenge for health risk communication is that young adults may not be aware or lack acknowledgement of their personal risk of developing T2D. To date, no knowledge is available on potential relationships between personality traits and T2D risk perception in this target group. This cross-sectional study aimed to investigate direct and indirect (mediated via health-related behaviours and body mass index) associations between the Five-Factor Model personality traits and T2D risk perception among university students in Denmark. METHODS: Participants included 1205 students (80% females; mean age = 25) from five major universities. All variables were assessed by means of self-report in an online questionnaire. Health-related behaviours included physical activity, sweets consumption and prior T2D screening. Covariates included socio-demographic factors and family history of T2D. RESULTS: A hierarchical multiple regression analysis revealed that higher levels of conscientiousness and emotional stability were directly negatively associated with T2D risk perception after controlling for covariates, health-related behaviours, and body mass index. Binary logistic regression analyses showed several significant associations between personality traits and health-related behaviours as well as body mass index. Sobel tests indicated that both physical activity and body mass index partially mediated the association between conscientiousness and T2D risk perception. The association between extraversion and T2D risk perception was fully mediated by PA. CONCLUSIONS: We present novel evidence suggesting that personality traits, health-related behaviours and body mass index are associated with T2D risk perception among young adults. Thus, it may be beneficial to tailor health risk communications targeting T2D to match recipients' personality characteristics instead of using the one size fits all approach.

Barriers to lifestyle changes for prevention of cardiovascular disease - a survey among 40-60-year old Danes.

BACKGROUND: Elimination of modifiable risk factors including unhealthy lifestyle has the potential for prevention of 80% of cardiovascular disease cases. The present study focuses on disclosing barriers for maintaining specific lifestyle changes by exploring associations between perceiving these barriers and various sociodemographic and health-related characteristics. METHODS: Data were collected through a web-based questionnaire survey and included 962 respondents who initially accepted treatment for a hypothetical cardiovascular risk, and who subsequently stated that they preferred lifestyle changes to medication. Logistic regression was used to analyse associations between barriers to lifestyle changes and relevant covariates. RESULTS: A total of 45% of respondents were identified with at least one barrier to introducing 30 min extra exercise daily, 30% of respondents reported at least one barrier to dietary change, and among smokers at least one barrier to smoking cessation was reported by 62% of the respondents. The perception of specific barriers to lifestyle change depended on sociodemographic and health-related characteristics. CONCLUSION: We observed a considerable heterogeneity between different social groups in the population regarding a number of barriers to lifestyle change. Our study demonstrates that social inequality exists in the ability to take appropriate preventive measures through lifestyle changes to stay healthy. This finding underlines the challenge of social inequality even in populations with equal and cost-free access to health care. Our study suggests supplementing traditional public campaigns to counter cardiovascular disease by using individualized and targeted initiatives.

Determinants of preferences for lifestyle changes versus medication and beliefs in ability to maintain lifestyle changes. A population-based survey.

Preferences for medication treatment versus lifestyle changes are of major importance in the management of chronic diseases. This study aims to investigate determinants of preference for lifestyle changes versus medication for prevention of cardiovascular disease as well as determinants of respondents' beliefs in their ability to maintain lifestyle changes. A representative sample of 40-60-year old Danish inhabitants was in 2012 invited to a survey and were asked to imagine that they had been diagnosed as being at increased risk of heart disease. Subsequently they were presented with a choice between a preventive medical intervention versus lifestyle change. The study population for the present paper comprises 1069 participants. A total of 962 participants preferred lifestyle changes to medication treatment. Significant determinants for preferring lifestyle changes were female gender and high level of physical activity. Significant determinants for not opting for lifestyle changes were being self-employed, poor self-rated health and smoking. Low educational attainment, lifestyle risk factors, self-reported health-related challenges and prior experience with heart disease were associated with a low belief in ability to maintain lifestyle changes. For conclusion we found a pervasive preference for lifestyle changes over medical treatment when individuals were promised the same benefits. Lifestyle risk factors and socioeconomic characteristics were associated with preference for lifestyle changes as well as belief in ability to maintain lifestyle changes. For health professionals risk communication should not only focus on patient preferences but also on patients' beliefs in their own ability to initiate lifestyle changes and possible barriers against maintaining changes.

Determinants of seafarers' fatigue: a systematic review and quality assessment.

PURPOSE: Fatigue 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. METHODS: Systematic 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. RESULTS: Most 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. CONCLUSIONS: Realistic 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.

Prevalence and correlates of psychological distress symptoms among patients with substance use disorders in drug rehabilitation centers in urban Nepal: a cross-sectional study.

BACKGROUND: The burden of substance misuse in developing countries is large and increasing, with negative consequences for physical and psychological health. Substance use disorders and psychological distress commonly co-exist, however few studies have examined this relationship in developing countries, including Nepal. Our aim was to investigate the prevalence of psychological distress symptoms and associated factors among patients with substance use disorders attending drug rehabilitation centers in Nepal. METHODS: We conducted a cross-sectional study including 180 patients attending drug rehabilitation centers in the Kathmandu Valley region of Nepal. We used the 6-item Kessler scale (K6) to measure symptoms of psychological distress, and data on socio-demographics, behavioral and psychosocial factors. Multivariable analyses were used to identify factors associated with distress. RESULTS: The prevalence of high psychological distress symptoms among patients with substance use disorder was 51.1 %. The mean score found on the K6 was 12.22 (SD = 5.87). Outcomes of multivariable analyses demonstrated various factors associated with symptoms of psychological distress, including age (ß = -0.122, 95 % CI = -0.218; -0.026), education (ß =2.694, 95 % CI = 0.274; 5.115), severity of drug abuse (Drug Abuse Screening Test-10-DAST10)(ß = 0.262, 95 % CI = 0.022;0.502), and family functioning (Adaptability, Partnership, Growth, Affection and Resolve-APGAR) (ß = -0.525, 95 % CI = -0.787; -0.264). CONCLUSIONS: High psychological distress symptoms are common in patients with substance use disorder in Nepal. Demographics (age, education), behavioral (drug abuse severity), and psychosocial factors (family functionality) were associated with psychological distress symptoms. If confirmed by future longitudinal studies such characteristics may assist in identifying groups at risk for co-morbid psychological distress symptoms among patients with substance use disorders. Future treatment approaches for substance use disorders should address co-existing mental illness in Nepal.

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 women's ability to negotiate condom use.

Stroke Risk Perception in Atrial Fibrillation Patients is not Associated with Clinical Stroke Risk.

BACKGROUND: Clinical risk stratification models, such as the CHA2DS2-VASc, are used to assess stroke risk in atrial fibrillation (AF) patients. No study has yet investigated whether and to which extent these patients have a realistic perception of their personal stroke risk. The purpose of this study was to investigate and describe the association between AF patients' stroke risk perception and clinical stroke risk. METHODS: In an observational cross-sectional study design, we surveyed 178 AF patients with a mean age of 70.6 years (SD 8.3) in stable anticoagulant treatment (65% treatment duration >12 months). Clinical stroke risk was scored through the CHA2DS2-VASc, and patients rated their perceived personal stroke risk on a 7-point Likert scale. RESULTS: There was no significant association between clinical stroke risk assessment and patients' stroke risk perception (rho = .025; P = .741). Approximately 60% of the high-risk patients had an unrealistic perception of their own stroke risk, and there was no significant increase in risk perception from those with a lower compared with a higher risk factor load (χ(2) = .010; P = .522). CONCLUSIONS: Considering possible negative implications in terms of lack of motivation for lifestyle behavior change and adequate adherence to the treatment and monitoring of vitamin K antagonist, the apparent underestimation of risk by large subgroups warrants attention and needs further investigation with regard to possible behavioral consequences.

What does it take to get a healthy diet at sea? A maritime study of the challenges of promoting a healthy lifestyle at the workplace at sea.

BACKGROUND AND AIM: Prevalence of obesity is high among Danish seafarers and appropriate health promotion interventions are required within the maritime setting. The aim of this study was to examine whether a training intervention for ship cooks could improve seafarers' diet on board and, in particular, to identify possible challenges in practice on board of vessels from 2 Danish shipping companies. MATERIALS AND METHODS: Interviews and participant observations were conducted during a 2-day cooking course. Interviews were repeated 1 year after (N:35) the course in order to assess self-perceived changes in preparing meals and ordering supplies, as well as perceived challenges in implementing changes and maintaining them. In addition, changes in self-reported eating behaviour before the cooking course and 1 year after were assessed based on a 1-year follow-up quantitative questionnaire survey (N:193). RESULTS: Participants reported positive opinions about the course and subsequent changes in promoting a nutritious and healthy diet at sea by way of health education. Also a significant change was found in these afarers' self-reported eating behaviour from T1 to T2. However several challenges were identified during the transfer and maintenance phase such as many cooks having received little or no prior training which limited their cooking abilities. Confined physical capacities on board, restricted space for storage and lack of proper equipment were other barriers and so were low frequency of supply options and high prices for fresh fruit and vegetables. CONCLUSIONS: To fully realise the benefits of the changes, these challenges related to the specific maritime workplace setting need to be acknowledged and addressed at management level.

A risky occupation? (Un)healthy lifestyle behaviors among Danish seafarers.

Sedentary working conditions, smoking, unhealthy eating habits and lack of exercise are some of the lifestyle risk factors that form a potentially growing problem for seafarers within certain parts of the maritime sector creating a heightened risk for chronic diseases such as diabetes and cardiovascular disease. Health promotion initiatives to combat this negative development requires as a first step identifying the magnitude of the different risk factors. A survey was conducted in 2007-08 with two Danish shipping companies on seafarers' health, wellbeing, diet, smoking and physical activity. In addition, a health profile was offered to the respondents, consisting of physiological measurements, such as fitness rating, body mass index (BMI), cholesterol measurement and blood pressure. The response rate in the questionnaire study was 57% (n = 360) of which 76% (n = 272) of the respondents received a health profile. Results (males) showed 44% daily smokers compared with 32% in the general Danish adult male population. Twenty-five percent of the seafarers were obese with a BMI > 30 compared with 12% of the Danish adult male population. Fifty-one percent of the respondents were defined as having metabolic syndrome, compared with 20% of the Danish adult male population. Seafaring is a risky occupation when looking at the seafarers' health and wellbeing. The results of this survey confirm the need for health promotion interventions such as smoking cessation courses, healthy cooking courses and physical exercise programs, etc. that can enable healthier lifestyle. The challenge will be to take into account the special seafaring conditions when implementing the interventions.