Adolescents in high-risk trajectory: clustering of risky behavior and the origins of socioeconomic health differentials.

BACKGROUND: We have evaluated high-risk behavior of adolescents 12 to 17 years of age on the basis of seven binomial psychosocial variables in order to assess whether there is a tendency of these variables to cluster in the same individuals and to identify socioeconomic covariates of risky behavior. METHODS: Study participants were 547 adolescents from four high schools in Greece: two in rural areas, one in an upper-medium socioeconomic class areas, and one in a low-to-medium socioeconomic class area of Athens. Clustering was assessed by evaluating concordance of high-risk attributes examined in pairs, and was expressed as a series of odds ratios (ORs) as well as by factor analysis. RESULTS: All but one OR were higher than the null value, but they were particularly high with respect to smoking and nonuse of safety belts (OR = 3.2, P < 10(-4)), smoking and binge drinking (OR = 3.3, P < 10(-4)), smoking and riding with a drunk driver (OR = 5.3, P = 10(-4)), smoking and driving under the influence of alcohol (OR = 9.7, P < 10(-4)), nonuse of oral contraceptives and riding a car with a drunk driver (OR = 15.4, P = 0.002), and driving under the influence of alcohol and riding with a drunk driver (OR = 18.6, P < 10(-4)). Factor analysis indicated that risky behavior could be explained in terms of two component factors, namely carelessness in the context of self interest and irresponsible sexual behavior. A composite index integrating information of all seven high-risk indicators regressed on sociodemographic characteristics showed that risky behavior increased sharply with age and was concentrated strongly in the low-education families and the lower income areas. CONCLUSIONS: Several aspects of high-risk behavior tend to aggregate in the same individuals, and the clustering pattern has already been developed by late adolescence, mostly among the less privileged families and population groups. It appears that socioeconomic class health differentials may have strong roots in late adolescence.

Blood lipids in Greek adolescents and their relation to diet, obesity, and socioeconomic factors.

A study of blood lipid levels in adolescent students in rural and urban areas of Greece was undertaken. Blood samples were drawn from 307 adolescents aged 12 to 18 years attending two rural and two urban high schools of different socioeconomic level (urban/lower, urban/higher). Obesity among adolescents had statistically significant detrimental effects on the lipids profile, being associated with higher total and low-density-lipoprotein (LDL) cholesterol and lower high-density-lipoprotein (HDL) cholesterol levels. Adolescents living in urban areas had substantially and significantly higher levels of total and LDL cholesterol, but among urban residents, higher socioeconomic status was associated with lower levels of total and LDL cholesterol. There was no clear evidence that total, LDL, and HDL cholesterol levels were substantially affected by qualitative aspects of diet as evaluated through a food frequency questionnaire. The results of this study indicate that the traditional Mediterranean pattern of living and eating in the rural areas of Greece is associated with a favorable lipid profile in adolescents, which may explain the very low incidence of coronary heart disease (CHD) in these areas. In urban areas lipid profiles are satisfactory in children of high socioeconomic status but unfavorable in children of low- to middle-class families, which are known to be at higher risk for CHD.

An epidemiological study of the factors influencing poisoning in children aged 0-5 years.

The aim of this cross disciplinary study was to identify the most significant variables related to childhood accidental poisoning. The study was carried out on a representative sample of families living in the Greater Athens Area comprising 1245 children aged up to 5 years. Data were collected by a team of researchers (paediatricians, psychologists and social workers) and involved a structured interview and a paediatric examination. The findings show that childhood poisoning is correlated with: (1) biological variables, such as skeletal anomalies, language disorders, number of recent infections and complications of pregnancy; and (2) social factors, such as father's educational level, monthly family income, and overcrowding. Sex of the child was not found to influence poisoning.

Maternal and infant health education in a rural Greek community.

PIP: Educational intervention programs in Florin, Greece, a mountainous rural area with a low (15-20%) attendance at prenatal clinics, were conducted to reduce perinatal and infant morbidity and mortality and to promote physical and psychomotor development. Prior community diagnostic surveys had identified low income, poor living conditions, and illiteracy as very closely linked with poor hygiene, poor nutrition, nonutilization of services, frequent infections and high perinatal and infant mortality. The objectives of the intervention were to assess the effects of health education on breast feeding practices and use of available medical services. 300 pregnant women participants were randomly identified by the clinic as the intervention group and 200 as controls. Both groups were similar with predominantly low socioeconomic status (69-73%) and peasant farmers. There were few basic housing amenities (13.1 with interventions and 12.7 for controls). 70% of the women lived in extended families. The intervention involved home visits on nutrition, general hygiene, breast feeding, and newborn care. Visits were scheduled every 2 weeks in the 1st 2 months of pregnancy and every month until the infant was 12 months old. It was found that nutrition counseling was positively associated with maternal weight between interventions and controls (11.33 vs. 10.30 p.05) but not on low birth weight. Prematurity was reduced (3.7% intervention vs. 8.3% controls, p.04). The perinatal mortality was 31% for interventions vs. 41% for controls, but there were a significantly higher number of fetal deaths (28 weeks) for interventions. There was no discernible impact on breast feeding practices except for demand feeding (61% interventions vs. 38% controls) perhaps because both groups considered breast milk the best. Overfeeding was affected by health counseling, but was reflected only after the 1st year (12.1% control vs. 6.7% intervention in the 90th percentile). The presence of anemia followed a similar pattern with intervention impact after the 1st year. There was no measurable impact in psychomotor development. Reported illness days had a significant lower mean 1 year for interventions. Illness reports checked against clinic visits showed underreporting for both groups. Colds, otitis, and gastroenteritis were the most common ailments. Both showed greater illness between 8 and 12 months with a slightly higher incidence of feverish episodes, gastroenteritis and otitis among controls. Hospitalizations were not significantly different. Both groups used the clinic for infant illness; home visits depressed the use of free routine checkups for interventions from 0 to 4 months. 5 neonatal deaths occurred among controls and interventions. It was anticipated that mortality is also affected by linkages to the community and improvement in medical services. The results were mixed but the program was partly successful.^ieng

Why medical ethics?

A brief summary is given of the factors which make knowledge of and sensitivity for medical ethics necessary for all health professionals today. It is then noted that most activities in this field are centered around diagnostic and therapeutic medicine, the one-to-one, doctor-to-patient relationship. Reasons are then given why ethical dilemmas in health promotion and preventive medicine are equally or more important than in therapeutic medicine.

In Greece, lament for the dead, denial for the dying.

KIE: Death in the urban Greek culture has become increasingly distant from everyday life; medical training and practice mirror this outlook by ignoring the study of ethical questions connected with the care of the dying. Doctors often avoid their terminally ill patients and dying patients are isolated, away from the public, within the hospital. Criteria for the determination of death are based on similar practices in other countries: permanent functional death of the brain stem constitutes brain death and, when brain death occurs, artificial life-support can be withdrawn.^ieng

Impact of a nationwide anti-smoking campaign.

An intensive anti-smoking campaign based mainly on messages on radio and television reduced to nearly 0 the 6% annual increase in tobacco consumption in Greece. When the campaign stopped the consumption rose again at the pre-campaign rate.

Effectiveness and safety of prenatal phenobarbital for the prevention of neonatal jaundice.

The effect of 100 mg of phenobarbital (PB) at bedtime for the last few wk of pregnancy on the incidence and severity of neonatal hyperbilirubinemia was studied. No effect was observed in the newborns of mothers who took less than ten tablets. In the 1310 newborns of adequately treated mothers (PB greater than or equal to 1.0 g), the incidence of marked jaundice (bilirubin > 16.0 mg/dl) and the need to perform an exchange transfusion were reduced by a factor of six in relation to the incidence in 1553 control infants. A randomly selected group of 415 children (182 control, 233 PB) were reexamined at 61 to 82 months of age. There was no difference in the overall morbidity and mortality between the control and treatment group. A detailed neurologic assessment failed to reveal any differences between the two groups. In the VisuoMotor Integration test, the PB group scored significantly better than the control group. In the Draw-A-Woman and the Verbal Intelligence Test, the difference was in the same direction but was not statistically significant. The degree of jaundice was not found to significantly influence the performance in the neurological examination and the intelligence tests. Sensorineural hearing defect was significantly more common in the children with moderate or marked jaundice (bilirubin > 12 mg/dl) than in those with lesser degrees of jaundice. Prenatal PB is a practical, effective, and safe method for decreasing the incidence of neonatal hyperbilirubinemia.

Bone growth in thalassaemic children.

X-ray measurements were made of the length and width of the 3 middle metacarpal bones of both hands, in 61 thalassaemic and 35 control children of both sexes aged 5--13 years. Growth in length of the bone was normal until age 11 years but after this it was smaller in thalassaemic children. The growth of total width in thalassaemic children was greater than that of the controls until age 11 years and then became equal. The proportion of children with bone age retardation was greater after 7 years.

Bone density in thalassemic children during the course of the disease.

The study was carried out on 50 thalassemic children and 20 control subjects aged 5--15 years. The cortical thickness in thalassemic children was less than in control subjects. The bone loss was more obvious in girls (P less than 0.0005) than in boys (P less than 0.05). The greater bone loss in girls could not be explained by the level of blood hemoglobin because in both sexes the mean value was the same (7.3 +/- 0.5 g/dl). Of the 12 thalassemic children observed for 9--24 months, 9 showed no signficant bone change, 2 showed an improvement of cortical thickness and only 1 showed bone loss. Of the 11 thalassemic children observed for 25--48 months, 4 showed significant bone loss and 7 no change of the bone density. In both groups the mean value of pretransfusion blood Hb was 7.3 g/dl and the sex distribution was equal. A relationship was found in both control and thalassemic children between bone density and urine phosphorus to urine creatinine ratio.

Serum 25-hydroxyvitamin D levels in thalassaemia.

Serum 25-hydroxyvitamin D levels were measured in 36 thalassaemic children and 27 controls aged 5-15 years. Blood specimens were collected from the beginning of April until the end of October 1976. We considered as the winter period the first 3 months and the summer period the last 4 months. We found that (a) thalassaemic children had lower levels of serum 25-hydroxyvitamin D than controls: (b) there was a seasonal variation of serum 25-hydroxyvitamin D in both groups; and (c) the thalassaemic children had malabsorption of vitamin D. We suggest that the bone lesions in thalassaemic children are related to vitamin D deficiency.