| 1. |
- Blomstrand, Ann, et al.
(författare)
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Forty-four-year longitudinal study of stroke incidence and risk factors - the Prospective Population Study of Women in Gothenburg
- 2022
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 40:1, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess stroke incidence over 44 years and association with risk factors. To study total stroke incidence at 60-82 years of age and risk factors. Design Prospective population study. Setting Gothenburg, Sweden, with similar to 450,000 inhabitants. Subjects A representative sample of a general population of women (1462 in total) in 5 age strata aged 38-60 years in 1968-1969 (the Population Study of Women in Gothenburg, PSWG) were followed up to the ages of 82-104 years in 2012. Further, analysis was also performed for the age interval 60-82 years. Main outcome measures Incidence of total stroke (TS), ischaemic (IS), haemorrhagic (HS), non-specified (NS) and fatal (FS) strokes and association with baseline classic risk factors (such as hypertension, atrial fibrillation, low physical activity, diabetes, high waist-hip-ratio, hyperlipidaemia, smoking), low education, mental stress, pre-eclampsia and oral health as expressed by loss of teeth and bone score. Blood pressure in levels 1-3 according to modern guidelines. Associations with atrial fibrillation, diabetes and myocardial infarction shown in survival analyses. The five cohorts contributed to risk time data concerning associations with TS in the 60-82 age interval from the examination performed when they were 60. Results Three hundred and thirty-seven (23%) women had a first-ever stroke, 64 (19%) fatal. TS was associated with physical inactivity, high triglycerides and low education in multivariable analysis. The main sub-type IS was associated with systolic blood pressure, physical inactivity and low education. Pre-eclampsia showed association with IS only in the univariable analysis. FS was associated with systolic blood pressure and smoking. During 60-82 years of age, having <20 teeth (HR 1.74, CI 1.25-2.42), diabetes (HR 2.28 CI 1.09-4.76), WHR (HR 1.29 per 0.1 units CI 1.01-1.63), systolic blood pressure (HR 1.11 per 10 units CI 1.04-1.18) and smoking (HR 1.57, CI 1.14-2.16), were associated with TS in the combined five cohorts. Conclusions Several classic risk factors showed independent associations with stroke. Vulnerability factors as low education and oral health, reflected by loss of teeth, also showed association with stroke. All these factors are possible to target in primary care preventive interventions.
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| 2. |
- Blomstrand, Ann, et al.
(författare)
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Implementation of a low-budget, lifestyle-improvement method in an ordinary primary healthcare setting: a stepwise intervention study
- 2012
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2:4
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate, in an ordinary primary healthcare setting, the effects of a screening questionnaire and a self-administered health profile dealing with special reference to the involvement of motivated individuals in need of lifestyle changes. Design Intervention study in a naturalistic context, using a screening questionnaire offered to consecutive patients, followed by a self-administered health profile and a health dialogue. Setting Hisingen primary healthcare area (130033 inhabitants), Gothenburg, Sweden. Participants Men and women aged between 18 and 79, visiting any of the eight public primary healthcare centres (PCC) during an 8-month period, were presented with a screening questionnaire and, were offered, a health profile, a plasma glucose (p-glucose), blood pressure check and a health dialogue. Main outcome measures Motivation level, negative lifestyle factors in screening questionnaire and intraindividual changes in blood pressure, p-glucose, body mass index (BMI) and lifestyle factors between baseline and 1-year follow-up. Results Subjects with less favourable lifestyle and higher motivation chose to participate. A higher percentage of presumptive participants reported a less favourable lifestyle. The presumptive participants also indicated higher motivation. Participants showed more readiness to initiate lifestyle changes compared to non-participants (p<0.001). At 1-year follow-up significant reductions in BMI, waist circumference, waist–hip ratio (WHR), blood pressure and p-glucose were observed. Conclusions The results indicate that the method is on target and applicable to motivated individuals with a ‘risk profile’. A pedagogical model including a self-administered health-profile and a health dialogue, combined with emphasising the individual's own resources, seems to be a feasible method for effective preventive work in primary healthcare.
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| 3. |
- Blomstrand, Ann, et al.
(författare)
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Stroke incidence and association with risk factors in women: a 32-year follow-up of the Prospective Population Study of Women in Gothenburg
- 2014
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:oct 28
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study stroke incidence among women over 32 years of age with a focus on subdividing by stroke type, to consolidate end points and associations with risk factors. Design: Prospective population study initiated in 1968–1969 with follow-ups in 1974, 1980, 1992 and 2001. Setting: Gothenburg, Sweden. Participants: A sample of 1462 women from five age strata examined in 1968–1969, representative of women in the general population. Main outcome measures: Main types of first-ever stroke and fatal stroke during 1968–2001 identified and validated. Stroke incidence rates in different age strata. Association with baseline smoking, body mass index (BMI), waist–hip ratio, hypertension, serum lipids, physical inactivity, perceived mental stress and education. Associations with atrial fibrillation (AF), diabetes, baseline hypertension and myocardial infarction (MI). Blood pressure (BP) levels 1–3, corresponding to modern guidelines, in relation to stroke risk. Results: 184 (12.6%) cases of first-ever stroke, 33 (18%) of them fatal. Validation reduced unspecified stroke diagnoses from 37% to 11%. Age-standardised incidence rate per 100 000 person-years was 448. A multivariate model showed a significant association between ischaemic stroke and high BMI: HR 1.07 (95% CI 1.02 to 1.12), smoking 1.78 (1.23 to 2.57) and low education 1.17 (1.01 to 1.35). Significant association was seen between haemorrhagic stroke and, besides age, physical inactivity 2.18 (1.04 to 4.58) and for total stroke also hypertension 1.45 (1.02 to 2.08). Survival analysis showed a significantly increased risk of stroke in participants with diabetes (p<0.001), AF (p<0.001) and hypertension (p=0.001), but not MI. Stroke risk increased with increasing BP levels but was already seen for diastolic pressure grade 1 and particularly when combined with systolic BP grade 1; 1.62 (1.17 to 2.25). Conclusions: Hypertension, smoking, AF, diabetes and high BMI were associated with increased stroke risk. Low education was associated with stroke. Validation of National Patient Registry diagnoses to increase specified diagnoses improved data quality.
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| 4. |
- Persson, Carina Ulla, 1970, et al.
(författare)
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Determinants of Stroke in a General Male Population : Forty-Eight Year Time-Dependent Updated Follow-Up of the Study of Men Born in 1913
- 2018
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Ingår i: Stroke. - : LIPPINCOTT WILLIAMS & WILKINS. - 0039-2499 .- 1524-4628. ; 49:12, s. 2830-2836
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose - To further improve preventive strategies against stroke, there is a need for epidemiological long-term studies. The study aimed at a prospective investigation of stroke determinants in the general male population.Methods - During a period of 48 years, from 50 to 98 years of age, a population-based sample of 854 men was followed using repeated medical examinations, lifestyle questionnaires, data from hospital records and the National Cause of Death Register.Results - Determinants of ischemic stroke were atrial fibrillation (hazard ratio [HR], 6.61; 95% CI, 4.47-9.77); mother dead from cardiovascular disease (HR, 1.53; 1.09-2.17); high education (HR, 0.81; 0.69-0.96); and high physical activity level during leisure time (HR, 0.68; 0.50-0.93). For hemorrhagic stroke heart rate (HR, 1.04; 1.01-1.06) and mother dead from stroke (HR, 3.56; 1.43-8.87) constituted an increased risk. Statistically significant determinants for all stroke were atrial fibrillation (HR, 5.34; 3.68-7.75); high diastolic blood pressure (HR, 1.02; 1.01-1.03); high body weight (HR, 0.96; 0.94-0.99); high educational level (HR, 0.79; 0.68-0.92); wide waist circumference (HR, 1.04; 1.01-1.07); smoking (HR, 1.25; 1.06-1.48); mother dead from cerebrovascular disease (HR, 1.43; 1.05-1.94); and diabetes mellitus (HR, 1.65; 1.02-2.68). Of all men diagnosed with atrial fibrillation, 88% had a stroke during follow-up.Conclusions - Atrial fibrillation was by far the strongest determinant of stroke during 48 years of follow-up in a male population sample followed until the age of 98 years. The results warrant improved prophylaxis through intense treatment of modifiable determinants.
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| 5. |
- Rusek, Linnéa, et al.
(författare)
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Lifetime risk of stroke in the general male population
- 2020
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 142:1, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Most previous studies of incidence rates of stroke are from register studies, while data from prospective cohort studies are limited. The aim of the present study was to describe hazard rates, prevalence and cumulative proportion free from stroke during a lifelong follow-up of a representative sample of middle-aged men sampled from the general population. Methods A population-based sample of 855 men, all born in 1913, was investigated at 50 years of age and followed up with repeated medical examinations at age 54, 60, 67, 75 and 80. Data from hospital records and the Cause of Death Register were collected, and all stroke events during 48 years of follow-up were registered. Medical records were scrutinized in order to confirm and validate the stroke diagnoses. Results One man was excluded because of stroke prior to baseline, while 176 of the remaining 854 men (20.7%) suffered a first-ever stroke during follow-up. The total 5-year stroke risk (hazard rate) increased with age, from 3.54 (95% CI: 0-7.55) per 1000 persons at risk at age 50 years, to 119.05 (95% CI: 45.39-192.70) at age 90 years. The stroke prevalence peaked at age 80 and older, with about 120 cases per 1000 years of observation. The survival rate (cumulative proportion free from stroke) at age 98 was 50.0%. Conclusion One out of five men in this population sample suffered a stroke of any type during follow-up from 50 to 98 years of age and the cumulative incidence was close to 50%.
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| 6. |
- Bergdahl, Ingvar A., et al.
(författare)
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Mercury in serum predicts low risk of death and myocardial infarction in Gothenburg women.
- 2013
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Ingår i: International archives of occupational and environmental health. - : Springer Science and Business Media LLC. - 1432-1246 .- 0340-0131. ; 86:1, s. 71-7
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose Markers of mercury (Hg) exposure have shown both positive and negative associations with cardiovascular disease (CVD). We assessed the association between serum Hg (S–Hg) and risk of cardiovascular disease in a prospective population-based cohort, with attention to the roles of dental health and Wsh consumption. Methods Total mortality, as well as morbidity and mortality from acute myocardial infarction (AMI) and stroke, was followed up for 32 years in 1,391 women (initially age 38–60), in relation to S–Hg at baseline, using Cox regression models. Potential confounders (age, socioeconomic status, serum lipids, alcohol consumption, dental health, smoking, hypertension, waist-hip ratio, and diabetes) and other covariates (e.g., Wsh consumption) were also considered. Results Hazard ratios (HR) adjusted only for age showed strong inverse associations between baseline S–Hg and total mortality [highest quartile: hazard ratio (HR) 0.76; 95% conWdence interval (CI) 0.59–0.97], incident AMI (HR 0.56; CI 0.34–0.93), and fatal AMI (HR 0.31; CI 0.15–0.66). Adjustment for potential confounding factors, especially dental health, had a strong impact on the risk estimates, and after adjustment, only the reduced risk of fatal AMI remained statistically signiWcant. Conclusions There was a strong inverse association between Hg exposure and CVD. Likely, reasons are confounding with good dental health (also correlated with the number of amalgam Wllings in these age groups) and/or Wsh consumption. The results suggest potential eVects of dental health and/or Wsh consumption on CVD that deserve attention in preventive medicine.
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| 7. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of women in Gothenburg
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:3, s. 140-6
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Tidskriftsartikel (refereegranskat)abstract
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden. cecilia.bjorkelund@allmed.gu.se OBJECTIVES: To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005. DESIGN: Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. SETTING: Gothenburg, Sweden with approximately 450,000 inhabitants. SUBJECTS: Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59-90%, n =1901). MAIN OUTCOME MEASURES: Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. RESULTS: There was no significant difference in mean BMI from 1968-1969 versus 2004-2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004-2005 versus 1968-1969. HDL-cholesterol (not measured until 1992-1993), showed a significantly higher mean level in 2004-2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. CONCLUSIONS: Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.
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| 8. |
- Blomstrand, Ann, et al.
(författare)
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Effects of leisure time physical activity on well-being among women in a 32-year perspective.
- 2009
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 37:7, s. 706-712
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To explore potential effects of physical activity on well-being in a population study. Results are from baseline and 32-year follow-ups. METHODS: In a population study of 1462 women in five age strata cross-sectional and prospective analysis were carried out. Activity levels were divided into low, intermediate and high. Well-being was based on self-reported well-being using a Likert-type 7-point scale. RESULTS: Cross-sectional analysis showed strong associations between level of physical activity and well-being. The odds ratio (OR) for poor well-being in women with low physical activity compared with physically more active women was, when studied cross-sectionally, after 12 years in 1980-81 3.94, 95% confidence interval (CI) 2.70-5.74, after 24 years in 1992-93 4.01, CI 2.61-6.17, and after 32 years in 2000-01 7.17, CI 3.56-14.44. Similar associations were observed when relating physical activity at baseline to subsequent well-being: after 12 years: OR 2.09, 95% CI 1.31-3.34, after 24 years: OR 2.74; 95% CI 1.56-4.83, and after 32 years: OR 1.49, 95% CI 0.77-2.88. There was a linear correlation between changes in the individual's physical activity level and her simultaneous changes in experience of well-being between 1980-81 and 1992-93 and between 1992-93 and 2000-01 as well as between 1980-81 and 2000-01. CONCLUSIONS: Strong associations were observed between leisure time physical activity level and reported experience of well-being cross-sectionally and prospectively. Well-being increased with concurrent changes in physical activity. Increased physical activity in sedentary individuals appears to promote not only health but also well-being.
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| 9. |
- Blomstrand, Ann, et al.
(författare)
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Low-budget method for lifestyle improvement in primary care. Experiences from the Göteborg Health Profile Project.
- 2005
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:2, s. 82-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe a self-administered preventive tool dealing with risk factors for cardiovascular disease and its effect with special reference to the question: did the project involve persons most in need of lifestyle changes? DESIGN: Screening questions offered to consecutive patients and followed by a self-administered health profile, intervention, and follow-up. Setting. Primary healthcare area of Askim, Sweden. SUBJECTS: Men and women between 18 and 65 years of age visiting GPs for acute disorders or planned visits during a three-month period were offered screening questions and, if wanted, a health profile. MAIN OUTCOME MEASURES: Participation rates, effects on lifestyle factors. RESULTS: There was an overrepresentation of subjects with a less favourable lifestyle among those who asked for the health profile. There was good agreement for all variables between self-estimation in screening questions and grading in the basal health profile. Lifestyle improvement was observed for dietary habits, physical activity, and mental stress at the one year follow-up. CONCLUSIONS: The results indicate that a relevant selection of persons with a "risk profile" can be made by means of simple screening questions. The pedagogic model using self-administered health profile in combination with own responsibility seems to be a tool for low-budget preventive work in primary healthcare.
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| 10. |
- Brechensbauer Brandin, Madeleine, et al.
(författare)
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Centralen : Studier i området kring Stockholms Centralstation
- 1989
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Rapport (populärvet., debatt m.m.)abstract
- Denna skrift handlar om Centralen i Stockholm och dess närmaste omgivningar, Centralplan, T-centralen, Vasagatan och Klarabergsgatan. Den är resultatet av Arkitekturskolans arbete läsåret 1983- 84 och innehåller förutom en rad projekt också historiska utblickar och samtidskritiska resonemang. En stor del av innehållet redovisades redan våren 1984 - det skedde genom en utställning på Arkitekturmuseet och en preliminär publikation. Materialet har sedan svällt ut med innehållsrika uppsatser om Centralen, om äldre och nyare insatser för att förena konst och arkitektur och om den föga kända, ännu obebyggda Blekholmen.
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