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- Andersson, Per
(författare)
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Predicting Health Behaviour – Population-Based Studies of Knowledge and Behaviour Related to Cardiovascular Diseases
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to study factors that affect behaviour related to CVD (cardiovascular diseases). Study I tested whether gender, education and so-cioeconomic status correlated to knowledge about risk factors, and Study II studied knowledge and risk behaviour from a national perspective (Sweden versus Poland). Furthermore, Study III examined whether obese people dif-fered from people of normal weight regarding knowledge about risk factors, and Study IV examined whether risk behaviour is affected by personal ex-perience of illness and family history of CVD. The studies are population-based with cross-sectional design. Data were obtained by questionnaires and by screening results of risk factors related to CVD. The studies were carried out among 50-year old men and women in Västmanland, Sweden (n=1011) and in Wroclaw, Poland (n=1043).The results show that women are more knowledgeable than men about the risk factors for CVD, and that low education is associated with insufficient knowledge about CVD (Study I). The discrepancy between knowledge and behaviour was greater among the Poles than it was among the Swedes (Study II). Obese individuals did not differ significantly from individuals with a normal weight regarding knowledge of cardiovascular risk factors when education was controlled for (Study III). Individuals with a personal experience of illness may be more inclined to change smoking behaviour than the average person (Study IV).In conclusion, knowledge about risk factors for CVD varies with education, gender and, to a certain degree, nationality. However, knowledge does not only consist of the conditions of behaviour change. The results in the thesis substantiate theories suggesting that change in risk behaviour is a process over time. Predictors of risk behaviours on the individual level as well as national level are of importance, and needs to be considered in the every day practice of health care professionals.
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| 2. |
- Cederholm, Tommy, et al.
(författare)
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Forskaren, samhället och jäv
- 2008
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Ingår i: Läkartidningen. - 0023-7205. ; 105:16, s. 7-1206
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 3. |
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| 4. |
- Gulliksson, Mats, 1954-
(författare)
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Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives. The first aim was to examine the effects of secondary prevention with a focus on determinants in the risk of recurrent coronary heart disease (CHD). The second aim was to analyse the effects of a cognitive behavioural therapy (CBT) intervention on the risk of recurrent cardiovascular disease (CVD) and to investigate the psychosocial situation of CHD patients. Material and methods. Papers I and II were based on the Swedish Acute Myocardial Infarction Statistics Register, 1969 to 2001: 775,901 events in 589,341 subjects. Papers III and IV were based on The Secondary Prevention in Uppsala Primary Care project (SUPRIM), a randomized controlled clinical trial in 362 CHD patients. Results. The risk of a recurrent acute myocardial infarction (AMI) event was highly dependent on time from the previous event, with the greatest risk immediately after an AMI event. In addition, sex, age, and AMI number influenced the general risk level. Furthermore, there has been a major decline in recurrence risk over 30 years, and there were considerable geographical differences in risk, best explained by residential area population density, with a high recurrent AMI risk in areas with the lowest and the highest population densities, and the lowest risk in areas with moderate population density. Disease status and sex were determinants of psychological well-being the first year after a CHD event. Sex seemed to be the stronger determinant. The CBT intervention focused on stress management during one year in patients with CHD. There was significantly improved outcome in the intervention group on recurrent CVD and recurrent AMI during a 9 year follow up. A dose-response relationship was demonstrated between attendance rate at intervention group meetings and outcome, the higher the attendance rate the better the outcome. Conclusions. The risk of a recurrent AMI event was dependent on time from the previous event, with major improvement seen in recent decades. Regional differences were best explained by population density. Female CHD patients were at high risk concerning well-being after a coronary event, which deserves special attention. The CBT intervention for CHD patients improved outcomes concerning the risk of recurrent CVD and AMI events.
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| 5. |
- Hemmingsson, Erik, et al.
(författare)
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Impact of social support intensity on walking in the severely obese : a randomized clinical trial
- 2008
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Ingår i: Obesity. - : Wiley. - 1930-7381 .- 1930-739X. ; 16:6, s. 1308-1313
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: There are few established methods for promoting physical activity (PA) in the severely obese. Because social support is a potential method for promoting PA, we compared mean steps/day during 18 weeks in severely obese outpatients receiving either standard support (SS) or added support (AS). METHODS AND PROCEDURES: Eighty severely obese outpatients from an obesity clinic were invited; 66 provided written consent, 55 were randomized, and 42 were included in final analyses (9 men, 33 women; age 44.4 +/- 13.1 years; BMI 41.9 +/- 5.5 kg/m(2)). All participants received a pedometer and a walking promotion booklet. In addition to SS, the AS group received ten 2-h group counseling sessions aimed at increasing weekly accumulated steps, every second week during the study. Each participant was asked to complete a 7-day walking diary every second week (10 observations). RESULTS: Baseline steps/day was 6,912 for the AS group and 5,311 for the SS group (P = 0.023). Data at 18 weeks showed that the AS group recorded 10,136 steps/day and the SS group 6,118 steps/day (P = 0.024). There was no allocation x time interaction (P = 0.46). During the follow-up period as a whole, the AS group recorded 1,794 more steps/day than the SS group (P = 0.0074). DISCUSSION: The AS group recorded more steps/day than the SS group, reaching a mean level of approximately 10,000 steps/day. However, the nonsignificant interaction between allocation x time suggests that this difference was present already at baseline and did not increase during follow-up.
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| 6. |
- Journath, Gunilla, et al.
(författare)
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Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare.
- 2008
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Ingår i: Journal of hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 26:10, s. 2050-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the association of physician's sex with blood pressure, lipid control, and cardiovascular risk factors in treated hypertensive men and women, stratified for the sex of their physician. METHODS: In a cross-sectional survey of hypertensive patients, 264 primary care physicians (PCPs), 187 men and 77 women from across Sweden, recruited 6537 treated hypertensive patients (48% men) during 2002-2005, consecutively collected from medical records and registered on a web-based form connected to a central database. Patients were included consecutively in the same order as they visited the healthcare centre. RESULTS: Hypertensive women more often reached target systolic/diastolic blood pressure levels (<140/90 mmHg) when treated by female PCPs than when they were treated by male PCPs (32 vs. 24%, P < 0.001). This difference remained when comparing female and male physicians' nondiabetic female patients. Both male and female patients had better control of total cholesterol and low-density lipoprotein cholesterol levels when treated by female PCPs than when treated by male PCPs (total cholesterol <5 mmol/l: women 30 vs. 24%, P < 0.001; men 42 vs. 34%, P < 0.001; low-density lipoprotein cholesterol <3 mmol/l: women 39 vs. 33%, P < 0.01; men 41 vs. 35%, P < 0.05). Female PCPs had a higher proportion of treated hypertensive patients with diabetes than did male PCPs but male PCPs had a higher prevalence of treated hypertensive men with microalbuminuria compared with female PCPs. CONCLUSION: Female physicians appeared more often to reach the treatment goal for blood pressure in female patients and cholesterol levels in all patients than did male physicians.
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| 7. |
- Journath, Gunilla, et al.
(författare)
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Sex differences in risk factor control off treated hypertensives : a national primary healthcare-based study in Sweden
- 2008
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Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation. - 1741-8267 .- 1741-8275. ; 15:3, s. 258-262
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Tidskriftsartikel (refereegranskat)abstract
- Background To evaluate potential sex differences, this study aimed to investigate blood pressure and lipid control and other risk factors for cardiovascular disease in treated hypertensive (tHT) patients from primary healthcare. Design and methods This cross-sectional survey of tHT patients was carried out between 2002 and 2005 by 264 primary care physicians from Sweden who consecutively recruited 6537 tHT patients (48% men and 52% women) from medical records. Results tHT men more often reached the treatment goal for systolic/diastolic blood pressure, less than 140/90 mmHg, than tHT women (30 vs. 26%, P < 0.01). Men had lower systolic blood pressure than women, however, women had lower diastolic blood pressure and higher pulse pressure. More tHT women had total cholesterol >= 5.0 mmol/l than corresponding men (75 vs. 64% P < 0.001). Men more often had diabetes (25 vs. 20% P < 0.001), left ventricular hypertrophy (20 vs. 16% P < 0.001), and microalbuminuria (24 vs. 16% P < 0.001). Women were more often treated with diuretics (64 vs. 48%) and P-receptor blockers, (54 vs. 51%), and men more often treated with angiotensin-converting enzyme inhibitors (27 vs. 18%), calcium channel blockers (34 vs. 26%), and lipid-lowering drugs (34 vs. 29%). Conclusion A need still exists for more intensified treatment of elevated blood pressure and hypercholesterolemia, especially in women. In hypertensives of both sexes, smoking and other risk factors also need to be addressed to reduce the risk of cardiovascular disease.
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| 9. |
- Norberg, Margareta, 1951-
(författare)
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Identifying risk of type 2 diabetes : epidemiologic perspectives from biomarkers to lifestyle
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type 2 diabetes is a significant health problem because of its high prevalence and strong association with cardiovascular morbidity and mortality. An increase of type 2 diabetes is predicted due to increasing obesity and sedentary lifestyle habits. The development from latent to diagnostic disease spans many years and during this time it is possible to prevent or postpone type 2 diabetes using lifestyle and pharmacological interventions. The objective of this thesis is to investigate and describe early patterns and risk indicators of type 2 diabetes. The focus is on type 2 diabetes as one component in metabolic syndrome, i.e. the clustering of several cardiovascular risk markers. Two studies based on the Västerbotten Intervention Programme (VIP) provided the data; one case-referent study nested within VIP which includes 237 diabetes cases that were clinically diagnosed 5.4 years after the health survey, each with two referents; and one panel study with 5 consecutive annual cohorts including subjects that participated in VIP between1990 and 1994 and returned to a follow-up after 10 years, a total of 16 492 individuals. Associations between risk markers and type 2 diabetes or metabolic syndrome are evaluated by several statistical techniques. A model of metabolic syndrome is hypothesized. A prediction model for developing type 2 diabetes among middle-aged individuals is proposed, where high risk is defined as having at least two out of three risk criteria (fasting plasma glucose ≥6.1 mmol/L, HbA1c ≥4.7% (Swedish Mono-S standard) and BMI ≥27 in men and BMI ≥30 in women). With positive predictive values of 32% in men and 46% in women, this model performs at least as well as other published prediction models. Information on family history of diabetes does not improve the result and the cumbersome oral glucose tolerance test is not needed. Therefore this model should be feasible for use in routine care. A model of metabolic syndrome with five composite factors, based on 14 variables including markers produced by adipose tissue and b-cells, suggest that obesity with insulin resistance and b-cell decompensation are the core perturbations in the early stages of type 2 diabetes, while inflammation and dyslipidemia could not be shown to be independent early risk indicators. The composite factors do not improve the prediction as compared to the single markers of fasting glucose, BMI and proinsulin and, possibly blood pressure values. Stress (measured as passive or tense working conditions) and weak social support (measured as emotional support), are suggested to be strong risk indicators along with high BMI for type 2 diabetes in women. In men BMI is predictive, but the stress variables are not shown to be associated with future type 2 diabetes. A social gap is indicated by double risk of metabolic syndrome among subjects with low (≤ 9 years at school) compared to high education (≥ 13 years). High consumption of Swedish smokeless tobacco, snuff (>4 cans/week), is independently associated with metabolic syndrome, obesity and hypertriglyceridemia, but not with dysregulation of glucose. To conclude, single markers, that are commonly used in daily practice, are useful and sufficient for identification of subjects that are in the early stages of type 2 diabetes. Obesity with insulin resistance and b-cell decompensation are the core perturbations in early development to T2DM. Lifestyle, socioeconomic and psychosocial markers, in addition to biomarkers, are important determinants of future type 2 diabetes and metabolic syndrome, albeit not similarly among men and women.
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| 10. |
- Rapp [Nordin], Erika, 1970-
(författare)
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Sensory, attitudinal, and contextual aspects of the meal : health implications and connections with risk factors for coronary heart disease and obesity
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet var att undersöka mat- och måltidsrelaterade faktorer som bidragande orsak till övervikt och hjärt-kärlsjukdom.I en sensorisk studie jämfördes individer som insjuknat i hjärtinfarkt med en frisk kontroll-grupp med avseende på preferens för mat med hög respektive låg fetthalt, smakkänslighet för grundsmakerna (surt, beskt, salt, sött, umami och metalliskt) samt det beska ämnet 6-n-propylthiouracil (PROP). Undersökningsgruppen hade mer ogynnsam metabolisk profil, vilket kan indikera högre intag av fet, energirik mat och mindre intag av frukt och grönsaker, jämfört med kontrollgruppen. Det påvisades emellertid ingen signifikant skillnad i smakkänslighet mel-lan grupperna. När grupperna slogs samman konstaterades däremot att känslighet för surt var relaterat till lågt body mass index (BMI), och känslighet för beska var relaterat till lågt HDL-kolesterol samt högt BMI och bukfetma. Det indikerar ett samband mellan riskprofil, smak-känslighet och matvanor. Upplevd beska kan vara en bidragande orsak till låg konsumtion av frukt och grönsaker. Båda grupperna föredrog generellt mat med hög fetthalt, varför preferens för hög fetthalt i sig inte kan anses vara en bidragande riskfaktor för insjuknande i hjärtinfarkt. För hälften av rätterna påvisades emellertid ingen signifikant skillnad i preferens för hög- respek-tive låg fetthalt. För att undersöka hur sensoriska egenskaper förändras vid olika fetthalter stu-derades två såser med varierande smörmängd. Totalt sett minskade smakegenskaperna (tomat, vitlök, timjan, kyckling, syrlighet) när mer smör tillsattes, medan smörsmaken och såsernas vis-kositet ökade. Stor skillnad i smörmängd (energiinnehåll) frambringar däremot endast små smakförändringar.I en enkätstudie påvisades att matvanor och inställning till mat och hälsa skilde sig mellan män och kvinnor samt beroende av BMI. En klusteranalys resulterade i tre grupper, varav en grupp med jämn könsfördelning som i genomsnitt hade högre BMI och sämre matvanor. I den gruppen ingick kvinnor som är mindre intresserade av sin hälsa och män som är mer fokuserade på mat som njutning, vilket indikerar att orsakerna till ohälsosamma matvanor skiljer sig mellan kvinnor och män. I en öppen fråga beskrevs essensen i en god måltid innefatta både krav på maten (råvaror, maträtter, menyer, sensoriska egenskaper samt näring och mättnad) och krav på sammanhanget (estetik, gemenskap, lugn och ro, och sinnesstämning). Att identifiera indivi-ders olika anspråk på en god måltid kan vara komplementära kunskaper till hjälp vid föränd-ring av mat- och måltidsvanor. Slutligen bidrog en litteraturfördjupning till kunskaper om mat- måltidsupplevelser med fokus på uppskattning och tillfredsställelse i relation till hälsotillstånd.Resultaten indikerar att det är av betydelse att identifiera enskilda individers förutsättningar och preferenser för mat och måltider vad gäller smak, matvanor och kontext i vardagen för att underlätta intervention och hälsofrämjande arbete.
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