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- Karjalainen, Tina, et al.
(författare)
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An evaluation of the performance of SCORE Sweden 2015 in estimating cardiovascular risk : The Northern Sweden MONICA Study 1999-2014
- 2017
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Ingår i: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; 24:1, s. 103-110
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Tidskriftsartikel (refereegranskat)abstract
- Background Risk prediction models for cardiovascular death are important for providing advice on lifestyle and in decision-making regarding primary preventive drug treatment. The latest Swedish version of the Systematic COronary Risk Evaluation (SCORE 2015) has yet not been tested in the population. Objective The objective of this study was to estimate the prevalence of high and very high risk of fatal cardiovascular disease (CVD) of the current population according to 2015 SCORE Sweden and to evaluate the predictive accuracy of the 2003 Swedish version of SCORE (2003 SCORE Sweden) and 2015 SCORE Sweden in a population with declining CVD mortality. Methods We estimated the high and very high risk group for cardiovascular death for individuals 40-65 years of age in the 2014 Northern Sweden MONICA population survey excluding subjects with known diabetes or previous CVD (n=813). Using the 1999 MONICA survey (n=3347) followed up for 10 years for CVD mortality, we assessed the calibration of both 2003 and 2015 SCORE Sweden. Results In 2014 2.6% of the population was considered at high or very high risk for fatal CVD, 95% were men and 76% were in the age group 60-65 years. Including subjects with a single markedly elevated risk factor, known diabetes or CVD, 12% of the population was at high or very high risk. During 10 years of follow-up of the 1999 cohort, 34 CVD deaths (24 men and 10 women) occurred. The 2003 SCORE overestimated the risk of death from CVD (ratio predicted/observed 2.3, P<0.001) whereas the 2015 SCORE slightly overestimated the number of deaths (predicted/observed 1.3, P=0.12). The 2015 SCORE predicted more accurately than the 2003 SCORE the number of deaths in the different risk and age categories. Conclusion The 2015 SCORE Sweden more adequately than 2003 SCORE Sweden predicts the number of deaths. In 2014, the proportion of high-risk individuals is small in northern Sweden. The main use of 2015 SCORE Sweden would therefore be as an educational tool between the physician and people without diabetes or CVD in a consultation regarding cardiovascular risk.
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- Malm, Dan, 1954-
(författare)
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Health-related quality of life in patients with pacemakers. A descriptive and experimental study
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to describe and evaluate the health-relatedquality of life (HRQoL) of patients with pacemakers, as well as to determine theeffects of a nurse-led intervention regarding health-related quality of life in theform of a self-care program for these patients. Descriptive designs were used todescribe (I) quality of life (n=182) as well as (II) HRQoL (n=697) of pacemakerpatients based on a nursing perspective. In order to describe the life situation ofthese patients from a deeper perspective (III) and examine the experiences ofdaily living with a pacemaker, patients (n=13) were interviewed and data wereanalyzed according to the grounded theory method, using constant comparativeanalysis. Finally (IV), 212 patients from three hospitals were allocated, using anexperimental, multi-center, randomized design, to either a control (n=115) or anexperimental group (n=97) to evaluate the effects of a nurse-led intervention, a10-month self-care program, on the HRQoL of patients with pacemakers.The total QoL for patients with pacemakers was acceptable. Through applicationof Orem s self-care theory, information, support and education can be providedin such a way that nursing care affects the entire QoL of patients withpacemakers. Measures should be taken on behalf women, those living alone, theelderly, blue-collar workers and retired persons, all of whom have a lower QoL(I, II). Experiences of daily living with a pacemaker generally indicate thatpatients with pacemakers can attain emotional stability and social participationunder the condition that there is understanding, empathetic treatment and insightconcerning the patient s new situation (III). There were no significantdifferences in HRQoL when comparisons were made between the experimentaland the control group. Two main findings for patients in the self-care program(experimental group) were: a significantly better HRQoL in terms ofexperiencing the symptoms that were the reason for pacemaker implantation ashaving decreased or disappeared, and a higher level of perceived exertion in a 11/2-minute stair test compared with patients who had standard checkups (controlgroup) (IV).In order to increase the HRQoL of patients with pacemakers it is important thathealth care professionals support the patient in a kind and professional mannerby providing clear, relevant information, and by planning a self-care programbased on a nursing assessment of the patient s needs using a comprehensiveapproach.
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- Theorell, Töres, et al.
(författare)
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A systematic review of studies in the contributions of the work environment to ischaemic heart disease development
- 2016
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 26:3, s. 470-477
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Forskningsöversikt (refereegranskat)abstract
- Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.
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