| 1. |
- Fu, Michael, et al.
(författare)
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Although Coronary Mortality Has Decreased, Rates of Cardiovascular Disease Remain High : 21 Years of Follow-Up Comparing Cohorts of Men Born in 1913 With Men Born in 1943
- 2018
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Ingår i: Journal of the American Heart Association. - : WILEY. - 2047-9980. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- Background - Despite a decline in mortality rates from cardiovascular disease (CVD) in the past few decades, the burden of CVD in a contemporary population remains inadequately addressed. Therefore, this study was aimed to investigate secular trends in mortality from coronary artery disease and all-cause mortality over 2 decades, by comparing 2 cohorts of men born 30 years apart and evaluate the prediction of the risk of CVD and all-cause death in a contemporary random sample of Swedish men.Methods and Results - Two cohorts of randomly selected men born in 1913 (855 men) and 1943 (798 men) were first examined at age 50 in 1963 and 1993, respectively, and followed longitudinally over 21 years. All-cause mortality and coronary artery disease death were lower in 50-to 71-year-old men born in 1943 compared with those born in 1913, with unadjusted hazard ratios of 0.57 (0.45-0.71) and 0.34 (0.22-0.53), respectively. After adjustment for risk factors (smoking, serum cholesterol, hypertension, systolic blood pressure, diabetes mellitus, body mass index, and physical activity), the differences between the cohorts remained significant for coronary artery disease, hazard ratios 0.57 (0.34-0.94), P=0.029, but not for all-cause mortality hazard ratios 0.82 (0.62-1.07), P=0.14. However, the rate of CVD events during follow-up was still high (30.7%) for the men born in 1943. No statistically significant interaction by birth cohort in contribution of risk factors to death was found between 2 cohorts except physical inactivity.Conclusions - Despite a marked reduction in the rate of coronary artery disease death over the past 30 years, the burden of CVD events and all-cause mortality remains high. Therefore, intensified efforts to modify contributing risk factors are still required.
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| 2. |
- Fu, Michael, 1963, et al.
(författare)
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Although Coronary Mortality Has Decreased, Rates of Cardiovascular Disease Remain High: 21 Years of Follow-Up Comparing Cohorts of Men Born in 1913 With Men Born in 1943
- 2018
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Ingår i: Journal of the American Heart Association (JAHA). - : Ovid Technologies (Wolters Kluwer Health). - 2047-9980. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite a decline in mortality rates from cardiovascular disease (CVD) in the past few decades, the burden of CVD in a contemporary population remains inadequately addressed. Therefore, this study was aimed to investigate secular trends in mortality from coronary artery disease and all-cause mortality over 2 decades, by comparing 2 cohorts of men born 30 years apart and evaluate the prediction of the risk of CVD and all-cause death in a contemporary random sample of Swedish men. METHODS AND RESULTS: Two cohorts of randomly selected men born in 1913 (855 men) and 1943 (798 men) were first examined at age 50 in 1963 and 1993, respectively, and followed longitudinally over 21 years. All-cause mortality and coronary artery disease death were lower in 50- to 71-year-old men born in 1943 compared with those born in 1913, with unadjusted hazard ratios of 0.57 (0.45-0.71) and 0.34 (0.22-0.53), respectively. After adjustment for risk factors (smoking, serum cholesterol, hypertension, systolic blood pressure, diabetes mellitus, body mass index, and physical activity), the differences between the cohorts remained significant for coronary artery disease, hazard ratios 0.57 (0.34-0.94), P=0.029, but not for all-cause mortality hazard ratios 0.82 (0.62-1.07), P=0.14. However, the rate of CVD events during follow-up was still high (30.7%) for the men born in 1943. No statistically significant interaction by birth cohort in contribution of risk factors to death was found between 2 cohorts except physical inactivity. CONCLUSIONS: Despite a marked reduction in the rate of coronary artery disease death over the past 30 years, the burden of CVD events and all-cause mortality remains high. Therefore, intensified efforts to modify contributing risk factors are still required.
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| 3. |
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| 4. |
- Novak, Masuma, 1969, et al.
(författare)
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Gender differences in the prevalence of metabolic syndrome in 50-year-old Swedish men and women with hypertension born in 1953
- 2013
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Ingår i: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 27, s. 56-61
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Tidskriftsartikel (refereegranskat)abstract
- To investigate potential gender differences in the role of hypertension as a risk factor for metabolic syndrome (MetS) we used a random population sample of 50-year-old men (n=595) and women (n=667; all born in 1953) who were examined in 2003-2004. Systolic (SBP) and diastolic (DBP) blood pressure values were dichotomized at >/=140 mm Hg and >/=90 mm Hg, respectively. MetS was defined using NCEP (National Cholesterol Education Programme) and IDF (International Diabetes Federation) criteria. MetS was more prevalent in men than in women (NCEP 16% versus 10%, P=0.003; IDF 26% versus 16%, P=0.000) and systolic hypertension was more common in men than in women (high SBP 24% versus 18%, P=0.003; high DBP 29% versus 24%, P=0.074). Women with high SBP had about a seven-fold increased NCEP risk compared with normotensive women (odds ratio (OR) 6.91, confidence interval (CI) 2.90-16.42), whereas high SBP in men was associated with about a three-fold increased NCEP risk (OR 2.72, CI 1.69-4.38). A similar pattern was observed for the IDF criterion of MetS. All interaction terms (sex x hypertension) were significant at P<0.01. At middle age, despite that fewer women had hypertension or MetS than men, hypertension carries a relatively greater risk for MetS in women than in men.Journal of Human Hypertension advance online publication, 1 December 2011; doi:10.1038/jhh.2011.106.
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| 5. |
- Rosengren, Annika, 1951, et al.
(författare)
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Obesity and trends in cardiovascular risk factors over 40 years in Swedish men aged 50.
- 2009
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Ingår i: Journal of internal medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 266:3, s. 268-76
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study trends over 40 years in cardiovascular risk factors in normal weight, overweight and obese men, all aged 50 when examined. Design. Cross-sectional studies of five successive cohorts of men aged 50. SETTING: City of Göteborg, Sweden. SUBJECTS: Random population samples of altogether 3251 urban Swedish men born in 1913, 1923, 1933, 1943 and 1953. MAIN OUTCOME MEASURES: Anthropometry, cardiovascular risk factors, rates of nonsmoking, normotension and serum cholesterol <5 mmol L(-1) over four decades. RESULTS: Over 40 years, there was a net increase in body mass index (BMI) from 24.8 (SD = 3.2) to 26.4 (3.7) kg m(-2) (P < 0.0001), with an increase in the prevalence of obesity (BMI >or= 30 kg m(-2)) from 6.0% in 1963 to 13.8% in 2003. Favourable trends with respect to smoking, blood pressure and serum cholesterol were observed similarly amongst normal weight, overweight and obese men. In 1963, 24% of obese men were normotensive compared to 45% in 2003, and 6% had serum cholesterol <5 mmol L(-1) compared to 34% in 2003. Compared with obese men in 1963, men who were obese in 2003 had an odds ratio (OR) of 3.39 being a nonsmoker [95% confidence interval (CI): 1.56 to 7.36], 2.67 of being normotensive (1.23 to 5.83) and having serum cholesterol <5 mmol L(-1) of 8.30 (2.37 to 29.0). However, optimal risk factor status - no smoking, normotension and total serum cholesterol <5 mmol L(-1)- was still present in less than one in six men in 2003, similar across BMI categories. CONCLUSIONS: Obese Swedish men who are now in their fifties have much lower levels of other risk factors compared with obese men 40 years ago. This could contribute to explain why coronary heart disease death rates still are falling despite increasing rates of obesity.
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| 6. |
- Rosengren, Annika, 1951, et al.
(författare)
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Serum lipids in fathers and sons at middle age. The study of sons to men born in 1913.
- 2003
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Ingår i: Journal of Internal Medicine. - 0954-6820. ; :254, s. 126-131
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To relate lipid levels in middle-aged men to that of their fathers at 50 years of age measured 30 years earlier. DESIGN AND SUBJECTS: In 1963, 855 men born in 1913 took part in a cardiovascular risk factor survey when they were at 50 years of age. In 1993, 475 sons to these men, aged 44-56, were invited to another examination; 263 of these men were examined (response rate: 56%) and compared with their 217 fathers when they were examined at 50 years of age in 1963. In the 1993 survey, 798 men aged 50, were also examined, from a general population sample of men born in 1943 (response rate: 55%). SETTING: City of Goteborg, Sweden. MAIN OUTCOME MEASURES: Serum lipids in sons as a function of lipids in their fathers. RESULTS: Compared with the men born in 1913, both sons and men born in 1943 had lower mean serum cholesterol, but higher body mass index (BMI) and serum triglycerides. There was a significant relation between serum cholesterol in sons and their fathers (r = 0.25; P < 0.0001). Amongst sons to fathers in the highest cholesterol quartile (>6.9 mmol x L(-1)), 37% had serum cholesterol above 6.5 mmol x L(-1), compared with 16% amongst sons to fathers in the lowest quartile (<5.7 mmol x L(-1)) [adjusted odds ratio 3.73 (1.52-9.12)]. Sons to fathers with the highest serum cholesterol levels had slightly lower BMI; otherwise there was no relation between serum cholesterol in the father and any other lifestyle or biological risk factor in the sons. Serum triglyceride concentration in the father was unrelated to any variable in the son. CONCLUSIONS: There was a moderately strong association between serum cholesterol concentration in fathers and sons at middle age. However, secular trends were also important in determining serum cholesterol concentrations in those born at a later period, indicating a major role of environmental factors. PMID: 12859693 [PubMed - indexed for MEDLINE]
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| 7. |
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| 8. |
- Welin, Lennart, et al.
(författare)
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Därför vill 1943 års män arbeta vidare efter 65 års ålder
- 2013
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 110:38
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- A random sample of men born in 1943 were asked about their views just before their 65th birthday (the common age of retirement in Sweden). 786 (64%) responded. They were divided into 4 groups: Group 1 (11%) retired before the age of 60, group 2 (25%) retired between the ages of 60 and 64, group 3 (22%) planned to retire around the age of 65, and group 4 (42%) planned to continue working after the age of 65. Men in group 1 reported more diseases and lower education than men in the other groups. Men in group 4 had higher education, more often office work, a partner who was still working and felt healthier than the other men. The men in group 4 were also happier with their work and had more influence on their working conditions than the other men, but they were worried about retiring too early.
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| 9. |
- Welin, Lennart, 1941, et al.
(författare)
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Insulin resistance, glucose intolerance, physical activity and other risk factors for coronary heart disease in elderly men. The study of men born in 1913 and 1923.
- 2003
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Ingår i: European Journal of Cardiovascular Prevention and Rehabilitation. - 1741-8267. ; :10, s. 283-288
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We have previously shown that insulin is not a major risk factor for CHD. Our data have been re-analysed with longer follow-up and the homeostasis model assessment (HOMA) method. DESIGN: Prospective cohort study of 57- and 67-year-old men. METHODS: Insulin resistance was estimated with the HOMA equation. Standard methods were used to measure risk factors. The endpoint (CHD) was the combination of non-fatal myocardial infarction and fatal CHD during 13 years of follow-up. RESULTS: The risk of CHD increased 2.5-fold in known diabetics compared with those with normal glucose tolerance, 2.2-fold among those in the highest compared with the lowest quintile of insulin resistance, and 2.4-fold among those in the highest compared with the lowest quintile of fasting insulin. Increased physical activity decreased the risk of CHD by 65%. Cholesterol was also a significant risk factor for CHD but blood pressure, obesity and smoking were not related to the incidence of CHD. CONCLUSION: Insulin resistance is a significant risk factor for CHD. Whether it is a causal risk factor remains to be proven. Regular physical activity protects against CHD. PMID: 14555884 [PubMed - indexed for MEDLINE]
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| 10. |
- Welin, Lennart, et al.
(författare)
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Prevalence of cardiovascular risk factors and the metabolic syndrome in middle-aged men and women in Gothenburg, Sweden
- 2008
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 8, s. 403-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Random samples of 50-year-old men living in Gothenburg have been examined every 10th year since 1963 with a focus on cardiovascular risk factors. The aims of the study were to acquire up-to-date information about risk factors in the fifth cohort of 50-year-old men and women, to re-examine those who were 50 years of age in 1993, and to analyse the prevalence of the metabolic syndrome (MetSyn) using different definitions. METHODS A random sample of men and women born in 1953 were examined in 2003-2004 for cardiovascular risk factors. Men born in 1943 and that participated in the examination in 1993 were also invited. Descriptive statistics were calculated. RESULTS The participation rate among men and women born in 1953 was 60 and 67% respectively. Among men born in 1943, the participation rate was 87%. The prevalence of obesity was from 15 to 17% (body mass index, BMI >or= 30) in the three samples. The prevalence of known diabetes was 4% among the 50-year-old men and 6% among the 60-year-old men, and 2% among the women. Increased fasting plasma glucose varied substantially from 4 to 33% depending on cut-off level and gender. Mean cholesterol was 5.4 to 5.5 mmol/l. Smoking was more common among women aged 50 (26%) than among men aged 50 (22%) and 60 years (15%). The prevalence of the MetSyn varied with the definition used: from 10 to 15.8% among the women, from 16.1 to 26% among 50-year-old men, and from 19.9 to 35% among the 60-year-old men. Only 5% of the men and women had no risk factors. CONCLUSION This study provides up-to-date information about the prevalence of cardiovascular risk factors and the MetSyn in middle-aged Swedish men and women. Different definitions of the MetSyn create confusion regarding which definition to use.
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| 11. |
- Wilhelmsen, Lars, 1932, et al.
(författare)
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Factors associated with reaching 90 years of age : a study of men born in 1913 in Gothenburg, Sweden
- 2011
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 269:4, s. 441-451
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Increasing numbers of people reach old age. We wanted to identify variables of importance for reaching 90 years old and determine how the predictive ability of these variables might change over time. Setting and subjects. All men in the city of Gothenburg born in 1913 on dates divisible by 3, which is on the 3rd, 6th, 9th etc., were included in the study. Thus, 973 men were invited, and 855 were examined in 1963 at age 50. Further examinations were made at age 54, 60 and 67. Anthropometric data, lifestyle and parental factors, blood pressure, lung function, X-ray of heart and lungs and maximum work performance were recorded. The area under the receiver operating characteristic curve was used to analyse the predictive capacity of a variable. Results. A total of 111 men (13%) reached 90 years of age, men who reached 90 years were more likely at age 50 to be nonsmokers, consume less coffee, have higher socio-economic status and have low serum cholesterol levels than those who did not reach this age; however, at age 50 or 62, parents' survival was of no prognostic importance. Variables of greatest importance at higher ages were low blood pressure and measures related to good cardiorespiratory function. In multivariable analysis, including all examinations, being a nonsmoker, consuming small amounts of coffee, having high housing costs at age 50, good maximum working capacity and low serum cholesterol were related to a better chance of survival to age 90. Conclusions. Low levels of cardiovascular risk factors, high socio-economic status and good functional capacity, irrespective of parents' survival, characterize men destined to reach the age of 90.
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| 12. |
- Zhong, You, et al.
(författare)
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Secular changes in cardiovascular risk factors in Swedish 50-year-old men over a 50-year period : The study of men born in 1913, 1923, 1933, 1943, 1953 and 1963
- 2017
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 24:6, s. 612-620
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Tidskriftsartikel (refereegranskat)abstract
- Background: During the past decades, declining trends in mean cholesterol levels and smoking have been observed in Western Europe, whereas obesity and a sedentary lifestyle have increased. Simultaneously, there has been a marked decrease in mortality from cardiovascular (CV) diseases. Methods: The aim of the study was to determine whether these trends in CV risk factors continued over a period of 50 years. Six systematic or random population samples of 50-year-old men (n = 3563) living in Gothenburg, Sweden, were investigated between 1963 and 2013. Results: During the 50 years, mean body mass index (BMI) at 50 years of age increased by 2 kg/m(2), from 24.8 kg/m(2) in 1963 to 26.8 kg/m(2) in 2013 (p< 0.001). A decrease in systolic blood pressure of nearly 10mmHg was observed from 1963 to 1993, but was not sustained through the past two decades. Mean serum cholesterol fell from 6.42 (SD 1.12) mmol/L to 5.34 (SD 0.97) mmol/L. The prevalence of smoking at 50 years of age decreased markedly from 56.1% in 1963 to 11.9% in 2013. The number of participants with a sedentary lifestyle during leisure time decreased until 1993, but has remained unchanged since. In 2013, 50-year-old men had a 6.9-times higher likelihood of lacking CV risk factors than 50-year-old men in 1963 (95% confidence interval (CI): 3.5-13.3, p< 0.001). The odds ratio for having four or more risk factors was only 0.13 (95% CI: 0.062-0.29, p< 0.001). Conclusion: Despite increasing body weight, the total CV risk factor burden has decreased in 50-year-old men over the past 50 years.
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| 13. |
- Björck, Lena, 1959, et al.
(författare)
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Secular trends in lipid-lowering treatment and lipid levels after a first acute myocardial infarction.
- 2007
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Ingår i: Vascular health and risk management. - 1176-6344. ; 3:6, s. 1045-51
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The beneficial effects of statins were unequivocally demonstrated in the Scandinavian Simvastatin Survival Study (4S) in 1994, leading to an increase in the use of lipid-lowering drugs. However, to what extent this translates into serum cholesterol levels in a real-life setting has not been systematically investigated. OBJECTIVE: To estimate secular trends from 1994 to 2002 in blood lipid levels among unselected younger patients after a first acute myocardial infarction (AMI). METHOD: Descriptive single centre study using consecutive data collection in 781 patients (aged <65 years) hospitalized with a first AMI during the period 1994-2002. RESULTS: From 1994-2002, the use of lipid-lowering drugs increased from 10% to 94% for men and from 23% to 90% for women. In 1994, the mean serum cholesterol levels were 6.53 mmol/l in men and 6.32 mmol/l in women, decreasing to 4.31 mmol/l and 5.13 mmol/l in men and women, respectively, in 2002. Still, only 56% of the men and 35% of the women had total serum cholesterol levels <4.5 mmol/l in 2002. CONCLUSION: Despite a marked increase in lipid-lowering drug treatment in which there was an increase from about 10% in 1994 to more than 90% in 2002, current target levels of <4.5 mmol/l for serum cholesterol were not achieved in a significant proportion of post-AMI patients.
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| 14. |
- Halford, Christina, et al.
(författare)
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A population-based study of nearly 15 000 observations among Swedish women and men during 1973-2003
- 2012
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 2:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Global self-rated health (SRH) has become extensively used as an outcome measure in population health surveillance. The aim of this study was to analyse the effects of age and secular trend (year of investigation) on SRH.Design Prospective cohort study, using population-based data from eight ongoing cohort studies, with sampling performed between 1973 and 2003.Setting Sweden.Participants 11 880 women and men, aged 25–99 years, providing 14 470 observations.Primary outcome measure Global SRH.Results In multiple ordinal logistic regression analyses, adjusted for the effects of covariates, there were independent effects of age (p<0.0001) and of year of investigation (p<0.0001) on SRH. In women the association was linear, showing lower levels of SRH with increased age, and more recent year of investigation. In men the association was curvilinear, and thus more complex. The final model explained 76.2% of the SRH variance in women and 74.5% of the variance in men.Conclusions SRH was strongly and inversely associated with age in both sexes, after adjustment for other outcome-affecting variables. There was a strongly significant effect of year of investigation indicating a change in SRH, in women towards lower levels over calendar time, in men with fluctuations across time.
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| 15. |
- Holtback, Charlotte, et al.
(författare)
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Mid-life extrapyramidal symptoms predict cognitive impairment 23 years later
- 2022
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:3, s. 305-313
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The prevalence of dementia is growing rapidly worldwide. The early identification and treatment of cognitive decline could reduce the burden on the health care system. Our objective was to investigate whether factors measured at an examination at age 50 predict cognitive impairment (CI) 23 years later. Materials & Methods In 1993 we enrolled a randomly selected sample of 798 men, 50 years of age, from the general population. They all underwent a physical examination, provided blood samples and filled out questionnaires addressing lifestyle and psychosocial factors. Cognitive testing was offered to all participants still alive in 2016, at age 73. Results A total of 333 men participated in the cognitive study, of which 80 (24.0%) performed at a level corresponding to mild cognitive impairment, and four (1.2%) at a level consistent with severe cognitive impairment. After the first step in the multivariable analysis, hypertension, heavy smoking, high intake of alcohol, financial stress, difficulty falling asleep, and cogwheel rigidity were associated with cognitive impairment. After further adjustment, only wide waist circumference measured in cm (OR 1.04, 95% CI 1.00-1.08, p = .04), leg pendulousness (OR 41.97, 95% CI 3.27-538.62, p = .004) and self-assessed hidden irritability (OR 2.18, 95% CI 1.10-4.32, p = .03) at baseline, remained as being associated with cognitive impairment 23 years later. Conclusions Extrapyramidal symptoms such as leg pendulousness, at the age of 50, may be an indicator for very early identification of future cognitive decline.
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| 16. |
- Janson Fagring, Annika, 1949, et al.
(författare)
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Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain
- 2008
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 8:165
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Unexplained chest pain (UCP) is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL). METHODS: A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED) or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected. RESULTS: The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL. CONCLUSION: Both men and women with UCP had higher depression scores than referents, but an independent association was only found in women. Among men, perceived stress at work emerged as the only psychosocial variable significantly associated with UCP.
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| 17. |
- Janson Fagring, Annika, 1949, et al.
(författare)
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Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987-2006 from the Swedish hospital and death registries
- 2010
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Ingår i: Heart. - : BMJ Publishing Group. - 1355-6037 .- 1468-201X. ; 96:13, s. 1043-1049
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study trends for 20 years in incidence and 1-year mortality in hospitalised patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden. Design and setting Register study of all patients aged 25–84 years identified from the Swedish National Hospital Discharge Register who were hospitalised with a first-time diagnosis of UCP or angina pectoris during 1987 to 2006. Participants A total of 378454 patients, 235855 with UCP and 142599 with angina. Main outcome measures 1-Year mortality and standardised mortality ratios (SMRs). Results From the period 1987–1991 to 2002–2006, the observed 1-year mortality rate in men and women with UCP aged 25–74 years decreased from 2.19% to 1.45% and from 1.85% to 0.91%, respectively. SMRs decreased from 1.67 (95% CI 1.39 to 1.95) and 1.63 (1.27 to 2.00) to 1.09 (0.96 to 1.23) and 0.88 (0.75 to 1.00). Corresponding decreases in 1-year mortality for a discharge diagnosis of angina were from 6.50% to 2.49% in men and from 4.80% to 1.68% in women, with SMRs decreasing from 2.69 (2.33–3.05) and 2.59 (2.06–3.12) to 1.09 (0.93–1.25) and 1.05 (0.81–1.29), respectively. Similar changes occurred in patients aged 75–84 years. Only men with UCP aged 75–84 years still retained a slightly increased mortality (SMR 1.14 (1.01–1.28)). Conclusions The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population.
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| 18. |
- Janson Fagring, Annika, 1949, et al.
(författare)
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Unexplained chest pain in relation to psychosocial factors and health-related quality of life in men and women.
- 2007
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Ingår i: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 6:4, s. 329-36
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Unexplained chest pain is a frequent and increasingly common complaint among patients admitted to Emergency Departments. Previous studies have defined unexplained chest pain as non-cardiac or non-coronary artery disease, i.e. patients with other organic causes explaining the chest pain could be included. To increase the knowledge of unexplained chest pain, this study only includes patients without any known explanation for their chest pain. AIM: To analyze gender differences regarding pain characteristics, psychosocial factors and health-related quality of life among patients diagnosed unexplained chest pain. METHODS AND RESULTS: The results are based on 179 patients (101 men, 78 women) between 16 and 69 years old (mean age 45.3) consecutively admitted to Emergency Department. Pain characteristics were assessed by Pain-O-Meter. Social relationships, depression, anxiety, and health-related quality of life were measured by a self-administered questionnaire. There were no gender differences regarding chest pain intensity; however women described their pain as burning (p<0.01) and frightening (p<0.03) more often than men. Men reported less depression (p<0.01) and less trait anxiety (p=0.01) than women. Chest pain intensity did not significantly impact health-related quality of life except physical functioning in men (p=0.05). CONCLUSION: Gender differences were few. Chest pain intensity did not significantly impact health-related quality of life.
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| 19. |
- Jerlock, Margaretha, 1946, et al.
(författare)
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Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain.
- 2006
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Ingår i: BMC Nursing. - : BioMed Central. ; 5:7
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity. METHOD: The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design. RESULTS: Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative. CONCLUSION: Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience.
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| 20. |
- Jerlock, Margaretha, 1946, et al.
(författare)
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Pain characteristics in patients with unexplained chest pain and patients with ischemic heart disease.
- 2007
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Ingår i: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1474-5151. ; 6:2, s. 130-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little scientific attention has been paid to providing a comprehensive multidimensional description of chest pain in patients with unexplained chest pain. AIMS: The aims of the present study were: (1) to describe the symptom chest pain, including the dimensions of intensity, quality, duration and location in patients with unexplained chest pain (UCP); and (2) to identify similarities and differences in how patients with UCP and patients with ischemic heart disease (IHD) describe chest pain. METHOD: A descriptive, correlational and comparative design. Totally 208 consecutive UCP patients and 40 IHD patients below 70 years of age participated. Pain was assessed using the instrument Pain-O-Meter. RESULTS: The occurrence of chest pain was 79% (n=165) in UCP patients versus 60% (n=22) in the IHD patients (p=0.001). Patients with UCP reported greater pain intensity and used more sensory and affective words than IHD patients (p<0.01). Relationships between pain location and amount of body surface involved in the pain and pain intensity in both groups were found (p<0.001). CONCLUSIONS: Our results showed some defining characteristics of the UCP group, but the many similarities between the two groups in their experience of chest pain made it impossible to clearly differentiate the groups' pain profiles.
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| 21. |
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| 22. |
- Jerlock, Margaretha, 1946, et al.
(författare)
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Psychosocial profile in men and women with unexplained chest pain
- 2008
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Ingår i: J Intern Med. - : Wiley-Blackwell. ; 264:3, s. 265-274
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL). DESIGN AND SUBJECTS: The study was conducted at a university hospital in Sweden including 231 patients aged 25-69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study. RESULTS: Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36. CONCLUSIONS: In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women.
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| 23. |
- Kjellgren, Karin I, 1950, et al.
(författare)
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Evaluation of doctoral nursing programs A review and a strategy for follow up.
- 2005
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Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 25:4, s. 316-325
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Tidskriftsartikel (refereegranskat)abstract
- Enhancing and assuring the quality of doctoral nursing programs is currently of major concern to promote growth in quality and quantity of research in nursing. The aims of the paper were to review the literature about evaluation of higher education with focus on doctoral programs in nursing, and to present a strategy to evaluate a doctoral nursing program. A search of literature in relevant databases was done using the keywords doctoral program, evaluation, nursing, program evaluation and higher education. From the review it is concluded that more systematic evaluations are necessary to guide the development of quality in nursing. Attention must be given to the curricula, competence in the faculty, the research activity and to the students' involvement in courses and research. Therefore, a strategy for evaluation should be ongoing, flexible, systematic and comprehensive. It should involve students, graduates, employers and faculty members in evaluation, include process and outcome data and give possibility for comparison to internal and external standards. The strategy developed aims to facilitate ongoing and future improvement of the doctoral nursing program. This process is dependent on a methodological pluralism of evaluation to detect what is of most weight for growth in the process of research and education. PMID: 15896417 [PubMed - indexed for MEDLINE]
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| 24. |
- Kjellgren, Karin I, 1950, et al.
(författare)
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Oförklarad bröstsmärta ur ett patientperspektiv
- 2009
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Ingår i: Vaskulär medicin. ; 25:4, s. 211-213
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- De senaste tjugo åren har antalet patienter med oförklarad bröstsmärta mer än fördubblats. Patienterna är oftast i medelåldern och mer än en tredjedel är födda utanför Sverige. Smärtan orsakar oro, ångest, osäkerhet och kraftlöshet. Två avhandlingar från Sahlgrenska akademin vid Göteborgs universitet [1, 2] har studerat oförklarad bröstsmärta, främst ur patientens synvinkel.
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| 25. |
- Meijer, A., et al.
(författare)
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Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis
- 2013
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 203:2, s. 90-102
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Tidskriftsartikel (refereegranskat)abstract
- Background The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity. To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity. An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses. Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively. The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.
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| 26. |
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| 27. |
- Persson, Christina, 1985, et al.
(författare)
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Cardiovascular risk factors in relation to dietary patterns in 50-year-old men and women: a feasibility study of a short FFQ
- 2019
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Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1475-2727 .- 1368-9800. ; 22:4, s. 645-653
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We aimed to assess the feasibility of a simple new fifteen-item FFQ as a tool for screening risk of poor dietary patterns in a healthy middle-aged population and to investigate how the results of the FFQ correlated with cardiovascular risk factors and socio-economic factors. DESIGN: A randomized population-based cross-sectional study. Metabolic measurements for cardiovascular risk factors and information about lifestyle were collected. A fifteen-item FFQ was created to obtain information about dietary patterns. From the FFQ, a healthy eating index was created with three dietary groups: good, average and poor. Multivariate logistic regression was used to assess relationships between dietary patterns and cardiovascular risk factors. SETTING: Sweden. SUBJECTS: Men and women aged 50 years and living in Gothenburg, Sweden. RESULTS: In total, 521 middle-aged adults (257 men, 264 women) were examined. With good dietary pattern as the reference, there was a gradient association of having obesity, hypertension and high serum TAG in those with average and poor dietary patterns. After adjustment for education and lifestyle factors, individuals with a poor dietary pattern still had significantly higher risk (OR; 95 % CI) of obesity (2.33; 1.10, 4.94), hypertension (2.73; 1.44, 5.20) and high serum TAG (2.62; 1.33, 5.14) compared with those with a good dietary pattern. CONCLUSIONS: Baseline data collected by a short FFQ can predict cardiovascular risk factors in middle-aged Swedish men and women. The FFQ could be a useful tool in health-care settings, when screening for risk of poor dietary patterns.
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| 28. |
- Wallmyr, Gudrun, 1956, et al.
(författare)
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Young people, pornography and sexuality: Sources and attitudes.
- 2006
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Ingår i: Journal of School Nursing. - 1059-8405. ; 22:5, s. 290-295
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate the use of and attitudes among young people toward pornography and their sources of information about sexuality. Eight hundred and seventy-six young people ages 15-25 years (555 females and 321 males) who visited a youth centre in Sweden for a period of 1 year answered a questionnaire about their use of pornography, their attitudes toward pornography, and sources of information about sexuality. Although most had seen pornographic movies, the youngest boys reported viewing the most pornography. The male participants reported that the most common reason they viewed pornography was to get aroused and to masturbate, whereas the female participants stated that they viewed pornography out of curiosity. The most frequent source of information about sexuality was peers. The results illustrate the importance of sex education to give factual information about sexuality and to counteract the messages about sexuality presented in pornography.
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| 29. |
- Welin, Catharina, 1945, et al.
(författare)
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Behavioural characteristics in patients with myocardial infarction: a case-control study
- 1995
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Ingår i: Journal of Cardiovascular Risk. - 1350-6277. ; 2:3, s. 247-254
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Over the past 10-20 years, evidence has accumulated suggesting that it is not just biological risk factors that are important for the development of coronary heart disease. The present study is one of a series of case-control studies in which a wide range of psychosocial factors have been analysed in the same population to obtain information on their relationship with myocardial infarction, as well as of the interaction between psychosocial and biomedical variables. METHODS: The relationship between behavioural factors and non-fatal myocardial infarction was studied by comparing consecutively admitted male (n = 288) and female (n = 55) patients with a population sample of 283 men and 129 women. All participants were under 65 years of age. The behavioural variables (type-A behaviour, health locus of control, sleep problems and alcohol consumption) were investigated by means of a self-administered questionnaire. RESULTS: No significant differences emerged between patients with myocardial infarction and controls in terms of their type-A behaviour pattern. After controlling for traditional risk factors (smoking, hypertension, serum cholesterol level and diabetes), men with myocardial infarction reported a significantly stronger external health locus of control (i.e. a weak belief in their capacity to control their health) compared with their controls, as well as more problems with sleep and a lower alcohol consumption; women with myocardial infarction reported significantly more problems with sleep than their controls. CONCLUSION: The importance of health locus of control, sleep problems and alcohol consumption is amplified by the fact that they are related to myocardial infarction independently of conventional biomedical risk factors. These behavioural factors should be studied further in prospective investigations. PMID: 7584801 [PubMed - indexed for MEDLINE]
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| 30. |
- Welin, Catharina, 1945, et al.
(författare)
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Independent importance of psychosocial factors for prognosis after myocardial infarction.
- 2000
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Ingår i: Journal of Internal Medicine. - 0954-6820. ; 247:6, s. 629-639
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: As a primary aim it was tested whether the 10-year prognosis after a myocardial infarction is related to psychological stress, lack of social support, anxiety, and/or depressive tendency. A secondary aim was to analyse the prognostic importance of a series of other psychosocial factors as well as interactions. METHODS: Non-selected patients aged below 65 years with a first infarction (230 men and 45 women) were followed for 10 years with 100% assessment of morbidity and cause-specific mortality. Baseline somatic and psychosocial variables were collected with the aid of standard, validated questionnaires. RESULTS: In multivariate analysis, factors increasing risk for coronary mortality included female sex (hazard ratio, +/- 95% confidence interval) 2.47 (1.06, 5.71), signs of left ventricular failure 3.93 (1.87, 8.26), ventricular dysrhythmia 3 months after the infarction 5.45 (2.21, 13. 42), high depression scores 3.16 (1.38, 7.25) and lack of social support 2.75 (1.29, 5.89). All-cause mortality was significantly related to left ventricular failure, ventricular dysrhythmias, and high depression scores with borderline significance for female sex and social support. Prognosis was affected during the entire follow-up period. It was not significantly associated with age, marital status, education, extra work, mental strain at work or in the marriage, anxiety, dissatisfaction with family life, problems with children, dissatisfaction with the financial situation, life events, anger-in, irritability, type A behaviour, or health locus of control. Incidence of nonfatal infarction was not associated with any of the baseline variables. CONCLUSION: In addition to known somatic predictors of prognosis after a myocardial infarction, prognosis is strongly influenced by depression and lack of social support, but not to a series of other psychosocial factors. It is recommended to use self-reporting scales to detect prognostically important psychosocial problems. PMID: 10886484 [PubMed - indexed for MEDLINE]
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| 31. |
- Welin, Catharina, 1945, et al.
(författare)
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Myocardial infarction in relation to work, family and life events
- 1995
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Ingår i: Cardiovascular Risk Factors. - 1130-7501. ; 5:1, s. 30-38
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Tidskriftsartikel (refereegranskat)abstract
- The relationship between psychosocial factors and nonfatal myocardial infarction (MI) was studied by comparing, controlling for traditional risk factors, consecutive male (n=55) patients, who had had a first MI, with a population sample of 283 men and 129 women. All were <65 years of age. The psychosocial factors were investigated by means of a self-administered questionnaire. Men with MI significantly more often did shift work, reported mental strain at work, reported dissatisfaction with their financial situation, and had experienced more negative life events during the last year, compared to controls. Women with MI more often reported mental strain at work and dissatisfaction with their financial situation compared with controls. After controlling for traditional risk factors (smoking, hypertension, serum cholesterol, and diabetes), all factors were still significantly related to MI among men. Among women, only mental strain at work remained significant. However, there were no differences between MI patients and controls in educational level, overtime or extra work, marital status, or other family circumstances. In multivariate analyses including traditional risk factors and all significant psychosocial factors, mental strain at work emerged as an independent risk factor in both sexes, whereas negative life events during the last year was an independent risk factor in men only.
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| 32. |
- Welin, Catharina, 1945, et al.
(författare)
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Psychological characteristics in patients with myocardial infarction : A case-control study
- 1994
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Ingår i: Cardiovascular Risk Factors. - 1130-7501. ; 4:3, s. 154-161
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Tidskriftsartikel (refereegranskat)abstract
- The relationship between psychological factors and nonfatal myocardial infarction (MI) was studied by comparing consecutive male (n=288) and female (n=55) patients, who had suffered a first MI, with a population sample of 283 men and 129 women. All were aged below 65. The psychological factors were investigated by means of a self-administered questionnaire. Both men and women with MI reported significantly more irritability and anxiety than their referents, and also more depressive symptoms and less meaningfulness. After controlling for traditional risk factors (smoking, hypertension, serum cholesterol, and diabetes) all factors were still significantly related to MI among men. Among women solely anxiety remained significant. However, there were no differences between MI patients and referents concerning anger-in or sense of guilt. In multivariate analyses including traditional risk factors and all significant psychological factors irritability and depression emerged as independent risk factors in men, whereas no independent psychological risk factors could be demonstrated in women.
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| 33. |
- Welin, Catharina, 1945, et al.
(författare)
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Social relationships and myocardial infarction: a case-control study.
- 1996
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Ingår i: Journal of Cardiovascular Risk. - 1350-6277. ; 3:2, s. 183-190
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: For more than 10 years there has been increasing evidence that not only biological risk factors are important for the development of coronary heart disease. The present study is one of a series of case-control studies in which a wide range of psychosocial factors in the same population have been analysed to obtain information on their relationship with myocardial infarction, and of the interaction between psychosocial and biomedical variables. METHODS: The association between social relationships and nonfatal myocardial infarction was studied by comparing consecutively admitted male (n = 288) and female (n = 55) patients with myocardial infarction with a population sample of 283 men and 129 women. All participants were under 65 years of age. The social relationships were investigated by means of a self-administered questionnaire. RESULTS: Men with myocardial infarction reported significantly lower perceived emotional support compared with their controls, as well as less social activity. Women with myocardial infarction reported significantly less social activity than their controls. There were no significant differences between cases and controls in social integration (number and frequency of social relationships and contacts). Neither did dissatisfaction with social relationships differ significantly between patients with myocardial infarction and controls. After controlling for traditional risk factors (smoking, hypertension, serum cholesterol level, diabetes) perceived emotional support remained significantly related to myocardial infarction in men, and so did the amount of social activity in both men and women. CONCLUSION: The importance of perceived emotional support and lack of social activity is amplified by the fact that they are related to myocardial infarction independently of conventional biomedical risk factors. These social factors should be studied further in prospective investigations. PMID: 8836861 [PubMed - indexed for MEDLINE]
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| 34. |
- Wiklund, Ingela, et al.
(författare)
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A comparison of different psychosocial questionnaires in patients with myocardial infarction.
- 1992
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Ingår i: Scandinavian Journal of Rehabilitation Medicine. - 0036-5505. ; 24:4, s. 195-202
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Tidskriftsartikel (refereegranskat)abstract
- In a consecutive study of 140 patients investigated one month after myocardial infarction (MI), a battery of American and English questionnaires was used to measure depression, anxiety, sleep problems, health locus of control and perceived health. These measures were compared with a well-documented generic questionnaire, the Nottingham Health Profile (NHP), and a similarly well-documented mood scale, the Mood Adjective Check List (MACL). There was close agreement among all measures depicting anxiety and tension. The concordance between the measures of anxiety states and depression was lower. Depression and sleep problems seem to constitute separate concepts, since they are not as highly related to the other measures of anxiety. Because psychosocial factors are important measures for the outcome after an infarction, accurate assessments of these variables are required. Further research is clearly warranted to clarify the complicated interaction between psychosocial constructs and to improve the methods used for their evaluation.
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