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- Nilsson, Peter, et al.
(author)
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The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese.
- 2002
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In: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 252:1, s. 70-78
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Journal article (peer-reviewed)abstract
- Objective. To study effects on non-cancer mortality of observational weight loss in middle-aged men stratified for body mass index (BMI), taking a wide range of possible confounders into account. Design. Prospective, population based study. Setting. Male population of Malmö, Sweden. Participants. In all 5722 men were screened twice with a mean time interval of 6 years in Malmö, southern Sweden. They were classified according to BMI category at baseline (<21, 22-25, overweight: 26-30, and obesity: 30+ kg m-2) and weight change category until second screening (weight stable men defined as having a baseline BMI ± 0.1 kg m-2 year-1 at follow-up re-screening). Main outcome measures. Non-cancer mortality calculated from national registers during 16 years of follow-up after the second screening. Data from the first year of follow-up were excluded to avoid bias by mortality caused by subclinical disease at re-screening. Results. The relative risk (RR; 95% CI) for non-cancer mortality during follow-up was higher in men with decreasing BMI in all subgroups: RR 2.64 (1.46-4.71, baseline BMI <21 kg m-2), 1.39 (0.98-1.95, baseline BMI 22-25 kg m-2), and 1.71 (1.18-2.47, baseline BMI 26+ kg m-2), using BMI-stable men as reference group. Correspondingly, the non-cancer mortality was also higher in men with increasing BMI, but only in the obese group (baseline BMI 26+ kg m-2) with RR 1.86 (1.31-2.65). In a subanalysis, nonsmoking obese (30+ kg m-2) men with decreased BMI had an increased non-cancer mortality compared with BMI-stable obese men (Fischer's test: P=0.001). The mortality risk for nonsmoking overweight men who increased their BMI compared with BMI-stable men was also significant (P=0.006), but not in corresponding obese men (P=0.094). Conclusions. Weight loss in self-reported healthy but overweight middle-aged men, without serious disease, is associated with an increased non-cancer mortality, which seems even more pronounced in obese, nonsmoking men, as compared with corresponding but weight-stable men. The explanation for these observational findings is still enigmatic but could hypothetically be because of premature ageing effects causing so-called weight loss of involution.
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| 3. |
- Stagmo, Martin, et al.
(author)
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The Swedish national programme for quality control of secondary prevention of coronary artery disease - Results after one year
- 2004
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In: European Journal of Cardiovascular Prevention & Rehabilitation. - : Oxford University Press (OUP). - 1741-8267 .- 1741-8275. ; 11:1, s. 18-24
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Research review (peer-reviewed)abstract
- Background: Guidelines for the prevention of coronary artery disease (CAD) have been developed both in Europe and in the USA. However, several surveys have shown that these guidelines are poorly implemented in clinical practice. Design/methods: The Swedish Quality Control Programme on Secondary Prevention of CAD includes patients after myocardial infarction, or having undergone coronary artery surgery or percutaneous coronary intervention. Fifty of Sweden's 79 hospital districts are currently participating. Patients are asked to send report-cards regarding risk factor management to a central registry after discharge from hospital, at a 3-6 month visit and then yearly for 5 years. Results: Results based on data from 1 year after the index event show that a majority of patients reach targets for serum cholesterol (70%), and low-density lipoprotein (LDL)-cholesterol (71%). Mean value for total cholesterol is 4.6 (± SD 0.9) mmol/l, LDL-cholesterol 2.7 (± SD 0.8) mmol/l. Blood pressure targets are less often achieved, with 58% reaching the European Society of Cardiology target for systolic (< 140 mmHg) and 81% for diastolic (< 90 mmHg) blood pressure. A large proportion of patients are prescribed preventive drugs: aspirin (96%), beta-blockers (78%) and lipid-lowering drugs (83%). Conclusions: The Swedish Quality Control Programme is one of the first attempts to assess implementation of guidelines on a national level based on patient participation. It is hoped that shared care programmes and increased patient involvement with feedback on achieved treatment goals in relation to guidelines will improve outcomes in patients with CAD. © 2004 The European Society of Cardiology.
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| 6. |
- Gudbjörnsdottir, Soffia, et al.
(author)
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Nationella diabetesregistret 1996-2003 : Kvalitetsvärdering visar att diabetesvården har förbättrats
- 2004
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 101:47, s. 3790-3797
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Journal article (other academic/artistic)abstract
- The Swedish National Diabetes Register presents results during the period 1996- 2003. Quality of care data from more than 75,000 diabetic patients (2003) treated at medical departments and primary health care centres are evaluated concerning national goals of HbA1c <6,5% and BP <140/85 mm Hg, the prevalence of lipid treatment, smoking etc. The national goals of HbA1c and BP were reached with increasing degree in cross-sectional analysis during the period, and were achieved by 33% and 71% at medical departments, and by 61% and 48% in primary health care in 2003. A similar tendency was also seen in longitudinal analysis of subgroups 1996-2003. The use of antihypertensive and lipid-lowering drugs was also considerably increased. This should imply a reduction of the risk for diabetic complications. As the national goals are still difficult to reach, individual goals should be set for the treatment.
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| 7. |
- Nilsson, Peter, et al.
(author)
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Prevalence of the metabolic syndrome: impact on cardiovascular epidemiology - a population study from Malmö, Sweden
- 2002
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In: Heart Drug. - : S. Karger AG. - 1424-0556 .- 1422-9528. ; 2:6, s. 273-278
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Journal article (peer-reviewed)abstract
- <i>Background:</i> The metabolic syndrome is an emerging risk factor complex of considerable importance for cardiovascular risk epidemiology. Insulin resistance is regarded as a key factor in this syndrome, which is also known as the insulin resistance syndrome (IRS). Epidemiological studies are needed to estimate the prevalence of the syndrome in various populations and subgroups based on gender or social/ethnic background, in order to be able to plan preventive measures. <i>Objectives:</i> To determine the prevalence and distribution of the metabolic syndrome/IRS and its association with social and ethnical background factors in middle-aged subjects. <i>Methods:</i> This was a cross-sectional case-control study carried out in Malmö, a city in southern Sweden. We included 4,567 subjects, born between 1926 and 1945, participating in a cohort study of diet and disease. The metabolic syndrome/IRS was defined as the presence of insulin resistance (by homeostasis model assessment in normoglycaemic subjects) together with two or more of the following variables: dyslipidaemia (i.e. elevated triglycerides or decreased high-density lipoprotein cholesterol), expanded waist circumference and hypertension. History of lifestyle, marital status, occupation, education level and ethnical background were assessed by a self-administered questionnaire. <i>Results:</i> The overall prevalence of the metabolic syndrome/IRS was 16.7%, with a strong relationship to age. After adjustments for age and sex, the presence of the metabolic syndrome/IRS was associated with the following factors: low physical activity [odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2–1.7], high alcohol intake (OR 1.6, 95% CI 1.1–2.4), low educational level (OR 1.5, 95% CI 1.3–1.8), low social class (OR 1.5, 95% CI 1.3–1.8) and non-Swedish origin (OR 1.5, 95% CI 1.2–1.9). <i>Conclusions:</i> The distribution of the metabolic syndrome/IRS in the general population is influenced by lifestyle habits, sociodemographic factors and ethnical background.
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| 8. |
- Rööst, Mattias, et al.
(author)
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Sömnbesvär ett folkhälsoproblem. Potentiell riskfaktor för typ 2-diabetes, insulinresistens, hypertoni, dyslipidemi och för tidigt åldrande
- 2002
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In: Läkartidningen. - 0023-7205. ; 99:3, s. 154-157
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Journal article (peer-reviewed)abstract
- A large proportion of the adult population complains over difficulties in falling asleep, difficulties in maintaining sleep, or early awakening. Despite the fact that sleep disorders may be secondary symptoms to established or subclinical disease processes, more and more evidence has now accumulated to support the notion that sleep disorders may also play a primary role in the pathophysiology of cardiovascular disease. This has recently been documented in association with metabolic disturbances and impaired insulin action following experimental sleep deprivation. Sleep disorders may finally prove to be part of the pathophysiological chain linking adverse psychosocial stress with the metabolic syndrome, and ultimately premature ageing and early mortality.
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| 9. |
- Nilsson, Peter, et al.
(author)
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Hypertension in diabetes : trends in clinical control in repeated large-scale national surveys from Sweden
- 2003
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 17:1, s. 37-44
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Journal article (peer-reviewed)abstract
- Hypertension in diabetes is an important and treatable cardiovascular risk factor. Treatment targets from guidelines cannot always be achieved in everyday clinical practice. It is therefore of great importance to monitor trends in hypertension control in defined populations. Patients with type I diabetes (range 6685-10100; treated hypertension 21-29%) or with type II diabetes (range 15935-22605; treated hypertension 47-56%) were included in four national samples between 1996 and 1999. This screening was part of the procedures for the National Diabetes Register in Sweden, which monitors trends in clinical practice and risk factors for patients with diabetes, recruited both in primary health care and at the hospital level. A favourable trend in mean and median blood pressure levels was noticed during the 4-year study period, based either on data from repeated surveys or on repeated measures in the same individual, both for type I diabetes (mean: -2/-2 mmHg; P < 0.01) and for type II diabetes (mean: -5/-3 mmHg; P < 0.001). Correspondingly, the proportion of hypertensive patients in acceptable control of blood pressure (less than or equal to140/ 85 mmHg) increased (P < 0.001) both in type I diabetes (52.0-57.9%) and in type 11 diabetes (22.4-33.3%). It was concluded that hypertension is a widespread cardiovascular risk factor in patients with diabetes, especially systolic hypertension. A trend for a better systolic blood pressure control during the late 1990s in hypertensive patients with type II diabetes in Sweden could translate into substantial (estimated) clinical benefits in cardiovascular and diabetes-related morbidity. The National Diabetes Register makes a quality assessment of the hypertension treatment possible.
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| 10. |
- Brånemark, Per-Ingvar, et al.
(author)
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Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results.
- 2004
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In: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - : Informa UK Limited. - 0284-4311. ; 38:2, s. 70-85
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Journal article (peer-reviewed)abstract
- Despite refinements in surgical technique, including bone grafting and sophisticated prosthetic reconstructions, there are limitations to what can be achieved with bone-anchored fixed prostheses in patients with advanced atrophy of the maxillae. A new approach was suggested by a long-term study on onlay bone grafting and simultaneous placement of a fixture based on a new design: the zygoma fixture, and the aim of this study was to assess its potential. Twenty-eight consecutive patients with severely resorbed edentulous maxillae were included, 13 of whom had previously had multiple fixture surgery in the jawbone that had failed. A total of 52 zygoma fixtures and 106 conventional fixtures were installed. Bone grafting was deemed necessary in 17 patients. All patients have been followed for at least five years, and nine for up to 10 years. All patients were followed up with clinical and radiographic examinations, and in some cases rhinoscopy and sinoscopy as well. Three zygoma fixtures failed; two at the time of connection of the abutment and the third after six years. Of the conventional fixtures placed at the time of the zygoma fixture, 29 (27%) were lost. The overall prosthetic rehabilitation rate was 96% after at least five years of function. There were no signs of inflammatory reaction in the surrounding antral mucosa. Four patients with recurrent sinusitis recovered after inferior meatal antrostomy. To conclude, the zygoma fixture seems to be a valuable addition to our repertoire in the management of the compromised maxilla.
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