| 1. |
- Eriksson, Anders, et al.
(författare)
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Accuracy of death certificates of cardiovascular disease in a community intervention in Sweden.
- 2013
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 41:8, s. 883-889
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to investigate the possibility to evaluate the mortality pattern in a community intervention programme against cardiovascular disease by official death certificates.Methods: For all deceased in the intervention area (Norsjö), the accuracy of the official death certificates were compared with matched controls in the rest of Västerbotten. The official causes of death were compared with new certificates, based on the last clinical record, issued by three of the authors, and coded by one of the authors, all four accordingly blinded.Results: The degree of agreement between the official underlying causes of death in "cardiovascular disease" (CVD) and the re-evaluated certificates was not found to differ between Norsjö and the rest of Västerbotten. The agreement was 87% and 88% at chapter level, respectively, but only 55% and 55% at 4-digit level, respectively. The reclassification resulted in a 1% decrease of "cardiovascular deaths" in both Norsjö and the rest of Västerbotten.Conclusions: The disagreements in the reclassification of cause of death were equal but large in both directions. The official death certificates should be used with caution to evaluate CVD in small community intervention programmes, and restricted to the chapter level and total populations.
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| 2. |
- Ekblom, Kim, 1970-, et al.
(författare)
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Bilirubin and UGT1A1*28 are not associated with lower risk for ischemic stroke in a prospective nested case-referent setting
- 2010
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Ingår i: Cerebrovascular Diseases. - : S. Karger. - 1015-9770 .- 1421-9786. ; 30:6, s. 590-596
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bilirubin, an antioxidant, has been associated with reduced cardiovascular disease risk. A major cause of elevated plasma bilirubin is the common UGT1A1*28 promoter polymorphism in the gene of the bilirubin-conjugating enzyme UDP-glucuronosyltransferase-1A1, which reduces transcription by 70%. Earlier studies reporting a protective effect of bilirubin on stroke, have not included analysis of UGT1A1*28. The purpose of this study is to investigate if bilirubin and UGT1A1*28 are protective against ischemic stroke in a prospective case-referent setting.Methods: Cases with first-ever ischemic stroke (n=231; median lag time 4.9 years), and 462 matched referents from the The Northern Sweden Health and Disease Study Cohort were included. Plasma bilirubin was measured and UGT1A1*28 was analyzed by fragment analysis.Results: Plasma bilirubin was lower in cases than in referents, but the difference reached significance only for women. The UGT1A1*28 polymorphism (allele frequency 30%), showed a strong gene-dose relationship with bilirubin levels both among cases and referents, but was not associated with risk for stroke. Among multiple other variables analysed the strongest correlation with bilirubin was found for plasma iron.Conclusions: There was no evidence for a protective effect of the UGT1A1*28 polymorphism against stroke and consequently neither for bilirubin. The findings suggest that other factors influencing the risk for stroke also might affect bilirubin levels.
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| 3. |
- Eriksson, Malin, 1969-, et al.
(författare)
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Social capital, gender and educational level : impact on self-rated health
- 2010
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Ingår i: The Open Public Health Journal. - : Bentham Science Publishers. - 1874-9445. ; 3, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Social capital has been recognized as one important social determinant for health, but we still have limited knowledge about how it can be used to explain inequality in health. This study investigated the links between individual social capital and self-rated health by gender and educational level, and analyzed if access to social capital might explain the observed disparities in self-rated health between men and women and different educational groups. Study design: A cross-sectional survey in Northern Sweden. Methods: A social capital questionnaire was constructed and mailed to 15 000 randomly selected individuals. Different forms of structural and cognitive social capital were measured. Self-rated health was used as the outcome measure. Crude and adjusted OR and 95% CI were calculated for good selfrated health and access to each form of social capital. Multivariate regression was used to analyze how sociodemographic factors and access to social capital might influence differences in self-rated health by gender and educational level. Results: Access to almost each form of social capital significantly increased the odds for good self-rated health for all groups. A higher education significantly increased the odds for access to each form of social capital, and being a man significantly increased the odds for having access to some forms of social capital. The health advantage for higher educated and men partly decreased when controlling for access to social capital. Conclusions: Access to social capital can partly explain the observed health inequality between men and women and different educational groups. Strengthening social capital might be one way of tackling health inequality. It is important to consider the structural conditions that create unequal opportunities for different groups to access social capital.
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| 4. |
- Jerdén, Lars, et al.
(författare)
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Gender Differences and Predictors of Self-Rated Health Development Among Swedish Adolescents
- 2011
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Ingår i: Journal of Adolescent Health. - : Elsevier BV. - 1054-139X .- 1879-1972. ; 48:2, s. 143-150
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of the study was to evaluate the development of self-rated health among boys and girls during adolescence. Methods: Longitudinal cohort study, involving 1,046 Swedish adolescents from the seventh (12-13 years old) to the ninth grade. Self-rated health (well-being) and health-related empowerment were measured using a questionnaire. Results: In the seventh as well as in the ninth grade, the proportion of adolescents reporting a good health was lower in girls than in boys. In general, girls showed lower health-related empowerment as compared with boys and this difference remained between both the grades. In boys and girls belonging to both grades, a high empowerment score was related to a high self-rated health. For both boys and girls, self-rated health declined between the seventh and ninth grade. In girls, the proportion rating their health as "very good" declined from 47 % to 30%, and in boys the same proportion declined from 56% to 46%, indicating an increasing gender difference. Only a minor proportion of adolescents (16% of the boys and 13% of the girls) reported an improvement. A high self-rated health in grade nine was, in girls, predicted by positive school experiences in seventh grade and, in boys, by a good mood in the family. Conclusion: During adolescence, girls reported lower self-rated health than boys and this gender difference increased over the years. High empowerment is related to high self-rated health, and positive school experiences and a good mood in the family seem to be important predictors of a positive development of self-rated health.
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| 5. |
- Kardakis, Therese, et al.
(författare)
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Lifestyle interventions in primary health care : professional and organizational challenges
- 2014
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 24:1, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Interventions that support patient efforts at lifestyle changes that reduce tobacco use, hazardous use of alcohol, unhealthy eating habits and insufficient physical activity represent important areas of development for health care. Current research shows that it is challenging to reorient health care toward health promotion. The aim of this study was to explore the extent of health care professional work with lifestyle interventions in Swedish primary health care, and to describe professional knowledge, attitudes and perceived organizational support for lifestyle interventions.METHODS: The study is based on a cross-sectional Web-based survey directed at general practitioners, other physicians, residents, public health nurses and registered nurses (n = 315) in primary health care.RESULTS: Fifty-nine percent of the participants indicated that lifestyle interventions were a substantial part of their duties. A majority (77%) would like to work more with patient lifestyles. Health professionals generally reported a thorough knowledge of lifestyle intervention methods for disease prevention. Significant differences between professional groups were found with regard to specific knowledge and extent of work with lifestyle interventions. Alcohol was the least addressed lifestyle habit. Management was supportive, but structures to sustain work with lifestyle interventions were scarce, and a need for national guidelines was identified.CONCLUSIONS: Health professionals reported thorough knowledge and positive attitudes toward lifestyle interventions. When planning for further implementation of lifestyle interventions in primary health care, differences between professional groups in knowledge, extent of work with promotion of healthy lifestyles and lifestyle issues and provision of organizational support such as national guidelines should be considered.
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| 6. |
- Malmberg, Gunnar, 1957-, et al.
(författare)
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Longitudinal data for interdisciplinary ageing research. Design of the Linnaeus Database
- 2010
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 38:7, s. 761-767
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: To allow for interdisciplinary research on the relations between socioeconomic conditions and health in the ageing population, a new anonymized longitudinal database - the Linnaeus Database - has been developed at the Centre for Population Studies at Umea University. This paper presents the database and its research potential. Design: Using the Swedish personal numbers the researchers have, in collaboration with Statistics Sweden and the National Board for Health and Welfare, linked individual records from Swedish register data on death causes, hospitalization and various socioeconomic conditions with two databases - Betula and VIP (Vasterbottens Intervention Programme) - previously developed by the researchers at Umea University. Whereas Betula includes rich information about e. g. cognitive functions, VIP contains information about e. g. lifestyle and health indicators. Population and sample size: The Linnaeus Database includes annually updated socioeconomic information from Statistics Sweden registers for all registered residents of Sweden for the period 1990 to 2006, in total 12,066,478. The information from the Betula includes 4,500 participants from the city of Umea and VIP includes data for almost 90,000 participants. Both datasets include cross-sectional as well as longitudinal information. Potential: Due to the coverage and rich information, the Linnaeus Database allows for a variety of longitudinal studies on the relations between, for instance, socioeconomic conditions, health, lifestyle, cognition, family networks, migration and working conditions in ageing cohorts. Conclusions: By joining various datasets developed in different disciplinary traditions new possibilities for interdisciplinary research on ageing emerge.
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| 7. |
- Rönnlund, Michael, et al.
(författare)
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Secular trends in cognitive test performance : Swedish conscript data 1970–1993
- 2013
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Ingår i: Intelligence. - : Elsevier BV. - 0160-2896 .- 1873-7935. ; 41:1, s. 19-24
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Tidskriftsartikel (refereegranskat)abstract
- We investigated time-related patterns in levels of cognitive performance during the period from 1970 to 1993 based on data from Swedish draft boards. The conscripts, including more than a million 18–19-year old men, had taken one of two versions of the Swedish enlistment battery (SEB67; 1970–1979 or SEB80; 1980–1993), each composed of four subtests. The results revealed significant Flynn effects, with estimated gains of 1.2–1.5 IQ-units per decade. The effect seem to hold across ability levels, even though tendencies of more pronounced effects in the lower half of the ability distribution was observed. The largest gains were for visuospatial tests (Paper Form Board and Metal Folding), with little change, even slight losses during the second sub-period, for tests of verbal knowledge (Concept Discrimination and Synonyms) and a mixed pattern for a test of technical comprehension (losses followed by gains). Finally, comparisons of trends in cognitive performance and in standing height show that the gains in cognitive performance over the years from 1980 to 1993 occurred in the absence of overall gains in height, which speaks against nutrition as the cause of the Flynn effects.
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| 8. |
- Weinehall, Lars, et al.
(författare)
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Counseling on lifestyle habits in the United States and Sweden : a report comparing primary care health professionals' perspectives on lifestyle counseling in terms of scope, importance and competence
- 2014
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Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 15:1, s. 83-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The role of primary care professionals in lifestyle counseling for smoking, alcohol consumption, physical activity, and diet is receiving attention at the national level in many countries. The U. S. and Sweden are two countries currently establishing priorities in these areas. A previously existing international research collaboration provides a unique opportunity to study this issue.METHODS: Data from a national survey in Sweden and a study in rural Upstate New York were compared to contrast the perspectives, attitudes, and practice of primary care professionals in the two countries. Answers to four key questions on counseling for tobacco use, alcohol consumption, physical activity, and eating habits were compared.RESULTS: The response rates were 71% (n = 180) and 89% (n = 86) in the Sweden and the U.S. respectively. U.S. professionals rated counseling "very important" significantly more frequently than Swedish professionals for tobacco (99% versus 92%, p < .0001), physical activity (90% versus 79%, p = .04), and eating habits (86% versus 69%, p = .003). U.S. professionals also reported giving "very much" counseling more frequently for these same three endpoints than did the Swedish professionals (tobacco 81% versus 38%, p < .0001, physical activity 64% versus 31%, p < .0001, eating 59% versus 34%, p = .0001). Swedish professionals also rated their level of expertise in providing counseling significantly lower than did their U.S. counterparts for all four endpoints. A higher percentage of U.S. professionals expressed a desire to increase levels of counseling "very much", but only significantly so for eating habits (42% versus 28%, p = .037).CONCLUSIONS: The study demonstrates large differences between the extent that Swedish and American primary care professionals report being engaged in counseling on lifestyle issues, how important they perceive counseling to be, and what expertise they possess in this regard. Explanations might be found in inter-professional attitudes, the organization of healthcare, including the method of reimbursement, traditions of preventive healthcare, and cultural differences between the two countries. Further studies are needed to explore these questions, with the aim of facilitating improved lifestyle counseling in primary care.
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| 9. |
- Agvall, Björn, 1963-
(författare)
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Heart failure in primary care with special emphasis on costs and benefits of a disease management programme
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim. Heart failure (HF) is a common condition associated with poor quality of life (QoL), high morbidity and mortality and is frequently occurring in primary health care (PHC). It involves a substantial economic burden on the health care expenditure. There are modern pharmacological treatments with evident impact on QoL, morbidity, mortality, and proved to be cost-effective. Despite this knowledge, the treatment of HF is considered somewhat insufficient. There are several HF management programmes (HFMP) showing beneficial effects but these studies is predominantly based in hospital care (HC).The first aim of this thesis was to describe patients with HF in the PHC regarding gender differences, diagnosis, treatment and health related costs (I, II).The second aim was to evaluate whether HFMP have beneficial effects in the PHC regarding cardiac function, quality of life, health care utilization and health care-related costs (III,IV).Methods. The initial study involved retrospective collection of data from 256 patients with symptomatic HF in PHC (I). The data collected were gender, age, diagnostics and ongoing treatment. The second study was an economic calculation performed on 115 patients (II). The economic data was retrospectively retrieved as the number of hospital days, visits to nurses and physicians in HC and PHC, prescribed cardiovascular drugs and performed investigation during retrospectively for one year. The third and fourth study was based on a randomized, prospective, open-label study which was subsequently performed (III,IV). The study enrolled 160 patients with systolic HF who were randomized to either an intervention or a control group. The patients in the intervention group retrieved follow-up of HF qualified nurses and physicians in the PHC, involving education about HF and furthermore, optimizing the treatment according to guidelines if possible. The patients in the control group had a followup performed by their regular general practitioner (GP) receiving customary management according to local routines but there was no contact with HF nurses. The primary endpoint of the study was a composite endpoint consisting of changes in survival, hospitalization, heart function and quality of life (QoL) and to compare differences in resource utilization and costs (III,IV).Results. In the first study, the prevalence was 2% and the average age was 78 years (I). The most frequent cause of HF was IHD followed o hypertension. The diagnosis in the study population was based on clinical criteria and only 31% had been subjected to echocardiography. The most common treatment was diuretics (84%) and angiotensin converting enzyme inhibitors (ACEI) were used in 56% of patients. In the following prospective study, the intervention group had significant improvements in composite endpoints. There were in the intervention group more patients with reduced levels of NTproBNP (p=0.012) and improved cardiac function (p=0.03). No significant changes were found in New York Heart Association (NYHA) functional class or QoL. The intervention involved less health care contacts (p=0.04), less emergency ward visits (p=0.002) and hospitalizations (p=0.03). The total cost for HC and PHC was EUR 4471 in the intervention group and EUR 6638 in the control group which implies a cost reduction of EUR 2167 (33%).Conclusions. HF is common in PHC with a prevalence of 2% the study population had an average age of 78 years. Only 31 % of the HF patients have performed an echocardiographic investigation. Treatment with ACEI occurred in 56 %. Differences were found between genders since women had performed significantly fewer echocardiographic investigations and, had less treatment with ACEI. When implementing HFMP in PHC, beneficial effects were found regarding cardiac function and health care-related costs in patients with systolic HF. These findings indicate that HFMP might be used even in PHC.
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| 10. |
- Andréasson, Sven, et al.
(författare)
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Att förebygga sjukdom - en ledarskapsfråga
- 2010
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 107:48, s. 3070-3071
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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