| 1. |
- Brunström, Mattias, et al.
(författare)
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Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
- 2022
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 31:1, s. 31-39
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. Materials and Methods Individuals >= 18 years with a blood pressure (BP) recording in Vasterbotten or Sodermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Vasterbotten County (intervention) compared with Sodermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. Results A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. Conclusions This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.
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| 2. |
- Brunström, Mattias, et al.
(författare)
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Association of physician education and feedback on hypertension management with patient blood pressure and hypertension control
- 2020
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.
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| 3. |
- Andersen, Pia, 1958-
(författare)
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Physical activity on prescription with access to counsellor support implemented in routine care : Healthcare and patient perspectives
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The Swedish PAP (physical activity on prescription) programme FaR®, introduced in 2001, has been adopted by all Swedish regions, which are responsible for provision of healthcare in Sweden. Several studies have shown positive outcomes of the Swedish PAP on patients’ physical activity and other health-related outcomes. There are no guidelines for best practises of the Swedish PAP, which has led to the development of different organizational structures for its delivery. This thesis project was developed with the ambition of providing knowledge for further development of PAP in clinical practise.Aim: The overall aim was to investigate and generate improved understanding of a structure for physical activity on prescription with access to physical activity counsellors, implemented in routine healthcare.Methods: To address the overall aim, four real-world studies with different design and analysis methods were carried out. The study population consisted of patients 18 years or older prescribed PAP in primary and secondary care in Region Kronoberg’s healthcare organization. Study I investigated characteristics of healthcare delivery of PAP over a four-year period, including all patients prescribed PAP in these years. Study II explored factors that influenced patient’s long-term engagement in physical activity after prescription. Study III investigated differences in physical activity and health-related quality of life (HRQoL) at one-year follow-up between patients who used versus patients who did not use counsellor support after prescription. Study IV investigated factors associated with patients increase in physical activity at one-year follow-up. Data sources for the studies were electronic medical records (Studies I, II, III and IV), individual interviews (Study II) and a baseline and a follow-up questionnaire (Studies III and IV). Different statistical analyses were performed in Studies I, III and IV. Study II used qualitative content analysis based on an approach including both inductive and deductive analysis. The final study samples of PAP recipients were N = 4,879 (Study I), n = 13 (Study II), n = 400 (Study = III) and n = 355 (Study IV).Results: Study I: 4,879 PAP recipients were identified, one-third had used the offer of counsellor support. PAP recipients had a high frequency of diagnosis and healthcare consumption prior to PAP. Counsellor users had higher frequency of multiple diagnoses and healthcare visits than non-counsellor users. The main prescriber of PAP was physicians and the main prescribing setting was primary care. Study II: PAP recipients’ long-term engagement with physical activity was influenced by the determinants of capability, opportunity, and motivation. Receiving a prescription of physical activity, and professional counselling and follow up from a physical activity counsellor, and adaption of PAP to the individual’s capacity were important for patients change of physical activity. Study III: Counsellor users had better outcomes in both physical activity and HRQoL than non-users of this support. Study IV: Nearly half of the PAP recipients had increased physical activity one year after prescription. Increased physical activity was positively associated with lower baseline activity, counsellor use, and positive perception of given support after PAP.Conclusions: Patients who were prescribed PAP had a high frequency of diagnoses and high healthcare consumption in the year prior to the prescription. Due to the positive findings regarding patient outcomes on physical activity, and patient experiences of counsellor support, it could be suggested that individualized counselling and follow up by a physical activity counsellor is of importance for patients’ engagement in physical activity, especially for patients with lower baseline activity. Since increased activity was also seen among nonusers of counsellor support, a general recommendation for physical activity counsellor support for all PAP recipients could not be suggested.
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| 4. |
- Brower Scribani, Melissa, 1979-
(författare)
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Insights on weight maintenance and impacts of obesity for two rural populations in the United States and Sweden
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Obesity is a serious public health concern worldwide, and nearly 40% of all adults in the United States and 21% in Sweden are now living with obesity. Efforts focusing mainly on weight loss have fallen short in reducing obesity prevalence. There is a great need for improved insight into what factors may promote a healthy weight, thereby avoiding the adverse health outcomes linked to obesity. Primary weight maintenance is a prevention strategy that emphasizes keeping a long-term stable weight in the non-obese range.Aim: The overall aims of this thesis were to improve understanding of the patterns of obesity and obesity-related mortality among rural adults in Central New York State (U.S.) and Västerbotten County (Sweden), and to explore factors that are related to primary weight maintenance.Material and methods: Data from U.S. health surveys and health examinations in Sweden were used to compare twenty-year (1989-2009) trends in body mass index (BMI) and obesity using multi-factor analysis of variance. The association between obesity and risk of 1) premature all-cause death, and 2) premature circulatory death, was compared between the U.S. and Sweden using proportional hazards regression. In 2009, a longitudinal questionnaire of attitudes, behaviors and perceptions regarding weight maintenance was administered to U.S. subjects. Associations between ten-year weight change and survey variables were tested using multiple linear regression, separately for sex and age strata. To gain a deeper understanding of influences, facilitators and barriers to healthy eating and physical activity, a qualitative interview study was conducted with U.S. women aged 26-35, with data analyzed by qualitative content analysis.Results: Over twenty years, BMI increased for both men and women in all age strata in both countries, and those with no university education consistently had higher BMI than their university-educated counterparts. BMI increased more for younger groups (ages 36-45) compared to those aged 46-55 and 56-62. U.S. females aged 36-45 showed the greatest increases in average BMI, particularly when comparing 1999 to 2009. Increases in the prevalence of obesity (BMI≥30) in Sweden were more modest than in the U.S. Severe obesity (BMI≥35) was associated with significantly increased risk of premature death from all causes and from circulatory causes for all subjects. Severe obesity was less common in Sweden (2% of men, 3% of women) than in the U.S. (8% of men, 9% of women). Nonetheless, severely obese Swedish men had 2.9 times the risk of premature death from all causes compared to those of normal weight, and 4.9 times the risk for circulatory causes. The gradient of risk among U.S. men was significantly lower than in Sweden; those with severe obesity had a 1.6 times increased risk for all-cause premature death and 3.2 times increased risk for premature circulatory death. The pattern of risk among women did not differ between countries. Longitudinal analysis of U.S. health survey participants showed that women aged 26-35 gained the most weight of any group (mean=10.3kg gained over ten years). The variables found to be associated with ten-year weight change were different across sex and age groups. Among women, all variables associated with weight change were exercise-related. Among men, three of the four predictors were focused on eating habits. Interviews with women aged 26-35 revealed the challenges of healthy eating and engaging in physical activity. Women often identified as caregivers for others, and those with more social support, who were financially stable and showed self-efficacy around healthy choices were able to more consistently engage in healthy habits.Conclusions: Obesity is an increasing problem for the rural adult population in both the U.S. and Sweden. When primary weight maintenance strategies are designed to support individuals towards healthy eating and increased physical activity, the complexity of the living environment must be considered. Individual conditions and personal relationships as well as the physical environment, home environment and work environment must be included in the assessment. Development of targeted programs for primary weight maintenance should be a focus of public health work for adults in rural areas in both Sweden and the U.S.
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| 5. |
- Harryson, Lisa, et al.
(författare)
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Örat mot marken, blicken mot horisonten : Västerbottensmodell för samordning avregionalt och lokalt folkhälsoarbete
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Uppdrag: I denna rapport sammanfattas det regeringsuppdrag som Länsstyrelsen Västerbotten haft under åren 2019–2021. Syftet med uppdraget var att utveckla metoder och arbetssätt för samordning av ett regionalt arbete för en god och jämlik hälsa utifrån bestämningsfaktorerna i de åtta målområdena, med målet att skapa bättre förutsättningar för det lokala främjande och förebyggande folkhälsoarbetet i länet. Genomförande: Uppdraget har genomförts i nära samarbete mellan Länsstyrelsen Västerbotten, Region Västerbotten och Umeå Universitet. Tillsammans har dessa tre aktörer genomfört en omfattande och noggrann inventering av förutsättningarna för lokalt och regionalt folkhälsoarbetet i länet, vilken har legat till grund för aktiviteter som genomförts och processer som startats under pilotprojektets tid. Detta innefattar i huvudsak kommunbesök, dialoger, samverkanskonferenser, utbildning i folkhälsa och folkhälsoarbete, studiebesök till Bodö samt förankring och framtagande av en avsiktsförklaring för en god, jämlik och jämställd hälsa.Resultat: Pilotprojektet har bidragit till goda förutsättning för att etablera en samordningsstruktur som stimulerar och förtydligar det gemensamma regionala folkhälsoarbetet, vilket i sin tur stärker det lokala folkhälsoarbetet. Arbetet med pilotprojektet har lett till ökad kunskap hos beslutsfattare och andra aktörer om betydelsen av och förutsättningarna för att bedriva ett folkhälsoarbete med fokus på jämlikhet. Pilotprojektet har även bidragit till att utveckla relationer, kunskaper, drivkrafter, engagemang och motivation hos länets folkhälsoaktörer. Med utgångspunkt i de lokala behoven har pilotprojektet utvecklat arbetssätt för samordning av lokalt och regionalt folkhälsoarbete. Detta arbetssätt kan sammanfattas i en modell som möjliggör för aktörer att bidra till, få hjälp med och samarbeta efter de egna förutsättningarna i syfte att stärka både det lokala och regionala folkhälsoarbetet. Västerbottensmodellen består av följande komponenter:Lyssna – ett behovsorienterat förhållningssätt: Lokala perspektiv och behov styr hur samverkan fungerar och utvecklas för att olika aktörer tillsammans ska kunna bidra till ett gott folkhälsoarbete utifrån sina förutsättningar.Lita på varandra – en tillitsbaserad arbetsprocess: Det behovsorienterade förhållningssättet karakteriserar såväl de externa som det interna arbetsprocesserna med en kontinuerlig dialog mellan lokala och regionala aktörer.Göra – strukturerade metoder: Gemensamt utformade och väl förankrade metoder ger goda förutsättningar för att kunna etablera en samordningsstruktur för lokalt och regionalt folkhälsoarbete.När pilotprojektet tar slut behövs en samordnade funktion som tar vid helheten av det pilotprojektet stått för, varför pilotprojektet tog initiativ till att bilda Forum för folkhälsa i Västerbotten. Intentionen är att Forum för folkhälsa i Västerbotten ska förvalta och utveckla de metoder och arbetssätt för regional samordning som pilotprojektet arbetat fram, vilka inkluderar: kunskapshöjande insatser, dialoger, överenskommelser, samverkanskonferenser och informationsspridning. Förhoppningen är att Forum för folkhälsa i Västerbotten kommer utgöra ett nav för samverkan som både främjar och stödjer dialog, informations- och erfarenhetsutbyte, utveckling och utbildning och bidrar till uppföljning av folkhälsoarbetet i länet.
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| 6. |
- Lindgren, Helena, et al.
(författare)
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The STAR-C Intelligent Coach : a Cross- Disciplinary Design Process of a Behaviour Change Intervention in Primary Care
- 2020
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Ingår i: pHealth 2020. - : IOS Press. - 9781643681122 ; , s. 203-208
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Konferensbidrag (refereegranskat)abstract
- A broad range of aspects are needed to be taken into consideration in the design and development of personalized coaching systems based on artificial intelligence methodologies. This research presents the initial phase of joining different professional and stakeholder perspectives on behavior change technologies into a flexible design proposal for a digital coaching system. The diversity and sometimes opposed views on content, behavior, purposes and context were managed using a structured argument-based design approach, which also feed into the behavior of the personalized system. Results include a set of personalization strategies that will be further elaborated with the target user group to manage sensitive issues such as ethics, social norms, privacy, motivation, autonomy and social relatedness.
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| 7. |
- Ng, Nawi, 1974, et al.
(författare)
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Living alone and mortality among older people in Västerbotten County in Sweden: a survey and register-based longitudinal study
- 2020
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Living alone is increasingly common and has been depicted as an important cause of mortality. We examined the association between living alone and mortality risks among older men and women in northern Sweden, by linking two unique longitudinal datasets.We used the Linnaeus database, which links several population registers on socioeconomic and health. This register-based study included 22,226 men and 23,390 women aged 50 and 60years in Västerbotten County who had participated in the Västerbotten Intervention Program (VIP) during 1990-2006, with a total of 445,823 person-years of observation. We conducted Cox-proportional hazard regression to assess the risk of living alone on the mortality that was observed between 1990 and 2015, controlling for socio-demographic factors, chronic disease risk factors and access to social capital.Older men and women who lived alone with no children at home were at a significantly higher risk of death compared to married/cohabiting couples with children at home (with an adjusted hazard ratio of 1.38, 95% CI of 1.26-1.50 in men and 1.27, 95% CI of 1.13-1.42 in women). Living alone was an even stronger factor than the well-established chronic disease risk factors and a lack of access to social capital.A significant association between living alone and mortality among the older adult population in Sweden was observed. Providing good social support for older people is important in preventing the negative health impact of living alone.
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| 8. |
- Ng, Nawi, 1974, et al.
(författare)
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Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme
- 2021
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Ingår i: Frontiers in Public Health. - : Frontiers Media SA. - 2296-2565. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Vasterbotten Intervention Programme (VIP) in the Region Vasterbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD. Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019-2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated. Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps. Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985). Dissemination: The collaboration between Umea University and Region Vasterbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.
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| 9. |
- Santosa, Ailiana, et al.
(författare)
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Gender differences and determinants of prevalence, awareness, treatment and control of hypertension among adults in China and Sweden
- 2020
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFailure to promote early detection and better management of hypertension will contribute to the increasing burden of cardiovascular diseases. This study aims to assess the gender differences in the prevalence, awareness, treatment and control of hypertension, together with its associated factors, in China and Sweden.MethodsWe used data from two cross-sectional studies: the Vasterbotten Intervention Program in northern Sweden (n =25,511) and the Shanghai survey in eastern China (n=25,356). We employed multivariable logistic regression to examine the socio-demographics, lifestyle behaviours, and biological factors associated with the prevalence, awareness, treatment and control of hypertension.ResultsMen had a higher prevalence of hypertension (43% in Sweden, 39% in China) than their female counterparts (29 and 36%, respectively). In Sweden, men were less aware of, less treated for, and had less control over their hypertension than women. Chinese men were more aware of, had similar levels of treatment for, and had less control over their hypertension compared to women. Awareness and control of hypertension was lower in China compared to Sweden. Only 33 and 38% of hypertensive Chinese men and women who were treated reached the treatment goals, compared with a respective 48 and 59% in Sweden. Old age, impaired glucose tolerance or diabetes, a family history of hypertension or cardiovascular diseases, low physical activity and overweight or obesity were found to increase the odds of hypertension and its diagnosis.ConclusionsThis study shows the age and gender differences in the prevalence, awareness, treatment and control of hypertension among adults in China and Sweden. Multisectoral intervention should be developed to address the increasing burden of sedentary lifestyle, overweight and obesity and diabetes, all of which are linked to the prevention and control of hypertension. Development and implementation of the gender- and context-specific intervention for the prevention and control of hypertension facilitates understanding with regard to the implementation barriers and facilitators.
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| 10. |
- Tinc, Pamela J., et al.
(författare)
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Key factors for successful implementation of the National Rollover Protection Structure Rebate Program : A correlation analysis using the consolidated framework for implementation research
- 2020
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health (NOROSH). - 0355-3140 .- 1795-990X. ; 46:1, s. 85-95
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes.Methods: Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes.Results: Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating.Conclusions: The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.
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