| 1. |
- Angbratt, Marianne, et al.
(author)
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Calcium intake in a Swedish adult population : relationship to life-style factors and bone mineral density. A descriptive study
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Other publication (other academic/artistic)abstract
- Background. This study is part of a community-based intervention programme dealing with the prevention of osteoporosis. The study aims were to estimate the calcium intake from dairy products and calcium supplements within a general population, and thereafter to study associations between calcium intake, relevant lifestyle factors, and forearm bone mineral density.Methods. A randomised sample of 15 % of the inhabitants aged 20 - 79 years ( = 1510) from two Swedish municipalities answered a questionnaire, and a selected sub-sample (n=448) had their forearm bone mineral density measured.Results. The mean consumption of calcium from dairy products was 878 mg/day. Men consumed more than women, and calcium intake decreased with increasing age. Twelve percent of the youngest age group in the study population and 31 % of the oldest age group did not meet the recommended daily intake. Associations were found between calcium intake and both residence and physical activity. There was a tendency towards an association between calcium intake and forearm bone mineral density. No other associations with lifestyle factors were observed.Conclusion. Calcium intake is in general well attained in an adult Swedish population, although the intake range is wide (55 to 3213 mg/day from dairy products). Women aged 50-59 years and older people are at increased risk of not meeting the recommended daily intake.
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| 2. |
- Angbratt, Marianne, 1947-
(author)
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Estimated calcium intake related to lifestyle and bone mineral density in an adult Swedish population
- 2005
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Licentiate thesis (other academic/artistic)abstract
- Osteoporosis is a public health problem. It is a disease that is present for a long period without signs, before resulting in the clinical sign, i.e. fracture(s). Osteoporosis can be prevented in part and there are treatments. Among other lifestyle factors, the dietary intake of calcium is important when working with preventive intervention towards individuals and groups. For dietary assessment, an instrument adjusted for Swedish circumstances is needed.The aims of the thesis are to design and validate an instrument estimating calcium intake (I), to estimate calcium intake from dairy products and supplements in an adult Swedish population, and to explore associations between calcium intake and some lifestyle factors and between calcium intake and bone mineral density (II).Two questionnaires were prepared, one short (A), containing questions about dairy products and supplements, and another more extensive (B), with questions on a wide variety of food products. The questionnaires were validated with dietary history as the gold standard. Two age groups of women, 20-30 and 50-60 years, were included (n=467) (I). A randomised sample of 15% women and men aged 20-79 years in two communities answered a questionnaire (n= 1510). Forearm bone mineral density was measured in a subsample of this group (n=448) (II).We found questionnaire A to be sufficient when discriminating individuals with low calcium intake from individuals with sufficient calcium intake (I). The mean calcium intake from dairy products was well attained (878 mg/day) although the range was wide. However, 12% in the 20-30 years age group and 31% in the 70- 79 years age group did not meet the recommended daily intake. Associations were found between calcium intake and residence and also physical activity. There was a tendency towards an association between calcium intake and forearm bone mineral density. No other associations with lifestyle factors were observed (II).ln osteoporosis intervention work there is every reason to strive towards meeting the recommended daily intake for all individuals, and our quick and cheap food frequency questionnaire could be of value.
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| 3. |
- Angbratt, Marianne, et al.
(author)
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Prediction of obesity from infancy to adolescence
- 2011
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In: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 100:9, s. 1249-1252
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Journal article (peer-reviewed)abstract
- Aim: To examine the development of childhood obesity and to determine the earliest age when estimating body mass using only weight and height data is associated with a corresponding estimate at the age of 15. less thanbrgreater than less thanbrgreater thanMethods: Subjects included are all children born in 1991 in Ostergotland County, Sweden. Weight and height data collected during regular check-ups at well-child centres and school health care assessments up to 15 years of age were assembled from health records. Correlations between childhood estimates of body mass and the body mass index (BMI) at 15 years of age were computed pairwise. Correlations with r andgt; 0.5 were defined as reliably strong. less thanbrgreater than less thanbrgreater thanResults: Complete data were available for 3579 children (62%). Fewer girls (2.6%; C.I. 1.9-3.3) than boys (4.6%; C.I. 3.7-5.5) were obese at 15 years of age. Correlations with BMI at 15 years of age were strong (significantly higher than 0.5) from 5 years of age. Only 23% of girls and 8% of boys found to be obese at 5 years of age were of normal weight at the age of 15. less thanbrgreater than less thanbrgreater thanConclusion: From 5 years of age, point estimates of body mass using only weight and height data are strongly associated with BMI at the age of 15. More data sources are needed to predict weight trajectories in younger children.
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| 4. |
- Angbratt, Marianne, et al.
(author)
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Prevalence and correlates of insufficient calcium intake in a Swedish population : Populations at risk across the lifespan
- 2007
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In: Public Health Nursing. - : Wiley. - 0737-1209 .- 1525-1446. ; 24:6, s. 511-517
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Journal article (peer-reviewed)abstract
- To examine associations between calcium intake in the diet, lifestyle factors, and forearm bone mineral density (BMD) in order to identify population subgroups for targeting by screening programs. A questionnaire was sent to a random sample of 15 of the inhabitants aged 20-79 years from 2 Swedish municipalities, and the subsample from one of the municipalities was invited to measurement of BMD. The survey response rate was 74 (n=1,1121,510) and participation in BMD measurements was 68 (n=448659). Only a tendency (p=.085) toward direct association between calcium intake and forearm BMD was found, and the best multiple regression model was retained to explain BMD excluded calcium intake. Low calcium intake was, instead, in complementary analyses, found to be correlated with the factors old age, female sex, and urban residence in the best multiple regression model. Population subgroups whose calcium intake is in a range that justifies preventive action could be identified. Screening programs staffed by public health nurses can thereby be informed regarding the subgroups of the population that are at the highest risk of insufficient calcium intake. © 2007, Blackwell Publishing, Inc.
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| 5. |
- Angbratt, Marianne, et al.
(author)
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Questionnaire about Calcium Intake : Can We Trust the Answers?
- 1999
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In: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 9:3, s. 220-225
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Journal article (peer-reviewed)abstract
- The aim of this study was to construct and evaluate reliable questions concerning calcium intake and to include them in a questionnaire to be used in a community-based intervention program for preventing osteoporosis. Estimating calcium intake is an important factor in evaluating risk profiles for community residents. A very large amount of calcium in the Swedish diet comes from dairy foods. Two questionnaires were designed. Questionnaire A contained eight questions concerning consumption of dairy foods. Questionnaire B contained 52 questions on consumption of calcium-rich food groups and dishes, and also included the eight questions mentioned above. Questionnaire A was sent to 467 randomized women aged 20–30 and 50–60 years. Women with a low calcium intake also answered questionnaire B. In order to validate the questionnaires a selected number of the women were interviewed using a dietary history. In total 363 women answered questionnaire A, 118 of whom had a calcium intake below the recommended amount. Ninety-six women completed questionnaire B. Twenty-two women were interviewed with the dietary history. Statistical analyses using t-tests of the differences between answers to the same questions in two questionnaires and the interview, gave the following results. Questionnaire A provides reliable information about those who do not reach the recommended level of calcium intake. Questionnaire B does not provide any more information than questionnaire A. It is not possible to rank calcium levels in the diet with the questionnaires. Using the estimated calcium intake from dairy foods obtained in questionnaire A, individuals at risk of consuming less than the recommended intake of calcium can be identified, as can those consuming the required amount. In conclusion, questionnaire A is useful in discriminating between subjects with low and high calcium intake.
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| 6. |
- Ekberg, Joakim, 1976-, et al.
(author)
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Design of an online health-promoting community : Negotiating user community needs with public health goals and service capabilities
- 2013
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In: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 13:1
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Journal article (peer-reviewed)abstract
- Background: An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.Methods: Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.Results: The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.Conclusions: OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users' needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.
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| 7. |
- Ekberg, Joakim, et al.
(author)
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History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents
- 2012
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In: International Journal of Obesity. - : Nature Publishing Group. - 0307-0565 .- 1476-5497. ; 36:4, s. 524-528
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. less thanbrgreater than less thanbrgreater thanMETHODS: All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. less thanbrgreater than less thanbrgreater thanRESULTS: Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.
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| 8. |
- Gerdin, Elisabeth Warnberg, et al.
(author)
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Dental caries and body mass index by socio-economic status in Swedish children
- 2008
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In: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 36:5, s. 459-465
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Journal article (peer-reviewed)abstract
- Objectives: The aim of the present study was to evaluate the association between dental caries, childhood body mass index (BMI), and socioeconomic status in Swedish children. Methods: The study cohort consisted of 2303 10-year-old children with data on socioeconomic status, BMI at 4, 5, 7 and 10 years of age, and caries at 6, 10 and 12 years of age. Anthropometric measures were carried out by trained nurses according to standardized routines. The occurrence of caries was registered from county records, and the children were classified into one of five socioeconomic clusters based on their census registration address. Results: Caries prevalence decreased with increasing socioeconomic status at all ages, whereas childhood BMI and proportion of overweight/obese children were unrelated to socioeconomic status. Obese, but not overweight, children had more caries affected teeth than non-obese, and BMI had an independent, though weak, effect on caries variation in multiple regression. Interestingly, overweight/obese 4-year-olds, who had normal body weight at 5, 7 and 10 years of age, had significantly less caries than children who had normal body weight from 4 to 10 years of age. Conclusions: Overweight and caries prevalence are significantly associated in Swedish children. However, the association is weak. Nevertheless, the concept that child dental services and child welfare services can benefit from joint programs is supported.
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| 9. |
- Grahn Kronhed, Ann-Charlotte, et al.
(author)
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Association between physical activity and forearm bone mineral density in 20-72-year-olds
- 2002
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In: Advances in Physiotherapy. - : Taylor & Francis. - 1403-8196 .- 1651-1948. ; 4:2, s. 87-96
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Journal article (peer-reviewed)abstract
- Physical activity may influence bone mineral density (BMD) in different ways. In the present study the amount of physical activity and the associations between forearm BMD, body mass index, physical activity and several other lifestyle factors were explored. A random sample of the population in a Swedish municipality was invited to the study and examined by a questionnaire and by forearm bone mineral measurements using single photon absorptiometry. Forearm BMD was measured in 880 subjects. Forearm BMD was stable from 20 to 50 years of age in women and from 20 to 60 years of age in men. Reported moderate leisure-time physical activity levels in men were significantly associated with higher forearm BMD than low leisure-time physical activity levels ( p = 0.042). The findings that moderate levels of leisure-time physical activity in men were associated with higher forearm BMD, give some support to the hypothesis that increased amount of physical activity in a population might be of benefit in the prevention of osteoporosis. Further longitudinal studies of the effect of physical activity in the prevention of osteoporosis, falls and fractures are warranted.
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| 10. |
- Lindhe Söderlund, Lena, 1954-, et al.
(author)
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Applying motivational interviewing to counselling overweight and obese children
- 2009
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In: Health Education Research. - : Oxford University Press (OUP). - 0268-1153 .- 1465-3648. ; 24:3, s. 442-449
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Journal article (peer-reviewed)abstract
- The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.
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| 11. |
- Timpka, Toomas, 1957-, et al.
(author)
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A high-precision protocol for identification of preschool children at risk for persisting obesity
- 2007
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 2:6
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Journal article (peer-reviewed)abstract
- Background: Recent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence. Methodology/Principal Findings: We analysed data obtained for child health surveillance up to age 5 from 5778 children born in a swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls, The sensitivity was higher for girls (41 %) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% Cl 24.5 to 589.91for boys. Conclusion/Significance: A simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sersitivity was low especially for boys. Implementation and further evaluations of the protocol in chlid health centre settings are warranted. © 2007 Timpka et al.
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