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Stenman E, Borgström Bolmsjö B, Grundberg A, Sundquist K. Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people. Scand J Prim Health Care 2024:1-12. [PMID: 39091122 DOI: 10.1080/02813432.2024.2385547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs). DESIGN Cross-sectional study. SETTING 99 Swedish healthcare centers. INTERVENTION Metabolic risk factors and health behaviors were assessed. THDs were provided. SUBJECTS 1831 (62.3%) THD participants that consented to take part in the research project. MAIN OUTCOME MEASURES (1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls. RESULTS Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3-4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs. CONCLUSION Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups. CLINICALTRIALS.GOV NCT04912739.
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Affiliation(s)
- Emelie Stenman
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Beata Borgström Bolmsjö
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Anton Grundberg
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
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Ares-Blanco S, López-Rodríguez JA, Polentinos-Castro E, Del Cura-González I. Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe. BMC PRIMARY CARE 2024; 25:165. [PMID: 38750446 PMCID: PMC11094967 DOI: 10.1186/s12875-024-02400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. METHODS Cross-sectional study using data collected from the European Health Interview Survey 2013-2015 of individuals aged 40-74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. RESULTS 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43-8.15; colorectal screening aOR: 1.87, 95% CI: 1.80-1.95; mammography aOR: 1.76, 95% CI: 1.69-1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85-1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. CONCLUSIONS Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.
- Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- General Ricardos Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Elena Polentinos-Castro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Isabel Del Cura-González
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
- Aging Research Center, Karolinksa Instituted, Stockholm, Sweden
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Berhe NM, Hassen HY, Van Geertruyden JP, Ndejjo R, Musinguzi G, Bastiaens H, Abrams S. Types and Effectiveness of Community-Based Cardiovascular Disease Preventive Interventions in Reducing Alcohol Consumption: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e61323. [PMID: 38947657 PMCID: PMC11212836 DOI: 10.7759/cureus.61323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 07/02/2024] Open
Abstract
Cardiovascular disease (CVD) poses a global health challenge, with modifiable risk factors, notably alcohol consumption, impacting its onset and progression. This review synthesizes evidence on the types and effectiveness of community-based interventions (CBIs) aimed at reducing alcohol consumption for CVD prevention. Electronic databases were systematically searched until October 31, 2019, with updates until February 28, 2023. Given the heterogeneity in outcome measures, we narratively synthesized the effectiveness of CBIs, adhering to the synthesis without meta-analysis (SWiM) guidelines for transparent reporting. For selected homogenous studies, a random-effects meta-analysis was utilized to estimate the effects of CBIs on alcohol consumption. Twenty-two eligible studies were included, with 16 demonstrating that CBIs reduced alcohol consumption compared to controls. Meta-analysis findings revealed reductions in above moderate-level alcohol consumption (pooled odds ratio (OR)=0.50, 95% confidence interval (CI): 0.37, 0.68), number of alcohol drinks per week (standardized mean difference=-0.08, 95% CI: -0.14, -0.03), and increased odds of low-risk drinking (pooled OR=1.99, 95% CI: 1.04, 3.81) compared to the control groups. Multi-component interventions (particularly those combining health education, awareness, and promotion activities) and those interventions with a duration of 12 months or more were notably effective. The beneficial effects of CBIs focusing on achieving a reduction in alcohol consumption showed promising outcomes. Implementing such interventions, especially multicomponent interventions, could play a significant role in mitigating the increasing burden of CVDs. Future studies should also consider employing standardized and validated tools to measure alcohol consumption outcomes to enhance the consistency and comparability of findings.
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Affiliation(s)
- Neamin M Berhe
- Department of Primary & Integrated Care, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
- Department of Health Sciences, Société Générale de Surveillance (SGS) Life Sciences, Mechelen, BEL
| | - Hamid Y Hassen
- Department of Primary & Integrated Care, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
| | - Jean-Pierre Van Geertruyden
- Global Health Institute, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, UGA
| | - Geofrey Musinguzi
- Department of Primary & Integrated Care, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, UGA
| | - Hilde Bastiaens
- Department of Primary & Integrated Care, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
- Global Health Institute, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
| | - Steven Abrams
- Global Health Institute, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
- Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, BEL
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Johansson LM, Eriksson M, Dahlin S, Lingfors H, Golsäter M. Healthcare professionals' experiences of targeted health dialogues in primary health care. Scand J Caring Sci 2024; 38:231-239. [PMID: 37749903 DOI: 10.1111/scs.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/19/2023] [Accepted: 09/03/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND In Sweden, population-based targeted health dialogues are an important part of health promotion and disease prevention in primary health care. Targeted health dialogues are performed with a pedagogical approach to allow individuals to reflect over their resources, situation and motivation to change lifestyle habits together with a healthcare professional. AIM The aim of this study was to explore healthcare professionals' experiences of targeted health dialogues in primary health care. METHODS Three focus group interviews were conducted with 20 healthcare professionals. The interviews were analysed using qualitative content analysis. RESULTS The main category A possibility to promote healthy behaviours and prevent disease describes how the targeted health dialogues were experienced as a valuable opportunity to promote health among inhabitants. The significance of the primary healthcare centre's health promotion and prevention strategies was emphasised to enable the targeted health dialogues as a part of the assignment to promote health. These strategies were expressed as shared focus and organisational space and support making it possible for example to reach all socioeconomic groups. The work with targeted health dialogue was described as a complex task requiring extensive competence. Furthermore, the pedagogical tool including the visual health profile was experienced to have an important impact on the dialogue offering direction for actions to promote health and prevent disease. CONCLUSIONS Targeted health dialogues can be a valuable opportunity for healthcare professionals in primary health care to promote a healthy lifestyle among inhabitants. Certain preconditions at both the meso- and the micro level is however required for this to come about.
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Affiliation(s)
- Lisbeth M Johansson
- Unit for Research and Development in Primary Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marit Eriksson
- Unit for Research and Development in Primary Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Sofia Dahlin
- Unit for Research and Development in Primary Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
- Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden
| | - Hans Lingfors
- Unit for Research and Development in Primary Care, Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Marie Golsäter
- Associate Professor, Child Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Child Health Services, Region Jönköping County, Jönköping, Sweden
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Milos Nymberg V, Nymberg P, Pikkemaat M, Calling S, Stenman E, Grundberg A, Smith JG, Sundquist K. Lifestyle and cardiovascular risk factors in a Swedish primary care population with self-reported psychiatric symptoms. Prev Med Rep 2024; 37:102547. [PMID: 38174323 PMCID: PMC10761795 DOI: 10.1016/j.pmedr.2023.102547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Objective Individuals with psychiatric illness suffer from poorer physical health compared with the general population and have a higher risk of developing cardiovascular and metabolic diseases. This cross-sectional study aims to describe the prevalence of lifestyle and cardiovascular risk factors and the association with self-reported psychiatric symptoms in a population of 40-year-old individuals screened with targeted Health Dialogues in southern Sweden. Methods All 40-year-old individuals registered at 99 primary healthcare centers in southern Sweden were invited to participate. Self-reported lifestyle habits on a web questionnaire, anthropometric measurements, blood pressure, and blood tests were collected. The Health Dialogue resulted in a risk level assessment for different lifestyle habits and a meeting with a trained coach. Results A total of 1831 individuals completed a Health Dialogue between 1st January 2021 and 30th June 2022. There were more individuals with high-risk levels for several lifestyle habits in the group with self-reported psychiatric illness compared with the rest of the study population. The analysis showed that physical inactivity, unhealthy diet, high-risk alcohol intake, tobacco use, psychosocial strain, higher BMI, and waist-hip ratio were associated with increased levels of psychiatric symptoms after adjustment for sex and socioeconomic factors. Conclusion Unhealthy lifestyle habits were associated with self-reported psychiatric symptoms in 40-year-old individuals assessed with targeted Health Dialogues in a primary care context. Organized screening might contribute to early detection of modifiable risk factors for cardiovascular disease. Individuals with psychiatric symptoms should be prioritized for screening of unhealthy lifestyle behaviors.
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Affiliation(s)
- Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
| | - Peter Nymberg
- School of Health and Welfare, Halmstad University, Sweden
| | - Miriam Pikkemaat
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
| | - Emelie Stenman
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Anton Grundberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - J. Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
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Alenius S, Olsson K, Thomasson E, Magnusson L. Health care professionals' experiences and perceptions of health promotion through the health dialogue intervention in the scania region, Sweden: a qualitative interview study. BMC PRIMARY CARE 2023; 24:173. [PMID: 37661252 PMCID: PMC10476376 DOI: 10.1186/s12875-023-02133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Cardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals' experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden. METHODS The study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used. RESULTS The analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: "Health dialogue, a potential start of a paradigm shift in Swedish primary care". CONCLUSIONS Conclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals' education in the method could increase the focus on self-efficacy during counselling, which could favour the participants' change process.
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Affiliation(s)
- Sara Alenius
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund, 221 00, Sweden
| | - Kjell Olsson
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, SE-21428, Sweden
- Department of Healthcare Management, Region Skåne, Kristianstad, 291 89, Sweden
| | - Ena Thomasson
- Department of Healthcare Management, Region Skåne, Kristianstad, 291 89, Sweden
| | - Lina Magnusson
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund, 221 00, Sweden.
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Kilic K, Weck S, Kampik T, Lindgren H. Argument-based human-AI collaboration for supporting behavior change to improve health. Front Artif Intell 2023; 6:1069455. [PMID: 36872933 PMCID: PMC9979214 DOI: 10.3389/frai.2023.1069455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
This article presents an empirical requirement elicitation study for an argumentation-based digital companion for supporting behavior change, whose ultimate goal is the promotion and facilitation of healthy behavior. The study was conducted with non-expert users as well as with health experts and was in part supported by the development of prototypes. It focuses on human-centric aspects, in particular user motivations, as well as on expectations and perceptions regarding the role and interaction behavior of a digital companion. Based on the results of the study, a framework for person tailoring the agent's roles and behaviors, and argumentation schemes are proposed. The results indicate that the extent to which a digital companion argumentatively challenges or supports a user's attitudes and chosen behavior and how assertive and provocative the companion is may have a substantial and individualized effect on user acceptance, as well as on the effects of interacting with the digital companion. More broadly, the results shed some initial light on the perception of users and domain experts of "soft," meta-level aspects of argumentative dialogue, indicating potential for future research.
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Affiliation(s)
- Kaan Kilic
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Saskia Weck
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Helena Lindgren
- Department of Computing Science, Umeå University, Umeå, Sweden
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Nordgren L, von Heideken Wågert P, Söderlund A, Elvén M. The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12071. [PMID: 36231373 PMCID: PMC9564635 DOI: 10.3390/ijerph191912071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Perceived stress can affect people's lifestyle behaviours and self-rated health. A balanced, healthy lifestyle can alleviate experiences of stress. For clinicians to use evidence-based and theory-based knowledge in health dialogues with people with non-communicable diseases, and in order to develop more effective behavioural counselling, more knowledge is needed. Hence, this study aimed to examine the mediating role of sedentary behaviour, daily physical activity, physical exercise, and dietary habits on the association between perceived stress and self-rated health in people with or without one to four self-reported non-communicable diseases (myocardial infarction, stroke, hypertension, diabetes). The study used a cross-sectional design. Responses from in total 10,583 individuals were collected in 2016 and 2019 by a self-report questionnaire. A series of simple and multiple regression analyses were conducted to examine the mediating effects of healthy lifestyle behaviours on the association between perceived stress and self-rated health. The results show that the investigated healthy lifestyle behaviours partly mediated the association between perceived stress and self-rated health in people with no diagnosis, and in people with one or two diagnoses. It can be concluded that healthy lifestyle behaviours could probably be targeted in relation to the number of noncommunicable diseases that the individuals have.
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Affiliation(s)
- Lena Nordgren
- Centre for Clinical Research Sörmland, Uppsala University, 631 88 Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, 751 22 Uppsala, Sweden
| | | | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, 722 20 Västerås, Sweden
| | - Maria Elvén
- School of Health, Care and Social Welfare, Mälardalen University, 722 20 Västerås, Sweden
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Törmä J, Lundqvist R, Eliasson M, Nilsson LM, Oskarsson V, Wennberg M. Comparison of dietary trends between two counties with and without a cardiovascular prevention programme: a population-based cross-sectional study in northern Sweden. Public Health Nutr 2021; 25:1-9. [PMID: 34296666 PMCID: PMC9991627 DOI: 10.1017/s1368980021003050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare temporal trends, over a 20-year period, in dietary habits between a county (Västerbotten) with a CVD prevention programme and a county (Norrbotten) without such a programme. DESIGN Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009 and 2014). Dietary habits were assessed by a semi-quantitative FFQ. SETTING Counties of Norrbotten and Västerbotten, Northern Sweden. PARTICIPANTS Five thousand four hundred Swedish adults (mean age 56·9 years; 51·2 % women) from Västerbotten (47 %) and Norrbotten (53 %). RESULTS No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein and alcohol were observed between the counties (Pfor interaction ≥ 0·33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; Pfor interaction = 0·36). Nor were there any between-county differences for the intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (Pfor interaction ≥ 0·09). Consumption of meat (Pfor interaction = 0·05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, Pfor interaction = 0·04). Men in Västerbotten decreased their intake of sweets to a greater extent than men in Norrbotten (Pfor interaction < 0·01). CONCLUSIONS Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favour of a county with a CVD prevention programme compared with a county without such a programme.
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Affiliation(s)
- Johanna Törmä
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
- Department of Development, Region Norrbotten, Robertsviksgatan 7, SE-971 89, Luleå, Sweden
| | - Robert Lundqvist
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Section of Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Lena Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Section of Medicine, Piteå Research Unit, Umeå University, Umeå, Sweden
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
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Andersson A, Enblad G, Erlanson M, Johansson AS, Molin D, Tavelin B, Näslund U, Melin B. High risk of cardiovascular side effects after treatment of Hodgkin's lymphoma - is there a need for intervention in long-term survivors? Ups J Med Sci 2021; 126:6117. [PMID: 33889307 PMCID: PMC8043572 DOI: 10.48101/ujms.v126.6117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) patients have a good prognosis after adequate treatment. Previous treatment with mantle field irradiation has been accompanied by an increased long-term risk of cardiovascular disease (CVD). This study identified co-morbidity factors for the development of cardiovascular side effects and initiated an intervention study aimed to decrease morbidity and mortality of CVD in HL survivors. DESIGN Hodgkin lymphoma patients aged ≤45 years diagnosed between 1965 and 1995 were invited to participate. In total, 453 patients completed a questionnaire that addressed co-morbidity factors and clinical symptoms. Of these, 319 accepted to participate in a structured clinical visit. The statistical analyses compared individuals with CVD with those with no CVD. RESULTS Cardiovascular disease was reported by 27.9%. Radiotherapy (odds ratio [OR]: 3.27), hypertension and hypercholesterolemia were shown to be independent risk factors for the development of CVD. The OR for CVD and valve disease in patients who received radiotherapy towards mediastinum was 4.48 and 6.07, respectively. At clinical visits, 42% of the patients were referred for further investigation and 24% of these had a cardiac ultrasound performed due to previously unknown heart murmurs. CONCLUSION Radiotherapy towards mediastinum was an independent risk factor for CVD as well as hypercholesterolemia and hypertension. A reasonable approach as intervention for this cohort of patients is regular monitoring of hypertension and hypercholesterolemia and referral to adequate investigation when cardiac symptoms appear. Broad knowledge about the side effects from radiotherapy in the medical community and well-structured information regarding late side effects to the patients are all reasonable approaches as late effects can occur even 40 years after cancer treatment.
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Affiliation(s)
- Anne Andersson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Section Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Martin Erlanson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Section Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Björn Tavelin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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Santos JV, Vandenberghe D, Lobo M, Freitas A. Cost of cardiovascular disease prevention: towards economic evaluations in prevention programs. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:512. [PMID: 32395556 PMCID: PMC7210201 DOI: 10.21037/atm.2020.01.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- João Vasco Santos
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Portugal.,MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Portugal
| | - Désirée Vandenberghe
- Department of Economics, Faculty of Economics and Business Administration, Ghent University, Belgium
| | - Mariana Lobo
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Portugal
| | - Alberto Freitas
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Portugal
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12
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Kriit HK, Williams JS, Lindholm L, Forsberg B, Nilsson Sommar J. Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden. BMJ Open 2019; 9:e030466. [PMID: 31530609 PMCID: PMC6756337 DOI: 10.1136/bmjopen-2019-030466] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/06/2019] [Accepted: 08/14/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To conduct a health economic evaluation of a proposed investment in urban bicycle infrastructure in Stockholm County, Sweden. DESIGN A cost-effectiveness analysis is undertaken from a healthcare perspective. Investment costs over a 50-year life cycle are offset by averted healthcare costs and compared with estimated long-term impacts on morbidity, quantified in disability-adjusted life years (DALYs). The results are re-calculated under different assumptions to model the effects of uncertainty. SETTING The Municipality of Stockholm (population 2.27 million) committed funds for bicycle path infrastructure with the aim of achieving a 15% increase in the number of bicycle commuters by 2030. This work is based on a previously constructed scenario, in which individual registry data on home and work address and a transport model allocation to different modes of transport identified 111 487 individuals with the physical capacity to bicycle to work within 30 min but that currently drive a car to work. RESULTS Morbidity impacts and healthcare costs attributed to increased physical activity, change in air pollution exposure and accident risk are quantified under the scenario. The largest reduction in healthcare costs is attributed to increased physical activity and the second largest to reduced air pollution exposure among the population of Greater Stockholm. The expected net benefit from the investment is 8.7% of the 2017 Stockholm County healthcare budget, and 3.7% after discounting. The economic evaluation estimates that the intervention is cost-effective and each DALY averted gives a surplus of €9933. The results remained robust under varied assumptions pertaining to reduced numbers of additional bicycle commuters. CONCLUSION Investing in urban infrastructure to increase bicycling as active transport is cost-effective from a healthcare sector perspective.
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Affiliation(s)
- Hedi Katre Kriit
- Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bertil Forsberg
- Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Johan Nilsson Sommar
- Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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13
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Flawed conclusions on the Västerbotten Intervention Program by San Sebastian et .al. BMC Public Health 2019; 19:1095. [PMID: 31409308 PMCID: PMC6693255 DOI: 10.1186/s12889-019-7444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022] Open
Abstract
An evaluation of Västerbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.
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Näslund U, Ng N, Lundgren A, Fhärm E, Grönlund C, Johansson H, Lindahl B, Lindahl B, Lindvall K, Nilsson SK, Nordin M, Nordin S, Nyman E, Rocklöv J, Vanoli D, Weinehall L, Wennberg P, Wester P, Norberg M. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet 2019; 393:133-142. [PMID: 30522919 DOI: 10.1016/s0140-6736(18)32818-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention. METHODS Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575. FINDINGS 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]). INTERPRETATION This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification. FUNDING Västerbotten County Council, the Swedish Research Council, the Heart and Lung Foundation, the Swedish Society of Medicine, and Carl Bennet Ltd, Sweden.
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Affiliation(s)
- Ulf Näslund
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Nawi Ng
- Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anna Lundgren
- Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Fhärm
- Unit of Family Medicine, Umeå University, Umeå, Sweden
| | - Christer Grönlund
- Department of Public Health and Clinical Medicine, Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Helene Johansson
- Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bernt Lindahl
- Unit of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Kristina Lindvall
- Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Stefan K Nilsson
- Unit of Physiological Chemistry, Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Emma Nyman
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Joacim Rocklöv
- Unit of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Davide Vanoli
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Weinehall
- Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Per Wester
- Unit of Medicine, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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