The possibility of lifestyle and biological risk markers to predict morbidity and mortality in a cohort of young men after 26 years follow-up.

To study the association between lifestyle and biological risk markers measured at one occasion, morbidity and mortality from cardiovascular disease (CVD) and cancer, and morbidity from diabetes approximately 26 years later

Prevention of ischaemic heart disease in primary health care. Experiences from a health promotion programme

This thesis is based on the Live for Life health promotion programme, which was started in the County of Skaraborg in 1989. Special reference is given to the results obtained from a health interview, which was offered, to 30- and 35-year old men and women in the county.Aims of the study: The main purpose was to describe and evaluate methods for health promotion work. Special aims were to characterise 30- and 35-year old persons in the county with respect to lifestyle factors and biological risk markers. The association between lifestyle and biological risk factors were studied, as well as the effect of lifestyle changes on biological risk markers. Sub-aims were to determine if there was an effect of the health promotion programme on hard end-points (mortality from ischaemic heart disease) in the community, and to evaluate the dietary instrument used.Study population and methods: All health care centres in the former County of Skaraborg participated in the Live for Life programme, and as one part of the programme 30- and 35-year old persons in the county were invited to a health dialogue using a "Health Curve". A nurse carried out this health interview. Information about dietary habits was obtained by using a specially designed self-instruction questionnaire. Register data were used for studying changes in mortality from ischaemic heart disease as a possible effect of the intervention programme.Results and conclusions: Detailed information has been obtained about lifestyle factors and biological risk markers from the health dialogues. Women reported better dietary habits and lower alcohol consumption than men, while men smoked less, experienced less mental stress and reported less psychological strain. Dietary habits were more favourable at the age of 35 years than at the age of 30, both in men and women. The specially designed dietary questionnaire showed good between-method correlation for fat and fibre with a 3-day food record and there was a significant association with dietary habits measured with the questionnaire and serum cholesterol concentration. The dietary questionnaire proved to be a useful tool as part of the health dialogue. Those who improved their lifestyle (dietary and physical activity habits were studied in this respect) also improved their biological risk markers. In communities offering the health dialogue there was a more favourable development concerning biological risk markers such as body mass index and serum cholesterol concentration compared with communities with a community health strategy only. In one of the communities of Skaraborg (Habo), which participated to full extent in the Live for Live programme, premature mortality from ischaemic heart disease decreased substantially compared with the rest of Sweden. This may be an effect of improvements in both primary and secondary prevention in co-operation between the community and primary health care

Trends in prevalence of thinness, overweight and obesity among Swedish children and adolescents between 2004 and 2015.

AIM: This study explored weight trends among children aged 4, 7, 11, 14 and 17 years in Jönköping County Sweden, from 2004 to 2015. METHODS: The study had a repeated cross-sectional design, and body mass index (BMI) was calculated based on height and weight measurements collected from child health and school health records. The prevalence of thinness, overweight and obesity was estimated with international cut-offs, with linear trends calculated separately for boys and girls. RESULTS: There were 190 965 measurements of BMI and these covered 82-97% of the younger children and 55-69% of the older children during the study period. The prevalence of thinness varied between 0.2% and 2.2% across time and age groups and did not change over the study period. There was a small decrease in overweight among both girls and boys aged four years. There were increasing trends in overweight and obesity in both girls and boys aged 11 and 14 years of age and a sharp increase among 17-year-old boys, with 7.3% obese in 2014/2015 and 3.6% in 2004/2005. CONCLUSION: The prevalence of obesity decreased from 2004 to 2015 or was stable in younger Swedish children, but increased among older children, with a large increase in adolescent boys

Health dialogues between pupils and school nurses : a description of the verbal interaction

Objective:The purpose of this study was to explore and describe the content and the verbal interaction in health dialogues between pupils and school nurses. Method: Twenty-four health dialogues were recorded using a video camera and the conversations were analysed using the paediatric version of the Roter Interaction analysis system. Results:The results showed that the age appropriate topics suggested by national recommendations were brought up in most of the health dialogues. The nurses were the ones who talked most, in terms of utterances. The pupils most frequently gave information about their lifestyle and agreed with the nurses’ statements. The nurses summarized and checked that they had understood the pupils, asked closed-ended questions about lifestyle and gave information about lifestyle. Strategies aimed to make the pupil more active and participatory in the dialogues were the most widely used verbal interaction approaches by the nurses. Conclusion:The nurses’ use of verbal interaction approaches to promote pupils’ activity and participation, trying to build a partnership in the dialogue, could indicate an attempt to build patient-centred health dialogues.  Clinical implications: The nurses’ great use of questions and being the ones leading the dialogues in terms of utterances point at the necessity for a nurses to have an openness to the pupils own narratives and an attentiveness to what he or she wants to talk about

Befolkningsuppdraget, exemplet hälsoundersökningar – först misstrott, nu evidensbaserat

SammanfattningVästerbottens Hälsoundersökningar och Hälsosamtal i Skaraborg och Jönköpings län representerar konceptet riktade hälsosamtal för prevention av hjärt-kärlsjukdomar. Utvärderingar visar en positiv effekt med lägre mortalitet, både på befolkningsnivå (deltagare och icke-deltagare sammantaget) och i ännu högre grad bland deltagarna, i jämförelse med motsvarande grupper nationellt. Utmaningar återstår, både vad gäller andelen deltagande invånare och hur motiven för arbetet kan stärkas utifrån primärvårdens perspektiv. Det centrala i konceptet, som skiljer det från andra mer generella hälsokontroller, är att det:drivs integrerat i primärvårdenär befolkningsbaseratkombinerar hälsofrämjande lågriskstrategi och sjukdomsförebyggande högriskstrategifokuserar på hälsosamtalet utifrån individens preferenser och möjligheter, levnadsvanor och levnadsförhållanden samt kardiovaskulära riskfaktoreranvänder personcentrerad samtalsmetodik och visuella pedagogiska hjälpmedelbaseras på medicinsk evidens för hjärt-.kärlpreventionanpassas till lokala förutsättningarkvalitetssäkras genom ett strukturerat kompetens- och metodstöd. AbstractVästerbotten Intervention Programme and health dialogues in the Counties of Skaraborg and Jönköping represent a concept of targeted health dialogues for prevention of cardiovascular diseases. Evaluations show lower mortality both on a population level (participants and non-participants together) and to an even higher degree among participants compared to the national level. There are differences between general health checks and the model for targeted health dialogues which is characterized by:Integration in primary carePopulation basedCombines health promotive low risk strategy and disease preventive high risk strategyFocus on the health dialogue taking the individuals preferences, life situation and cardiovascular risk factors into considerationPerson centred dialogue methods and visual pedagogic toolsBased on medical evidence for cardiovascular preventionAdaptation to local conditionsSystematic structure for competence and method suppor

Lifestyle changes in coronary heart disease - Effects of cardiac rehabilitation programs with focus on intensity, duration and content : A systematic review

Background: Although coronary heart disease (CHD) is the most common cause of death worldwide the literature shows a wide variation in the arrangement of cardiac rehabilitation and achieved lifestyle changes. Aim: The purpose of this study was to evaluate the effects of intensity (number of patient follow-ups), duration (length of intervention) and content in cardiac rehabilitation programs (CRP) regarding lifestyle changes in patients with CHD. Method: A systematic literature review of articles published in the databases PubMed and CINAHL between 1990 and 2007 was conducted. This resulted in 1120 hits of which 25 articles finally met the set criteria for inclusion. Results: The majority of significant positive results on lifestyle factors were shown among the studies describing high intensity and long duration. Included studies showed a wide variation in content, but four different interventions (informative content, educational content, practical content, behavioral and self care-oriented content) emerged. The group of studies which contained all four interventions focused on most lifestyle factors and achieved the most significant positive results. Conclusion: This systematic literature review shows that CRP should include high intensity, long duration and an intervention content covering information, knowledge, practical training, self care-activity and behavior changes in order to achieve effect on all four lifestyle factors of diet, physical activity and exercise, smoking and stress. Lifestyle changes can be reached in less lifestyle factors, with a longer duration and a variation of intensity of contacts but in combining with an informative and educational content with an additional content of a practical nature or self activity

Food intake in children and adolescents: a cross-sectional study from 2009/2010 to 2015/2016

The aim was to describe food intake over time in children and adolescents, with respect to age and gender. The present study was a repeated cross-sectional study using self-reported data from a health questionnaire. Data were collected from the School Health Services in south-east Sweden from 44 297 students, 10, 13-14 and 16 years of age, 48 % girls and 52 % boys from 2009/2010 to 2015/2016. Reported intakes for eight foods were analysed in relation to the Nordic Nutrition Recommendations. Seventeen per cent of the students reported an intake in line with the recommendations for at least six of the eight foods fish, vegetables, fruit, mealtime beverages, juice/chocolate drinks, sugar-sweetened beverages, sweets/snacks and pastries. Intake of at least two fruits a day was the recommendation that was followed by the lowest proportion of students (30 %), and this result was stable over the study period. There was a gradual increase over time in the proportion of students who reported an intake in line with the recommendations. Younger students compared to older students, as well as girls compared to boys, reported intakes in line with the recommendations to a statistically significant larger extent. Few students reported intakes in line with the recommendations, although the quality of food intake seems to improve over time. The present results indicate a deterioration in reported food intake in the early years of adolescence. Finding methods to support all children and especially older adolescents to eat healthier, including eating more fruit, is of great importance to public health.Funding Agencies|Region Jonkoping County</p

Associations between intakes of foods and their relations to overweight/obesity in 16-year-old adolescents

There is limited knowledge about the associations between intakes of different foods and inconsistency in the literature of the relation between the quality of food intake and bodyweight in adolescents. The aim of this study is to explore how healthy self-reported food intakes are associated with each other and with overweight/obesity in adolescents. This is a cross-sectional study of seven cohorts of adolescents (n 13 451) who turned sixteen from 2009/2010 up to 2015/2016 and responded to a health questionnaire used by the School Health Services in southeast Sweden. Associations between intakes of ten self-reported foods as well as between food intakes and weight groups based on the International Obesity Task Force standards (isoBMI) were explored by multivariable logistic regression. Healthy intakes of different foods were mostly associated with each other with the strongest association between a high intake of fruit and a high intake of vegetables (odds ratio (OR) = 25 (95 % confidence interval (CI) 20.0-33.1)). A low-frequency intake of sweets/snacks (OR = 2.35 (95 % CI 1.84-3.00)) was associated with overweight/obesity as well as a healthy choice of butter/margarine (&amp;lt;= 40 % fat) (OR =1.82 (95 % CI 1.39 to 2.41)), but a high-frequency intake of vegetables was negatively associated with overweight/obesity 0.77 (0.62-0.95). To promote health and achieve a healthy weight among adolescents, it is important to take both diet quality and total food amount into consideration.Funding Agencies|Region Jonkoping County</p

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Background Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL). Aim To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL. Method Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL. Result Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20–2.54] and 1.81 [1.25–2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96–5.34] compared to those with low PA and high education (OR 1.46 [0.89–2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42–3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89–6.63]. Conclusion Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.Funding Agencies|Unit for Research and Development in Primary Health Care, Futurum Academy for Health and Care, Region Jonkoping County, Sweden; Swedish Research Council; Swedish Heart and Lung Foundation</p