Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review.

The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies.

Experiences of physical activity and exercise among women with obstructive pulmonary disease.

BACKGROUND: With more women being diagnosed with obstructive pulmonary disease, it is important to know how women experience non-pharmacological rehabilitation including different types of physical activity and exercise. OBJECTIVE: This study aimed to explore how women with obstructive pulmonary disease experienced participating in pulmonary rehabilitation including yoga or strength- and endurance training to promote physical activity. A second aim included exploring experiences of physical activity and exercise through life. METHODS: Fifteen women with asthma or chronic obstructive pulmonary disease were interviewed about their experiences of participating in an exercise intervention and about their experiences of physical activity and exercise in their lives. The transcribed interviews were analyzed using qualitative content analysis. RESULTS: An overall theme, "Wishing to succeed in attending physical activity and exercise," emerged. Three categories were identified: 1) strategies to overcome insecurity; 2) a life situation which enables and hinders; and 3) an inner drive and focus on myself. CONCLUSIONS: The women's wishes to be physically activity and exercise involved hindering and enabling factors. Specifically, their gender roles as women were described as a hinder. This suggests a need to include a gender perspective when promoting physical activity and exercise to women with obstructive pulmonary disease.

Psychiatric diseases and dementia and their association with open-angle glaucoma in the total population of Stockholm.

OBJECTIVE: Association between some somatic diseases and primary open-angle glaucoma (POAG) are well-known. We aimed to study psychiatric diseases and dementia and their association with POAG in the total population of Region Stockholm. METHODS: All living individuals above 18 years of age who resided in Stockholm County, Sweden, on 1 January 2017 (N = 1,703,675) were included. Data were obtained from administrative regional data. We identified individuals with specified psychiatric disorders in the years 2010-2019, and further identified those with an incident diagnosis of POAG during 2012-2018. Analyses were performed by age-group and sex. We calculated odds ratios (ORs) with 95% confidence intervals (95% CI), adjusted for age and neighborhood socio-economic status for individuals with POAG, and used individuals without POAG as referents. RESULTS: A total of 16,299 cases of POAG were identified, of whom 9204 were women and 7095 men. Adjusted OR (95% CI) for the risk of POAG was 0.653 (0.610-0.698) for women and 0.714 (0.656-0.778) for men with dementia, respectively. The OR for POAG was 0.478 (0.355-0.643) for women with psychosis, and 1.164 (1.105-1.227) for women with depression. A high neighbourhood socio-economic status was associated with a higher risk of POAG. Other associations were non-significant. CONCLUSION: The prevalence of newly diagnosed POAG was decreased in men and women with dementia, and in women with psychosis, which could be an underestimation, owing to lack of investigation, which warrants attention. The risk of POAG was increased in women with depression, which could be secondary to the glaucoma diagnosis.KEY MESSAGESThe prevalence of newly diagnosed glaucoma was decreased in men and women with dementia, and in women with psychosis. A lower prevalence of newly diagnosed glaucoma may be due to an underestimation, owing to a lack of investigation.The risk of glaucoma was increased in women with depression, which could be secondary to the glaucoma diagnosis.

Health factors and longevity in men and women: a 26-year follow-up study.

Health factors have the power to prevent and postpone diseases and death; however, studies using the same methodology in both men and women are sparse. We aimed to study the ability of health factors to prevent mortality in a population-based, 26-year follow-up of Swedish men and women. During 1969-70, a health-screening programme was offered to a stratified sample of 3,064 individuals aged 18-64 years to estimate health-care needs. Missing data (largely according to protocol) for physical fitness, BMI, and smoking habits left 935 subjects, 463 men and 472 women. Alcohol consumption in grams per week and BMI was calculated. Tobacco smoking was recorded as yes/no. Multivariate analysis was performed by Cox regression with age adjusted hazard ratios (HR) and 95% confidence interval (CI). Moderate alcohol consumption did not lead to any decrease in mortality. Having two health factors halved the mortality risk in men and women (hazard ratio (HR) 0.52, confidence interval (CI) 0.39-0.70). A further risk reduction was seen in men with three health factors (HR 0.17, CI 0.074-0.41). Men had about 70 per cent higher risk of mortality compared with women after adjustments for all health factors (HR 1.67, CI 1.26-2.23). Men compared to women had greater benefit of all three health factors. This in combination with the overall higher mortality risk in men makes a healthy lifestyle more important for them. The benefit of moderate alcohol consumption could not be detected in this study, and may be explained by an unhealthy drinking pattern in Sweden.

Physicians' gender is associated with risk factor control in patients on antihypertensive and lipid lowering treatment.

The objective was to study gender differences in cardiovascular risk factors, lipid and blood pressure control in patients on combined lipid-lowering and antihypertensive treatment, in relation to gender of their physician. This was a cross-sectional study of 4319 patients (53% men) on lipid-lowering and antihypertensive treatment from two national surveys. Male physicians included 1643 men and 1311 women, and female physicians 605 men and 648 women. All data were collected consecutively from medical records. Women were older, had a higher systolic blood pressure (SBP), pulse pressure (PP), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), SBP>or=140 mmHg, and more often isolated systolic hypertension (ISH) compared with men. Men compared with women had more often diabetes, higher cardiovascular risk (SCORE) and achieved treatment goals more often for blood pressure in non-diabetics and TC in both non-diabetics and diabetics. Both men and women in well controlled and intermediate controlled groups were more often treated by physicians of their own gender. The female diabetes patients treated by female primary healthcare physicians more often achieved treatment goals for blood pressure [SBP/diastolic blood pressure (DBP)<130/80 mmHg]. Female physicians' male patients with diabetes more often belonged to the well controlled group. Physicians' gender may influence the control of risk factors for cardiovascular disease in both men and women on combined antihypertensive and lipid-lowering therapy.

Cardiovascular and total mortality in men and women with different blood pressure levels--A 26-year follow-up.

AIM: Our aim was to study different levels of high blood pressure and normal blood pressure (reference) to calculate the hazard ratios (HRs) for cardiovascular and total mortality in men and women with adjustments for many covariates. METHODS: A health-screening program was offered to a population-based sample in Stockholm County to estimate healthcare needs (a proxy for co-morbidity). Blood pressure measurements (mmHg systolic/diastolic) were available for 2280 participants (74%). Mortality was followed up for 26 years. RESULTS: HRs with confidence intervals (CI) were calculated. The HR for all-cause mortality in those with very high blood pressure, > or =160 and/or 95, was 1.93 (1.38-2.70) in men and 2.29 (1.42-3.69) in women. High blood pressure (> or = 140 and/or 90 but <160 and 95 cmHg) and prehypertension (> or = 130 and/or 85 but <140 and 90) were significant in women but not in men. Diagnosed hypertension with antihypertensive treatment adjusted for blood pressure level was non-significant in all models. CONCLUSION: Very high blood pressure was an independent risk factor for both total and cardiovascular mortality in both men and women after adjustments for all covariates including healthcare need. Hypertension seems just as important to treat in individuals with co-morbidities.

A randomized controlled pilot study of the effects of 6-week high intensity hatha yoga protocol on health-related outcomes among students.

OBJECTIVE: Modern hatha yoga exercises (YE) provide an alternative form of physical activity which may reduce stress, facilitate recovery and improve health. This study investigated the short-term effects of high intensity hatha yoga exercises (HIY) on health-related outcomes. METHODS: A 6-week randomized controlled study was performed to compare HIY with a control group not changing their exercise behavior. Healthy students (N = 44; median age: 25 years, range 20-39 years; HIY: n = 21, including 3 men; control group: n = 23, including 3 men) novice to yoga participated in the intervention which included one weekly class and recommended home training. Participants provided self-reports in questionnaires before and after the intervention. Self-reports included anxiety and depression (Hospital Anxiety and Depression Scale), stress (Perceived Stress Scale), sleep quality (Pittsburgh Sleep Quality Index), insomnia (Insomnia Severity Index), subjective health complaints (Common Symptoms in General Practice Index) and self-rated health (single-item). RESULTS: After the 6-week intervention, there were no between-group differences in anxiety, depression, stress, sleep or self-rated health. However, when investigating associations within the HIY-group, a higher HIY-dose was related to less depression (r = 0.47; p = 0.03), improved sleep quality (r = 0.55; p = 0.01), and less insomnia (r = 0.49; p = 0.02). CONCLUSIONS: There were no short-term between-group effects of HIY on mental distress, sleep or self-rated health. However, within the HIY-group, a higher dose was associated with improved mental health in terms of depression and with improved sleep. Although future studies with larger samples are needed, these preliminary findings suggest short-term positive effects of HIY on health-related outcomes among students. TRIAL REGISTRATION NUMBER: NCT01305096.

Prevalence of hypertension in immigrants and Swedish-born individuals, a cross-sectional study of 60-year-old men and women in Sweden.

OBJECTIVE: To estimate the prevalence of hypertension, defined as systolic or diastolic blood pressure or both of at least 140/90 mmHg measured on one occasion or being treated for hypertension or both, in 60-year-old men and women in groups of immigrants compared to Swedish-born. DESIGN AND METHOD: A population-based, cross-sectional study in Stockholm County including 4228 participants (77% participation rate), of whom 19% were immigrants. Outcome measures were prevalence of hypertension in immigrants compared to Swedish-born men and women with adjustments for various metabolic, lifestyle and socio-economic characteristics. RESULTS: The prevalence of hypertension among Swedish-born individuals (n = 3327) was 61% in men and 44% in women, among Finnish-born individuals (n = 327) it was 77% in men and 62% in women and among non-European immigrants (n = 123) it was 51% in men and 36% in women. The mean blood pressure in Finnish-born men was 149/90 (hypertensive). After adjustments for metabolic, lifestyle and socio-economic characteristics, the odds ratio for hypertension in immigrants from Finland was 2.02 (1.56-2.61) and the odds ratio in immigrants from non-European countries was 0.52 (0.34-0.80) using Swedish-born participants as reference. CONCLUSION: About half of all 60-year-olds in Sweden had high blood pressure. The high prevalence of hypertension found in Finnish-born immigrants remained after adjustments for many factors and needs a genetic or environmental explanation. The high prevalence of hypertension in Sweden, especially in Finnish-born immigrants, calls for preventive actions.

Risk factors associated with newly diagnosed high blood pressure in men and women.

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseases. Early diagnosis and prevention of hypertension are of great importance in reducing overall mortality. The objective was to determine which potential risk factors are associated with newly diagnosed high blood pressure in women and men. METHODS: This study is part of a population-based, cross-sectional study including 4,228 women and men aged 60 years in Stockholm County, Sweden. Newly diagnosed high blood pressure was defined as systolic and/or diastolic blood pressure exceeding 140/90 measured on one occasion. Subjects with known hypertension were excluded, leaving 3,156 individuals. RESULTS: Waist circumference > or =95 cm (quintiles 3-5) in men and > or =88.5 cm (quintiles 4-5) in women was associated with newly diagnosed high blood pressure. Secondary school was a protective factor in men (odds ratio (OR), men = 0.73, 95% confidence interval (CI) = 0.54-0.99) and university education was protective in both men (OR = 0.66, 95% CI = 0.52-0.85) and women (OR = 0.45, 95% CI = 0.34-0.59). Regular physical activity was negatively associated in women (OR = 0.77, 95% CI = 0.61-0.99), and high alcohol consumption (>30 g/day) was positively associated in men (OR = 1.60, 95% CI = 1.22-2.09). Women were negatively associated with newly diagnosed high blood pressure (OR = 0.50, 95% CI = 0.41-0.61). An interaction between college/university and gender was found in multivariate analysis (OR = 0.67, 95% CI = 0.47-0.97). CONCLUSION: Gender differences in risk profile for newly diagnosed high blood pressure might explain part of the differences in hypertension found between men and women. These findings should be considered when planning preventive actions against hypertension at the community level.

Experiences of hatha yogic exercises among patients with obstructive pulmonary diseases: A qualitative study.

BACKGROUND AND AIM: Obstructive pulmonary diseases can involve dyspnea and deconditioning. Hatha yogic exercises are a form of psychophysical attention-based activity. Research of experiences after participating in an adapted hatha yoga (YE) intervention remains limited. The aim of the present study was to explore the experiences of patients with obstructive pulmonary diseases (asthma and chronic obstructive pulmonary disease) in a 12-week hatha yoga intervention (YE). METHOD: Fifteen patients (10 women and 5 men, median age = 61, range: 44-76 years) who had participated in YE were interviewed after the intervention. Interview data were analyzed using qualitative content analysis. RESULTS: Three main categories emerged: "To focus and be aware of oneself", "To gain new knowledge through practice" and "To master one's own situation". The overall theme "From limitation to opportunity - to experience breathing as a tool in daily life" illustrates a learning process on different levels. The participants described improved physical symptoms and breathing techniques, greater energy/stamina and body awareness along with a new sense of control over their breathing in different situations. CONCLUSIONS: Patients with obstructive pulmonary diseases may strengthen their self-awareness and improve control of symptoms and learning new ways of breathing after practicing YE, which may provide a tool to control disease symptoms in daily life. Trial registration number NCT02233114.

Coping strategies among patients newly diagnosed with diabetes or rheumatoid arthritis at baseline and after 24 months.

Patients aged 18-65 years with newly diagnosed diabetes mellitus ( n = 89) or rheumatoid arthritis ( n = 100) were studied by the General Coping Questionnaire at baseline and after 24 months. In total, 34 diabetes mellitus and 46 rheumatoid arthritis patients were diagnosed with psychosocial problems. The use of negative coping strategies, such as protest, isolation, and intrusion, was associated mostly with being classified as having psychosocial problems. With the risk of experiencing a strong impact of the disease at 2 years of follow-up as outcome, intrusion was a significant and independent risk factor, while minimization was a significant and independent protective factor.

Cardiovascular events in patients under age fifty with early findings of elevated lipid and glucose levels - The AMORIS study.

BACKGROUND: The long-term trajectories of lipid and glucose levels in subjects who experience a major cardiovascular (CV) event at a young age has not been well studied. Our objective was to investigate lipid, lipoprotein, apolipoprotein (apo), and glucose levels in individuals experiencing a CV event before 50 years of age. METHODS AND FINDINGS: A first CV event [non-fatal myocardial infarction (MI), coronary revascularisation, or CV related death] before age 50 was recorded in 2,939 (cumulative incidence 1.2% in males and 0.3% in females) of 361,353 individuals included in the prospective Swedish AMORIS (Apolipoprotein-related MOrtality RISk) study with health examinations 1985-1996 and follow-up through 2011. In a nested case-control analysis, cases with a CV event were matched to randomly selected controls. Population risk factor trajectories were calculated up to 20 years prior to an event. Total cholesterol (TC), triglyceride (TG), and glucose levels were higher in cases than in controls as early as 20 years prior to the event with differences increasing over time. Low density lipoprotein, apoB, and the apoB/apoA-1 ratio were higher and increased over time, while HDL and apoA-1 were lower in cases compared to controls. The odds ratio was 2.5 (95% confidence interval 1.6-3.7) for TC ≥5 mmol/L and TG ≥1.7 mmol/L in cases versus controls. The adjusted population-attributable fractions including lipids, glucose, diabetes, smoking, hypertension, and obesity indicated that about 50% of CV events before age 50 may be associated with elevated lipid and glucose levels. CONCLUSIONS: Elevated TC, TG, LDL, apoB, and glucose levels and high apoB/apo A-1 ratio documented two decades before a CV event in subjects younger than 50 years may account for about half of CV events before age 50, which calls for early recognition and possibly treatment of modifiable CV risk factors in young individuals.

Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: A systematic review.

Background Health checks for cardiometabolic diseases could play a role in the identification of persons at high risk for disease. To improve the uptake of these health checks in primary care, we need to know what barriers and facilitators determine participation. Methods We used an iterative search strategy consisting of three steps: (a) identification of key-articles; (b) systematic literature search in PubMed, Medline and Embase based on keywords; (c) screening of titles and abstracts and subsequently full-text screening. We summarised the results into four categories: characteristics, attitudes, practical reasons and healthcare provider-related factors. Results Thirty-nine studies were included. Attitudes such as wanting to know of cardiometabolic disease risk, feeling responsible for, and concerns about one's own health were facilitators for participation. Younger age, smoking, low education and attitudes such as not wanting to be, or being, worried about the outcome, low perceived severity or susceptibility, and negative attitude towards health checks or prevention in general were barriers. Furthermore, practical issues such as information and the ease of access to appointments could influence participation. Conclusion Barriers and facilitators to participation in health checks for cardiometabolic diseases were heterogeneous. Hence, it is not possible to develop a 'one size fits all' approach to maximise the uptake. For optimal implementation we suggest a multifactorial approach adapted to the national context with special attention to people who might be more difficult to reach. Increasing the uptake of health checks could contribute to identifying the people at risk to be able to start preventive interventions.

Effect of heart rate on long-term mortality among men and women.

OBJECTIVE: This study aims at estimating the effect of high heart rate on total mortality during a long-term follow-up among men and women. During the years 1969-70, a stratified sample of 32,185 individuals aged 18-64 years was drawn from the population in Stockholm County (response rate 87%). A sub-sample, stratified by predicted health care needs, was invited to the health-screening program, and an extensive health examination performed on 2445 individuals out of 3064 individuals. An exercise test was performed on 1054 subjects. Complete data were available for 989 subjects, 490 men and 499 women. METHODS: Participants were followed up in the National Cause of Death Register up to the end of 1996. Multivariate analysis was performed adjusting for cardio-respiratory fitness, expected level of care need, obesity, smoking and hypertension. RESULTS: Among men, high heart rate (above 75 beats/minute) was associated with excess mortality, HR 1.63 (95% CI 1.30-2.03) in the age-adjusted model, and HR 1.57 (95% CI 1.05-2.35) in the full model. Among women, no significant excess risk was found, HR 1.18 (95% CI 0.89-1.58) in the age-adjusted model. CONCLUSIONS: High heart rate is an independent mortality risk marker for men but not for women.

Effects of yogic exercises on functional capacity, lung function and quality of life in participants with obstructive pulmonary disease: a randomized controlled study.

BACKGROUND: Knowledge of hatha yogic exercises, the most used yoga style, for increasing functional capacity in patients with obstructive pulmonary diseases remains limited. AIM: The aim was to evaluate the effects and feasibility of hatha yoga (HY) compared to a conventional training program (CTP) on functional capacity, lung function and quality of life in patients with obstructive pulmonary diseases. DESIGN: Randomized clinical trial. SETTING: The study was performed at the Karolinska University Hospital, Stockholm, among outpatients. POPULATION: Thirty-six patients with obstructive pulmonary disease. METHODS: Forty patients were randomized with 36 (24 women, median age =64, age range: 40-84 years) participating in HY (N.=19) or CTP (N.=17). Both HY and CTP involved a 12-week program with a 6-month follow-up. Functional capacity (using the 6-Minute Walk Test), lung function (spirometry), respiratory muscle strength (respiratory pressure meter), oxygen saturation (SpO2), breathlessness (Borg), respiratory rate (f) and disease-specific quality of life (CRQ) were measured at baseline, at 12 weeks and at a 6-month follow-up. RESULTS: Testing for interactions (group x time) with ANOVAs showed significant effects on the CRQ fatigue (P=0.04) and emotional (P=0.02) domains, with improvements in the CTP group after the 12-week intervention (P=0.02 and 0.01, respectively) but not in the HY group. No between group effects emerged, however, within each group, significant improvements emerged for the six-minute walk distance (6MWD) after 12-week intervention (HY: mean difference 32.6 m; CI: 10.1-55.1, P=0.014; CTP: mean difference 42.4 m; CI: 17.9-67.0, P=0.006). SECONDARY OUTCOMES: within-group improvements in CRQ appeared in both groups. Within the HY group, f decreased and SpO2 increased. Improved effects after follow-up emerged only for the CTP group for diastolic blood pressure (P=0.05) and CRQ emotional and fatigue domain (P=0.01). CONCLUSIONS: There were no between-group differences. After 12 weeks, 6MWD improved significantly within both groups. Within the HY group, improvements in the CRQ mastery domain, f and SpO2 emerged. Within the CTP group, there were improvements in lung function parameter forced vital capacity, respiratory muscle strength and all CRQ-domains. The CTP also exhibited effects on CRQ after the 6months follow-up. CLINICAL REHABILITATION IMPACT: Limited effects of HY and CTP emerged. HY seems feasible and safe as a form of physical exercise for pulmonary disease patients. As part of the rehabilitation, HY may constitute an alternative to other physical training activities and may be a useful addition to formal rehabilitation programs.

Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis.

We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18-65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy "protest" were important risk factors for depression and anxiety after 2 years.

Effects of High-Intensity Hatha Yoga on Cardiovascular Fitness, Adipocytokines, and Apolipoproteins in Healthy Students: A Randomized Controlled Study.

BACKGROUND: Yoga exercises are often used as a form of body and mind exercise to increase performance. However, knowledge about the physiologic effects of performing high-intensity Hatha yoga exercises over a longer time period remains limited. OBJECTIVE: To investigate the effects of high-intensity yoga (HIY) on cardiovascular fitness (maximal oxygen consumption, estimated from the Cooper running test), ratings of perceived exertion (RPE), heart rate (HR), heart rate recovery (HRR), blood pressure (BP), adipocytokines, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and glycosylated hemoglobin (HbA1c) in healthy students. METHODS: The 44 participants (38 women and 6 men; median age, 25 years [range, 20-39 years]) were randomly assigned to an HIY or a control group. The HIY program was held for 6 weeks (60 minutes once a week). Cardiovascular fitness, RPE, HR, HRR, BP, adipocytokines, HbA1c, ApoA1, and ApoB were measured at baseline and after 6 weeks in both groups. RESULTS: HIY had no significant effects on cardiovascular fitness (mean dose: 390 minutes [range, 210-800 minutes]), HR, HRR, BP, or any of the blood parameters. However, secondary findings showed that [corrected] ApoA1 (1.47 ± 0.17 to 1.55 ± 0.16 g/L; p = 0.03) and adiponectin (8.32 ± 3.32 to 9.68 ± 3.83 mg/L; p = 0.003) levels increased significantly in the HIY group after 6 weeks. CONCLUSIONS: Six weeks of HIY did not significantly improve cardiovascular fitness. However, secondary findings showed that [corrected] ApoA1 and adiponectin levels increased significantly in the HIY group. This finding suggests that HIY may have positive effects on blood lipids and an anti-inflammatory effect.

Gender differences and time trends in incidence and prevalence of type 2 diabetes in Sweden--a model explaining the diabetes epidemic worldwide today?

Gender differences in type 2 diabetes in Sweden were studied based on a literature search. The male predominance in 1940s (male/female ratio 1.2-1.4 in the ages 10-55 years) increased over time especially in the age 45-64 years with a male/female ratio up to 2.

Population groups in dietary transition.

BACKGROUND: Little is known about the effects of dietary acculturation in minority groups in the Nordic countries, including immigrants from non-Western societies. METHODS: A search was performed in Medlin33e/PubMed and SweMed+ for articles published in 1990-2011. RESULTS: A total of 840 articles were identified, with a final 32 articles used to tabulate results which were included in the primary analysis. High rates of vitamin D deficiency (23 articles) were found in immigrants of non-Western origin; deficiency rates were very high among both pregnant and non-pregnant women, and also among children, with young children of immigrant parents showing 50 times higher risk for rickets when compared to children of indigenous parents. The risk of iron deficiency (two articles) was high among immigrant women, while the results were inconclusive regarding children. High rates of dental caries (seven articles) were found among pre-school and younger school children of immigrant origin, while the risk of caries was not as evident among older children. In a secondary analysis, including 48 articles (results not tabulated), overweight and obesity (14 articles) were seen in many immigrant groups, resulting in a high prevalence of diabetes (2 review articles from a total of 14 original articles) and incidence of coronary heart disease (CHD; seven articles). For hypertension (three articles), dyslipidemia (four articles), and dietary patterns among immigrants (10 articles), the results were contradictory. CONCLUSIONS: Risk of vitamin D deficiency is alarmingly high in the Nordic countries among immigrants of non-Western origin, especially among women. Dental caries is high among immigrant children aged 0-7 years due to a higher intake of sugary products. Overweight and obesity, associated with a higher risk of diabetes and CHD, are prevalent in many immigrant groups and need further attention.

Time trends and gender differences in incidence and prevalence of type 1 diabetes in Sweden.

There are different opinions on a possible sex bias in diabetes. In Sweden we have access to data since the 1930s, making it an ideal model. We aimed to study gender differences and time trends in the incidence and prevalence of type 1 diabetes in Sweden. We found 31 articles on incidence and 8 on prevalence (6 overlapping). Times series on incidence were found regarding children 0-15 years of age (with the Swedish Childhood Diabetes Registry, SCDR, since 1977), with up to 14,721 children with diabetes and with a high degree of ascertainment. Incidence time series were also found for subjects aged 15-34 (Diabetes Incidence Study in Sweden, DISS, since 1983), with up to 7,369 subjects and with a lower degree of ascertainment compared to SCDR. Regarding age from 40 years and above fewer studies were found, and with a much lower number of subjects with type 1 diabetes. Diabetes incidence in children has had a relative increase of approximately 2% per year since 1938. Incidence rates in children 0-14 years of age show no gender differences, but in subjects aged 15-39 years a male preponderance up to twofold is found. Figures for subjects 40 years or older are more uncertain, but show a fairly equal incidence among men and women. The male preponderance in type 1 diabetes from age 15 up to 40-50 could be due to hormonal influence, with higher peripheral insulin resistance among men in young adults and younger middle age.