Exploring how people achieve recommended levels of physical activity, despite self-reported economic difficulties: a sense of coherence perspective.

BACKGROUND: The salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people - despite self-reported economic difficulties - comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO). METHOD: The study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness. RESULT: The findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits. CONCLUSION: This study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA. TRIAL REGISTRATION: Not applicable.

Associations between food intake and psychosomatic symptoms in 16-year-old adolescents.

AIMS: An increase in psychosomatic symptoms among adolescents has recently been reported. Few studies have examined the relation between food intake and psychosomatic symptoms. The aim was to study the association between food intake and overall psychosomatic burden and separate psychosomatic symptoms. METHODS: In this cross-sectional study, we used data from 6248 girls and 7153 boys in south-east Sweden who turned 16 years of age during the academic years 2009/2010 to 2015/2016 and responded to a health questionnaire at the school health services. The association between overall healthy food intake and a low psychosomatic burden was calculated as odds ratios (95% confidence interval) and stratified for other lifestyle habits and gender. RESULTS: Sixty-nine per cent of the boys and 35% of the girls had a low psychosomatic burden. There was a positive association between an overall healthy food intake and a low psychosomatic burden (P<0.0001), regardless of other lifestyle habits and gender. An overall healthy food intake was also positively associated with a lower frequency of the separate psychosomatic symptoms of concentration difficulties, sleep difficulties, a poor appetite or dizziness (P<0.0001). CONCLUSIONS: A healthy food intake seems to be associated with a low psychosomatic burden among adolescents. Further knowledge is needed to explore whether an improved food intake can reduce psychosomatic symptoms and enhance mental health.

Healthcare professionals' experiences of targeted health dialogues in primary health care.

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.

Agreement between questions about physical activity and sitting time, and device-based measures, used in Swedish targeted health dialogues in the context of primary health care.

BACKGROUND: It is important that easy-to-use measures like subjective questions about physical activity (PA) and sedentary behaviour are valid and reliable providing accurate measures, when they are used in health promotion work aiming to support people to improve their lifestyle habits such as PA. The aim of this study was to evaluate the concurrent validity of a structured interview form estimating self-reported PA and a question about sitting time used in Swedish targeted health dialogues in the context of primary health care. METHOD: The study was conducted in the southern part of Sweden. To evaluate concurrent validity of the interview form, time spent in moderate-to-vigorous physical activities (MVPA) and energy expenditure related to MVPA estimated by an interview form was compared with the same measures assessed by an ActiGraph GT3X-BT accelerometer. To evaluate a question about sitting time, the Swedish School of Sport and Health Sciences' single-item question about sitting time (SED-GIH) was compared with measures from an activPAL inclinometer. Statistical analyses included deriving Bland‒Altman plots and calculating Spearman's rank correlation coefficients. RESULT: Bland‒Altman plots indicated lower absolute variation in the difference between self-reported and device-based PA measures for lower PA levels, both for energy expenditure and time spent in MVPA. No systematic over- or underestimation was observed. The Spearman's correlation coefficient between self-reported and device-based PA measures was 0.27 (p = 0.014) for time spent in MVPA and 0.26 (p = 0.022) for energy expenditure. The correlation coefficient between the single item question and device-based sitting time measures was 0.31 (p = 0.002). Sitting time was underestimated by 74% of the participants. CONCLUSION: The PA interview form and the SED-GIH question on sitting time may be of value in targeted health dialogues in primary health care with the intention to support sedentary and insufficiently physically active persons in increasing their physical activity and limiting their sitting time. The questionnaires are easy to use and are more cost effective than device-based measures, especially regarding population-based interventions conducted in primary health care for thousands of participants such as targeted health dialogues. CLINICAL TRIAL REGISTRATION: Not applicable.

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 (≤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.

Physical activity related to mastery and vitality in a Swedish adult population with economic difficulties.

BACKGROUND: People with low socio-economic status report lower levels of physical activity (PA). There is insufficient knowledge about the availability of psychological resources for those who are physically active despite having a low socio-economic status. The aim of this study is to investigate the association between PA level and mastery and vitality, respectively, within an adult population with self-reported economic difficulties. METHOD: Data from a cross-sectional, population-based study (n = 817) were used. Linear regression was used to estimate the unstandardised regression coefficient (ß) with 95% confidence intervals (95% CI), describing associations between PA levels (independent variable) and scale scores of psychological resources in terms of mastery and vitality (outcome variables). Three models were constructed: Model I unadjusted; Model II adjusted for sex and age; and Model III adjusted for sex, age, smoking and food quality. RESULT: After adjusting for sex, age, smoking and food quality and using low-level PA as the reference, high-level PA, but not intermediate-level PA, was related to higher scale scores of mastery (ß = 0.72 [95% CI 0.08 to 1.37]). For vitality, both high-level PA and intermediate-level PA were related to higher scale scores (ß = 9.30 [95% CI 5.20 to 13.40] and ß = 6.70 [95% CI 1.40 to 12.00] respectively). CONCLUSION: In an adult population with self-reported economic difficulties, higher levels of physical activity were related to higher mastery and vitality. Our results support that the association between physical activity and psychological resources in terms of mastery and vitality should be considered in the context of targeted health dialogues. TRIAL REGISTRATION NUMBER: Not applicable.

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.

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.

All-cause mortality among young men 24-26 years after a lifestyle health dialogue in a Swedish primary care setting: a longitudinal follow-up register study.

OBJECTIVES: To compare mortality and socioeconomic status among men invited to a health dialogue with men from all of Sweden approximately 24 years after the start of the study, and to analyse the associations between lifestyle and all-cause mortality, incidence of cardiovascular disease (CVD) and cancer. DESIGN: Longitudinal follow-up register study of men 33-42 years old at baseline. SETTING: Primary care in a community in Sweden. SUBJECTS: All 757 men aged 33-42 years old in a community in southern Sweden, and 652 of these men who participated in a health examination between 1985 and 1987. INTERVENTIONS: Health examination, lifestyle-directed health dialogue and group activities in primary care in cooperation with local associations. PRIMARY AND SECONDARY OUTCOME MEASURES: All-cause mortality, income and educational level, and associations between lifestyle at baseline and all-cause mortality, incidence of CVD and cancer. RESULTS: At follow-up, all-cause mortality was 29% lower (OR=0.71, 95% CI 0.53 to 0.95) among all men invited to the health dialogue compared with all men from the same age cohort in all of Sweden (intention-to-treat) and 43% lower (OR=0.57, 95% CI 0.40 to 0.81) among participating men (on-treatment). A healthy lifestyle was associated with lower mortality (OR=0.16, 95% CI 0.07 to 0.36), with the strongest association for no smoking (OR=0.38, 95% CI 0.21 to 0.68) and a healthy diet (OR=0.37, 95% CI 0.20 to 0.68). A healthy lifestyle was also associated with a decreased incidence of CVD and cancer. There was a significantly higher proportion with short education among invited men compared with men from the same age cohort in all of Sweden. CONCLUSIONS: This study indicates that a combination of low-risk and high-risk strategies, combining a health examination with a lifestyle-directed health dialogue conducted in an ordinary primary care setting in cooperation with local associations, may have contributed to reduced premature mortality. However, we cannot exclude that there may be other factors explaining the lower mortality.

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.

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

OBJECTIVES: 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. DESIGN: A follow-up study of a cohort of men, 33-42 years old at baseline. SETTING: Primary healthcare centre in Sweden. PARTICIPANTS: All 757 men, living in the community of Habo in Sweden in 1985, and all 652 of these participating in a health examination in 1985-1987. INTERVENTIONS: Health profile and a health dialogue with a nurse. A doctor invited the high-risk group to further dialogue and examination. Intervention programmes were carried out in the primary healthcare centre and in cooperation with local associations. MAIN OUTCOME MEASURES: CVD and cancer diagnoses from the Swedish National Board of Health and Welfare. Data from pharmacy registers of sold drugs concerning diabetes mellitus. RESULTS: The participants were divided in three groups based on summarised risk points from lifestyle (smoking, physical activity, alcohol consumption) and biological risk markers (body mass index (BMI), blood pressure, serum cholesterol) selected from the health profile. Comparisons were done between these groups. The group with the lowest summarised total risk points had a significantly lower risk for CVD and cancer compared with the group with the highest summarised risk points. The group with the lowest risk points concerning lifestyle had a significantly lower risk for CVD, and the group with lowest risk points for biological risk markers had a significantly lower risk for both CVD and cancer compared with the groups with the highest risk points. Smoking and serum cholesterol were the most important risk factors. In association to diabetes, BMI and smoking were the most important risk factors. CONCLUSIONS: Risk factors measured on one occasion seemed to be able to predict CVD, cancer and diabetes 26 years later.

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 of and the verbal interaction in health dialogues between pupils and school nurses. METHODS: 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 summarised 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. PRACTICE 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.

Adolescents' and school nurses' perceptions of using a health and lifestyle tool in health dialogues.

AIM AND OBJECTIVE: To describe and explore adolescents' and nurses' perceptions of using a health and lifestyle tool in health dialogues in the School Health Service. BACKGROUND: In Sweden, dialogues concerning health and lifestyle are offered to adolescents aged 14 years with the purpose of encouraging an interest in a healthy lifestyle. A health and lifestyle tool including a health questionnaire and a health profile has recently been developed, with the aim of facilitating the communication about health and lifestyle in these dialogues. DESIGN: Qualitative descriptive design. METHOD: Twenty-nine adolescents and 23 nurses participated in focus group interviews, which were subjected to qualitative content analysis. RESULTS: The health and lifestyle tool was perceived as constituting a structure for the dialogues and as a clear and applicable starting point, focusing on individual aspects. The tool contributed to an understanding of the health situation and to the transmittal of health information on an individual as well as a group level. CONCLUSION: The tool was perceived as constituting a useful structure for the dialogues about health and lifestyle. When it was used the individual's health and lifestyle were concretised, which opened up for a dialogue and different aspects of health and lifestyle were detected. However, in some cases the outcome of the tool could be conceived as a stringent assessment and thereby complicate the dialogues. RELEVANCE TO CLINICAL PRACTICE: The use of a tool, such as the one used in this study, is one way to improve the dialogues in the School Health Service, allowing them to be more focused on the individual's needs and to detect aspects that would otherwise not be so easily detected. The implications of this study include using the findings to guide counselling sessions in the schools and other health care settings.

Health counselling: parental-oriented health dialogue -- an innovation for child health nurses.

The Health Curve, used by nurses in community-based health care, is an educational tool for conducting goal-directed dialogues concerning lifestyle and health. The aim of this study was to investigate how child health nurses experienced the Health Curve as a tool for conducting dialogues with parents. Fourteen nurses were interviewed. The data were analysed according to qualitative analysis. The results showed that nurses working in child health care experienced the Health Curve as a useful tool for conducting health dialogues with parents. Through their work with the Health Curve, the nurses gained a greater insight into, and understanding of, the families' health and life situation. The results indicated that working with the Health Curve could increase the opportunity for nurses to provide parents with support early in the process, helping the family to lead a healthy lifestyle.

Effects of a global health and risk assessment tool for prevention of ischemic heart disease in an individual health dialogue compared with a community health strategy only results from the Live for Life health promotion programme.

OBJECTIVE: To evaluate the effect of an individual health dialogue on health and risk factors for ischemic heart disease in addition to that of a community based strategy. METHOD: Inhabitants in four communities in the area of Skaraborg, Sweden were invited to a health examination including a health dialogue both at the age of 30 and 35 (target communities). In another four communities inhabitants were invited only at the age of 35 (reference communities). Health and risk factors in 35-year old inhabitants in the target communities who participated in the health dialogue in 1989-1991 and 1994-1996 were analysed and compared with 35-year olds in the reference communities participating during the same periods of time. RESULTS: Inhabitants in communities where there had been a previous individualised health intervention programme had, on the community level, a more favourable development concerning dietary habits, mental stress, body mass index, waist circumference, cholesterol, blood pressure and metabolic risk profile compared to inhabitants in communities with only a community based health intervention programme. CONCLUSIONS: An individual lifestyle oriented health dialogue supported by a global health and risk assessment pedagogic tool seems to be more effective than a community health strategy only.

The Swedish National Programme for Quality Control of Secondary Prevention of Coronary Artery Disease--results after one year.

BACKGROUND: Guidelines for the prevention of coronary artery disease (CAD) have been developed both in Europe and in the USA. However, several surveys have shown that these guidelines are poorly implemented in clinical practice. DESIGN/METHODS: The Swedish Quality Control Programme on Secondary Prevention of CAD includes patients after myocardial infarction, or having undergone coronary artery surgery or percutaneous coronary intervention. Fifty of Sweden's 79 hospital districts are currently participating. Patients are asked to send report-cards regarding risk factor management to a central registry after discharge from hospital, at a 3-6 month visit and then yearly for 5 years. RESULTS: Results based on data from 1 year after the index event show that a majority of patients reach targets for serum cholesterol (70%), and low-density lipoprotein (LDL)-cholesterol (71%). Mean value for total cholesterol is 4.6 (+/-SD 0.9) mmol/l, LDL-cholesterol 2.7 (+/-SD 0.8) mmol/l. Blood pressure targets are less often achieved, with 58% reaching the European Society of Cardiology target for systolic (<140 mmHg) and 81% for diastolic (<90 mmHg) blood pressure. A large proportion of patients are prescribed preventive drugs: aspirin (96%), beta-blockers (78%) and lipid-lowering drugs (83%). CONCLUSIONS: The Swedish Quality Control Programme is one of the first attempts to assess implementation of guidelines on a national level based on patient participation. It is hoped that shared care programmes and increased patient involvement with feedback on achieved treatment goals in relation to guidelines will improve outcomes in patients with CAD.

Lifestyle changes after a health dialogue. Results from the Live for Life health promotion programme.

OBJECTIVE: To evaluate the effect of a health dialogue on lifestyle habits, and to relate the lifestyle changes to changes of biological risk markers for ischaemic heart disease. DESIGN: Cross-sectional study, intervention and follow-up. SETTING: The community of Habo, population 9500, located in Skaraborg, Sweden. PATIENTS: All 35-year-old inhabitants in Habo were invited to a health examination during a study period between 1989 and 1992. A community intervention programme was combined with a health examination consisting of a health dialogue with a specially trained nurse and use of a "health curve" as an educational tool. The effect of the health examination was examined by comparing baseline characteristics of participants in 1989-1992 with their follow-up data in 1993. RESULTS: Participants in the health dialogue who were re-examined reported lifestyle improvements including less smoking, decreased dietary fat intake and increased physical activity. Those who reported improved dietary intake and increased physical activity improved their biological risk markers correspondingly (body mass index, waist to hip ratio, serum cholesterol concentration). CONCLUSIONS: The combination of a community and an individually based health programme can be effective with respect to lifestyle variables and, in those improving their lifestyle, in biological risk markers.

Gender differences in secondary prevention of coronary heart disease: reasons to worry or not?

OBJECTIVE: To analyse potential gender differences in cardiovascular risk factors and treatment patterns, reflecting clinical practice in secondary prevention. DESIGN: Observational national study during 3 years of patients eligible for secondary prevention of coronary heart disease (CHD). SETTING: Fifty-two healthcare districts in Sweden, involving primary health care and hospitals in collaboration, participating in a national quality assurance programme for the prevention of CHD. SUBJECTS: A national sample of male and female patients surviving acute myocardial infarction, or following CABG/PTCA interventions for CHD, controlled at 3-6 months (n = 9135) and 12 months (n = 4802) of follow-up. The proportion of female patients (25%) did not differ between visits. MAIN OUTCOME MEASURES: Self-reported data on lifestyle, drug treatment and cardiovascular risk factor levels after consultation in general practice or at hospital policlinics. RESULTS: No major gender differences were recorded in risk factor levels or in cardiovascular drug treatment patterns at 12 months of follow-up. Female patients participated in educational programmes to improve lifestyle to a higher degree than males (52.0 vs 45.1%), but after 1 year were more often (p < 0.001) self-reported smokers (11.7 vs 8.4%). Female patients showed higher levels of blood pressure, total cholesterol and HDL cholesterol, but not LDL cholesterol compared to male patients. CONCLUSIONS: In general, a gender-equal level of lipid control and access to medical drug treatment has been established for patients in secondary prevention from a national sample in Sweden, followed for 1 year after CHD manifestations and related interventions.

Time for a "vision zero" concerning premature death from ischaemic heart disease?

OBJECTIVE: To study the trend in premature mortality (before 75 years of age) from ischaemic heart disease (IHD) in a Swedish primary health care district compared to communities of similar demographic situation and all Sweden. DESIGN: Mortality from IHD in men and women was compared between the community of Habo and other Swedish communities of similar size and all Sweden for the period 1984-96. SETTING: The community of Habo in Sweden with about 9600 inhabitants. INTERVENTION: Intensified efforts by the local primary health care organisation, in co-operation with the community, in respect of primary and secondary cardiovascular prevention since the beginning of the 1980s. RESULTS: Mortality from IHD has decreased significantly both in Habo and in Sweden during these years. The decrease has been more prominent in Habo than in Sweden as a whole and other Swedish communities of similar demographic situation. CONCLUSION: With increased and purposeful efforts in primary and secondary prevention, in co-operation between the community and primary health care, it is possible to substantially decrease mortality from IHD in the community.