Association of Sublingual Varices With Heart- and Cerebrovascular Disease.

OBJECTIVE: The aim of this research was to investigate whether sublingual varices (SV) are associated with new events of ischaemic heart disease (IHD) and new events of cerebrovascular disease. METHODS: A prospective observational study was conducted amongst 1139 dental patients aged between 48 and 84 years across 2 cohorts (201 enrolled from 2010-2013 and 938 from 2018-2020). Participants provided baseline data on demographics, risk factors, and medical diagnoses, followed by an assessment of their tongue's ventral surface to classify veins as either having no sublingual varices (nSV) or having sublingual varices (SV). Information regarding medical diagnoses was gathered during the follow-up period from both participants and their medical records. The primary outcome variables were the onset of new IHD and new cerebrovascular disease events. Comparisons were made between participants with SV and nSV. RESULTS: The study population comprised 54% women with an average age of 66 years. SV were present in 33% of participants. Those with SV predominantly were male, older, and smokers; had a higher body mass index, and exhibited more instances of hypertension, diabetes, and dyslipidaemia than those with nSV. New occurrences of IHD (4.5% vs 1.8%, P = .009) and cerebrovascular disease (4.2% vs 2.0%, P = .026) were more prevalent in the SV group compared with the nSV group. The link between SV and new IHD events persisted even after adjustments for sex, age, and smoking habits (OR, 2.26; 95% CI, 1.074.76), but not for new cerebrovascular disease events (OR, 1.77; 95% CI, 0.843.71). CONCLUSIONS: Our study identifies a correlation between SV and new events of IHD, but not new events of cerebrovascular disease. The detection of SV occurred prior to the IHD events, suggesting a temporal relationship. This novel finding proposes a potential shared pathophysiology between IHD and SV.

Persistence and stability of sublingual varices over time and their connection to underlying factors: an 8 year follow up study.

OBJECTIVE: To investigate whether sublingual varices are constant or inconstant over time and whether this is connected to background variables, cardiovascular risk factors or disease. DESIGN: This longitudinal observational study was performed between 2010 and 2020 at the Public Dental Services Västra Vall, Varberg, Sweden. The study was based on 431 patients included in a previous study in which the relationship between sublingual varices and hypertension was examined. In connection to the annual dental examination, 281 patients were included in the follow-up study. They completed a questionnaire about background and health factors and diseases. Length and weight were measured. Two intraoral photos were taken with a digital camera. Two dentists independent of each other graded all photographs as none/few visible sublingual varices (nSV) or medium/severe sublingual varices (SV). RESULTS: The prevalence of SV was 25.6% at baseline and 30.6% at follow-up. At the follow up, a total of 76.5% had maintained their sublingual vascular status. Of those with nSV at baseline (n209), 80.9% still had nSV, and 19.1% had developed SV during the 8-year follow-up period. Of those 72 participants who had SV at baseline, 46 (63.9%) were unchanged at follow-up, and 26 (36.1%) were classified as nSV. Those who had developed SV at follow-up had a higher mean age (p = 0.003) and a higher prevalence of cardiovascular disease (CVD), 13.2% versus 3.0% (p = 0.021). This association with CVD did not persist after an adjustment for sex and age (OR 3.2, 95% CI 0.81-12.46). They exhibited more hypertension (35.0% vs. 22.5%) and diabetes type 2 (7.5% vs. 3.0%), but with no significant difference. CONCLUSIONS: This study revealed that 76.5% of the participants had an unchanged status regarding sublingual varices during an 8-year period and that the development from nSV to SV was associated with advanced age.

Individuals' Experiences of Being Screened for Hypertension in Dental Health Care - "No Big Deal".

Background: Hypertension is a common disease globally that accounts for the highest number of lost healthy life years and strongly associated with sequelae such as stroke and myocardial infarction. Early detection of individuals with high blood pressure can be ensured by screening also those who consider themselves "healthy". Screening has both positive and negative effects where a diagnosis of hypertension can lead to worry about the future. These effects need to be elucidated in order to balance between benefit and harm before screening is introduced. The aim of the study was to describe individuals' experiences of being screened for hypertension in dental health care. Methods: Data from individual semi-structured interviews, with twenty participants screened for cardiovascular risk factors in connection with dental examination and aged 55-80 years, were analysed by means of qualitative content analysis. Results: The results describe individuals' experiences of blood pressure screening in dental health care by means of the following theme: "No big deal" based on two categories: "Convenient way of measuring blood pressure" and "Increased awareness of health". Conclusion: The overall message from the interviews was that having one's blood pressure measured when visiting the dentist was convenient, easy and "No big deal". Blood pressure screening did not create any major concerns and contributed to an increased awareness of health.

The Association Between Sublingual Varices and Cardiovascular Risk Factors.

Objective: To study the association between sublingual varices (SV) and cardiovascular (CVD) risk factors. Methods: A total of 989 consecutive dental patients aged 55-84 years participated in the study, which applied a survey about risk factors, diseases and medications. Digital photos of the lateral borders of the tongue, height, weight, waist, hip and blood pressure were registered, and blood samples were analyzed. Those with SV were compared with those without SV (nSV). Results: Those with SV had more hypertension 41.8% vs 27.0% (p<0.0001), a higher systolic blood pressure (BP) 139.5 (SD 18.6) mmHg vs 134.3 (SD 18.8) mmHg (95% CI -7.73 ─ -2.72), more diabetes type 2 (DM-2) 7.4% vs 3.8% (p=0.014), a higher fasting plasma glucose 5.9 (SD 1.5) mmol/L vs 5.7 (SD 1.0) mmol/L (95% CI -0.42 ─ -0.05), more dyslipidemia 24.1% vs 17.7% (p=0.018), lower HDL 1.6 vs 1.7 (p=0.003), a greater waist circumference 97.0 cm vs 93.9 cm (95% CI -4.66 ─ -1.46), a greater waist/hip ratio 0.92 cm/cm vs 0.90 cm/cm (95% CI -0.03 ─ -0.01), and a higher BMI 26.6 kg/m2 vs 26.0 kg/m2 (95% CI -1.11 ─ -0.03). The following associations with SV were found in multivariate analysis: hypertension OR=1.6 (95% CI 1.19 ─2.13), a high systolic BP OR =1.5 (95% CI 1.11 ─2.13), a high fP-glucose OR= 1.8 (95% CI 1.03 ─3.21), a low HDL OR= 1.8 (95% CI 1.15 ─2.92), a greater waist circumference OR= 1.68 (95% CI 1.10 ─2.58), a greater waist/hip ratio OR=2.21 (95% CI 1.36 ─3.58), and a higher BMI OR=1.05 (95% CI 1.02 ─1.09). Conclusion: This study shows an association between SV and a high BP, a high fP-glucose, hypertension, diabetes mellitus type 2, dyslipidemia, abdominal obesity, older age and smoking.

White-coat hypertension detected during opportunistic blood pressure screening in a dental healthcare setting.

OBJECTIVE: To study white-coat hypertension (WCHT, blood pressure ≥140/90 mmHg in a clinic and normal blood pressure <135/85 mmHg at home), with blood pressure screening of a healthy population during their dental healthcare visit and the associated risk factors. DESIGN: A multicentre observational study. SETTING: A healthy general population at four dental clinics in a region in southern Sweden. SUBJECTS: 2025 individuals aged 40-75 years were screened for high blood pressure at their annual regular check-up dental visit. MAIN OUTCOME MEASURES: Frequencies of normal and elevated blood pressure (BP) in dental clinics, with home BP as a reference. According to BP results, the population was divided into three groups: normotension (NT), WCHT and suspected hypertension (HT). Background and life style factors were measured: sex, age, family history of hypertension, body mass index (BMI kg/m2), education level, tobacco use, and physical activity level. RESULTS: The overall prevalence of WCHT in the study was 17.7%, and the prevalence was 57.2% among those with clinically high blood pressure. Compared with NT, WCHT was associated with male sex (OR 1.56, CI 1.18-2.06), older age group (OR 2.33, CI 1.66-3.26), family history of hypertension (OR 1.61, CI 1.24-2.10), high BMI kg/m2 (OR 2.36, CI 1.80-3.10), daily snuff use (OR 1.74, CI 1.19-2.53). In comparison with WCHT, HT was associated with male sex (OR 2.16, CI 1.44-3.25), older age group (OR 2.85, CI 1.75-4.65), daily smoking (OR 2.10, CI 1.14-3.85), less daily snuff use (OR 0.59, CI 0.34-0.99). CONCLUSIONS: The prevalence of WCHT in a healthy population was 17.7%. Regarding cardiovascular risk factors, WCHT seems to be in the middle of NT and HT. Individuals with WCHT can be identified and given lifestyle advice in connection with a dental check-up, but follow-up and assessment of their cardiovascular risk should take place in primary care.Key pointsScreening in dental practice can detect white-coat hypertension (WCHT) (17.7%) and suspected hypertension (HT) (12.4%).Individuals with WCHT have more cardiovascular risk factors than normotensive individuals.Individuals with WCHT could be given lifestyle advice in dental clinics according to current guidelines.

The cost-effectiveness of a two-step blood pressure screening programme in a dental health-care setting.

BACKGROUND: Hypertension is one of the largest contributors to the disease burden and a major economic challenge for health-care systems. Early detection of persons with high blood pressure can be achieved through screening and has the potential to reduce morbidity and mortality. We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40-75 in comparison to care as usual (the no-screening baseline scenario). METHODS: A cost-effectiveness analysis (CEA) was carried out from the payer and societal perspectives, and the short-term (from screening until diagnosis has been established) cost per identified case of hypertension and long-term (20 years) cost per quality-adjusted life year (QALY) were reported. Data on the short-term cost were based on a real-world screening programme in which 2025 healthy individuals were screened for hypertension. Data on the long-term cost were based on the short-term outcomes combined with modelling in a Markov cohort model. Deterministic and probabilistic sensitivity analyses were carried out to assess uncertainty. RESULTS: The short-term analysis showed an additional cost of 4,800 SEK (€470) per identified case of hypertension from the payer perspective and from the societal perspective 12,800 SEK (€1,240). The long-term analysis showed a payer cost per QALY of 2.2 million SEK (€210,000) and from the societal perspective 2.8 million SEK per QALY (€270,000). CONCLUSION: The long-term model results showed that the screening model is unlikely to be cost-effective in a country with a well-developed health-care system and a relatively low prevalence of hypertension.

Two-year weight, risk and health factor outcomes of a weight-reduction intervention programme: Primary prevention for overweight in a multicentre primary healthcare setting.

Objective: To study the long-term effects of weight reduction, quality of life and sense of coherence in a primary health care (PHC)-based programme with two different intensities.Design: Prospective two-armed randomised intervention.Setting: Three PHC centres in south west of Sweden.Subjects: In total, 289 women and men aged 40-65 years with a BMI of 28-35 were recruited for a two-year weight-reduction programme. Participants were randomized to high-intensity or low-intensity groups. Blood samples, physical measurements and questionnaires were analysed. Participants received cookbooks and dietary lectures. The high-intensity group also received Motivational interviewing (MI), dietary advice on prescription (DAP- advice), a grocery store lecture, a website and weekly e-mails.Main outcome measures: Weight, quality of life, risks and health factors.Results: In total, 182 (64%) participants completed the 2-year follow-up. The total sample reduced their weight by 1 kg (p = 0.006). No significant differences regarding weight were found between the groups. Anxiety/depression decreased in EQ5-D (p = 0.021), EQ5-D VAS (p = 0.002) and SOC (p = 0.042). Between the groups, there were significant differences in EQ5-D usual activities (p = 0.004), anxiety/depression (p = 0.013), pain/discomfort (p = 0.041), fruit and vegetables (p = 0.005), HLV anxiety (p = 0.005), and visits to nurses (p = 0.012).Conclusion: The total population lost weight, and the high-intensity and low-intensity programmes did not result in significant differences in terms of weight. The high-intensity programme reported health benefits linked to lower levels of anxiety and depression, increased activity and intake of greens and reduced visits to physicians and nurses.Key pointsBoth groups had a consisting weight- reduction after two years.High intensity did not lead to a significant difference in weight reduction between the groups.The high-intensity group reported more health effects, such as better quality of life, reduced anxiety, and increased greenery intake. It is unknown how much support patients in a weight- reduction programme in PHC require to succeed with weight loss and a healthy lifestyle.

Characteristics of patients seeking a health promotion and weight reduction program in primary care.

PURPOSE: An important task in primary health care (PHC) is to address lifestyle-related diseases. Overweight (OW) individuals make up a large proportion of PHC patients, and they increasingly have lifestyle-related illnesses that influence their quality of life. Structured health promotion and weight reduction programs could help these patients. The objective of this study was to explore the characteristics, lifestyle habits, and health conditions of individuals seeking a health promotion and weight reduction program in PHC. PATIENTS AND METHODS: The study involved a comparative cross-sectional design performed in PHC in southwestern Sweden. The study population comprised 286 participants (231 women, aged 40-65 years, body mass index [BMI] 28-35 kg/m2) who were recruited between March 2011 and April 2014 to the 2-year program by adverts in local newspapers and recruitment from three PHC centers. Two reference populations were used: a general population group and an OW group. The study population data were collected using a questionnaire, with validated questions regarding health, lifestyle, illnesses, and health care utilization. RESULTS: People seeking a health promotion and weight reduction program were mostly women. They had a higher education level and experienced worse general health than the OW population, and they visited PHC more frequently than both reference groups. They also felt more stressed, humiliated, had more body pain, and smoked less compared to the general population. However, they did not exercise less or had a lower intake of fruits and vegetables than either reference population. CONCLUSION: Individuals seeking a weight reduction program were mostly women with a higher education level and a worse general health than the OW population. They used more health care services compared to the reference groups.

The outcome of two-step blood pressure screening in dental healthcare.

AIM: The purpose of this study was to evaluate a two-step screening method for hypertension in dentistry regarding the number needed to screen (NNS) and positive predictive value (PPV) and to risk-classify those with newly diagnosed hypertension. METHODS: In connection with their regular dental care check-up, 2025 subjects aged 40-75 years were screened for high blood pressure. Via a health questionnaire, data were collected concerning risk factors. Blood pressure was screened comprehensively in two steps, which included screening in a dental clinic and home measurements for one week. Recently discovered hypertensive participants were assessed for 10-year risk of cardiovascular mortality according to the guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). RESULTS: A total of 170 new hypertensive participants were found (NNS = 12; 95% confidence interval (CI): 11-13). The method yielded a PPV of 0.73 (95% CI: 0.68-0.78) and eliminated 84.8% of the false-positive participants. The results also showed that based on ESH/ESC risk estimation, 76.5% of those newly diagnosed hypertensive participants had a moderate or high risk of cardiovascular mortality within 10 years. CONCLUSIONS: The study shows that a two-step method for blood pressure screening in a dental setting including home measurement resulted in a high PPV and eliminated most of those with a false high blood pressure reading. The findings also show that two-step screening for hypertension is feasible in a larger population with more screening providers involved.

Is there a connection between sublingual varices and hypertension?

BACKGROUND: Sublingual varices have earlier been related to ageing, smoking and cardiovascular disease. The aim of this study was to investigate whether sublingual varices are related to presence of hypertension. METHODS: In an observational clinical study among 431 dental patients tongue status and blood pressure were documented. Digital photographs of the lateral borders of the tongue for grading of sublingual varices were taken, and blood pressure was measured. Those patients without previous diagnosis of hypertension and with a noted blood pressure ≥ 140 mmHg and/or ≥ 90 mmHg at the dental clinic performed complementary home blood pressure during one week. Those with an average home blood pressure ≥ 135 mmHg and/or ≥ 85 mmHg were referred to the primary health care centre, where three office blood pressure measurements were taken with one week intervals. Two independent blinded observers studied the photographs of the tongues. Each photograph was graded as none/few (grade 0) or medium/severe (grade 1) presence of sublingual varices. Pearson's Chi-square test, Student's t-test, and multiple regression analysis were applied. Power calculation stipulated a study population of 323 patients. RESULTS: An association between sublingual varices and hypertension was found (OR = 2.25, p < 0.002). Mean systolic blood pressure was 123 and 132 mmHg in patients with grade 0 and grade 1 sublingual varices, respectively (p < 0.0001, CI 95 %). Mean diastolic blood pressure was 80 and 83 mmHg in patients with grade 0 and grade 1 sublingual varices, respectively (p < 0.005, CI 95 %). Sublingual varices indicate hypertension with a positive predictive value of 0.5 and a negative predictive value of 0.80. CONCLUSIONS: An association was found between sublingual varices and hypertension. Examining the lateral borders of the tongue is easily done, causes no harm and could be a valuable method for the dental profession to take active part in preventive healthcare.

Lifestyle advice and lifestyle change: to what degree does lifestyle advice of healthcare professionals reach the population, focusing on gender, age and education?

Health promotion practice in health care has a high priority in the endeavour to achieve equal opportunities for health and diversity in health among the population. The purpose of the study was to investigate whether there is any connection between the lifestyle advice given by healthcare professionals and the lifestyle change of the population, focusing on age, gender and education level. The study is based on the data from a national population survey in Sweden in which 52 595 patients who had attended health care were interviewed by phone. The participants were asked whether healthcare professionals had raised the subject of lifestyle during the visit and whether the advice they gave had contributed to a lifestyle change. The results indicated that lifestyle issues were raised with 32.2% of those who attended health care, particularly among men, younger patients and those with a high education level. When lifestyle issues were raised, the advice contributed to 39.2% of patients making a lifestyle change, to a higher extent among men, older patients and those with a low education level. The study shows that lifestyle advice given by healthcare professionals, during both emergency and outpatient healthcare visits, is an important contributor to patients' lifestyle change.

Patients' experiences of lifestyle discussions based on motivational interviewing: a qualitative study.

BACKGROUND: According to World Health Organization about 75% of cardiovascular diseases and type 2 diabetes and 40% of all cases of cancer could be prevented if the risk factors tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol could be eliminated. Patients often need help in monitoring themselves to make the proper lifestyle changes and it is important that adequate support is provided to enable the patients to take control over their health. Motivational interviewing is a framework that can help to facilitate this movement. The aim of this study was to describe how patients in primary health care settings experience lifestyle discussions based on motivational interviewing. METHODS: This study has a descriptive design and qualitative content analysis was used as the method. Sixteen patients who had each visited a registered nurse for lifestyle discussions were interviewed. RESULTS: The results show that the lifestyle discussions could enable self-determination in the process of lifestyle change but that certain conditions were required. Mutual interaction between the patient and the nurse that contributes to a sense of well-being in the patients was a necessary condition for the lifestyle discussion to be helpful. When the discussion resulted in a new way of thinking about lifestyle and when patient initiative was encouraged, the discussion could contribute to change. The patient's free will to make a lifestyle change and the nurse's sensitivity in the discussions created fertile soil for change. CONCLUSIONS: This study focuses on MI-based discussions, and the result shows that a subset of patients, who self-reported that they are motivated and aware of their role in making lifestyle changes, appreciate these strategies. However, it is not known whether discussions would be experienced in the same way if RNs used another method or if patients who were less motivated, engaged, or aware of their role in making lifestyle changes were interviewed.

A home-based method for the detection of impaired glucose tolerance in hypertensive primary care patients.

OBJECTIVE: The aim of this project was to compare an oral glucose tolerance test (OGTT) partly performed in the patient's home (OGTTh) with a clinic-obtained OGTT with regard to the ability of the tests to identify patients with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM-2). DESIGN: A method comparison. SETTING: The study was completed at two primary health care centres. SUBJECTS: Fifty-one patients with hypertension aged 50-79 years completed both OGTT tests. MAIN OUTCOME MEASURES: Values for capillary P-glucose obtained two hours after a glucose load were compared between the two OGTT tests. Fasting plasma glucose (fP-glucose) and HbA1c were also measured. RESULTS: Thirty-seven patients were classified in the same group (normal/IGT/DM-2) by the two tests. The index of validity based on the test's ability to identify normal or pathological values (≥ 8.9 mmol/l) was 0.75. The value for kappa was 0.66 with a sensitivity of 0.54 and a specificity of 0.82. CONCLUSION: OGTTh may be a useful screening method for IGT in risk groups such as hypertensive patients.

Recurrent aphthous stomatitis and pain management with low-level laser therapy: a randomized controlled trial.

OBJECTIVE: The aim of the study was to determine whether low-level laser therapy (LLLT) has an analgesic effect in patients with recurrent aphthous stomatitis (RAS). STUDY DESIGN: A randomized single-blinded placebo-controlled trial was conducted with LLLT (wavelength, 809 nm; power, 60 mW; pulse frequency, 1800 Hz; duration, 80 seconds per treatment; dose, 6.3 J/cm(2)) in 40 patients with RAS. The intervention group was treated with LLLT on 3 occasions, with a 1-day interval. The control group was treated similarly, without any laser power. Pain perception (visual analog scale [VAS] rating) and patients' experience of eating, drinking, and brushing teeth was registered. RESULTS: VAS rating decreased (day 0 until day 2) from 84.7 to 31.5 (LLLT) and from 81.7 to 76.1 (placebo) (P < .0001). LLLT also relieved the difficulty of drinking, eating, and brushing teeth. CONCLUSIONS: LLLT reduced the pain and the inconvenience of eating, drinking, and brushing teeth for patients with RAS, compared with placebo.

Primary healthcare nurses' experiences with motivational interviewing in health promotion practice.

AIM: The aim of the study was to describe primary healthcare nurses' experiences with motivational interviewing as a method for health promotion practice. BACKGROUND: A person's lifestyle has a major effect on his or her health. Motivational interviewing is one way of working with lifestyle changes in health promotion practice. The basic plan of motivational interviewing is to help people understand their lifestyle problems and make positive lifestyle changes. Motivational interviewing has been proven to be more effective than conventional methods in increasing patient motivation. DESIGN: This study has a descriptive design and uses a qualitative method. METHODS: Twenty nurses who worked in primary health care and actively used motivational interviewing in their work were interviewed. Qualitative content analysis was used to process the data. RESULTS: The primary healthcare nurses' experiences with motivational interviewing as a method of health promotion practice demonstrate that motivational interviewing is a demanding, enriching and useful method that promotes awareness and guidance in the care relationship. The results also show that motivational interviewing is a valuable tool for primary healthcare nurses' health promotion practice. CONCLUSION: This study shows that motivational interviewing places several different demands on nurses who use this method. Those who work with motivational interviewing must make an effort to incorporate this new method to avoid falling back into the former practice of simply giving advice. Maintaining an open mind while implementing motivational interviewing in real healthcare settings is crucial for nurses to increase this method's effectiveness. RELEVANCE TO CLINICAL PRACTICE: The nurses in the study had a positive experience with motivational interviewing, which can contribute to the increased use, adaption and development of motivational interviewing among primary healthcare professionals. Increased motivational interviewing knowledge and skills would also contribute to promotion of health lifestyle practices.

Sublingual varices in relation to smoking and cardiovascular diseases.

The purpose of this study was to investigate the relation between sublingual varices, cardiovascular disease (CVD), and smoking. We studied 281 patients over 40 years old in this observational clinical study. During a dental check up visit, sublingual varices were sought on the lateral border of the tongue. Results were classified into two groups: grade 0 (few or none) and grade 1 (moderate or severe). Information about CVD and smoking was obtained from the patients and recorded. Multiple logistic regression analysis was used to assess the influence of particular variables on the incidence of sublingual varices. The presence and number of varices increased with increasing age, and the overall incidence was 98/281 (35%). Fifty-one of the patients were smokers (18%) and 45 (16%) had CVD, usually hypertension. Sublingual varices were significantly associated with age (odds ratio (OR) 1.1), smoking (OR 2.4), and CVD (OR 2.7).

In the shadow of the welfare society ill-health and symptoms, psychological exposure and lifestyle habits among social security recipients: a national survey study.

BACKGROUND: In Sweden social security is a means-tested financial allowance. The Social Services Act states that an individual is entitled to financial support when his/her needs are not met in any other way. The aim of the present study was to analyse the prevalence and impact of various illness factors and symptoms in social security recipients compared to non-recipients in a welfare state, in this case Sweden. METHODS: A simple random sample of 20 100 individuals was selected from a national survey that covered all individuals in the 18-84 year age group in Sweden. A postal survey was thereafter conducted. Multiple logistic regression was employed as a statistical test. Odds ratio (OR) and a 95% confidence interval (CI) was used. RESULTS: Social security recipients were found to have a significantly higher risk in most of the studied variables. Reduced psychological wellbeing measured by means of the GHQ12 was significantly higher in this group compared to the rest of the population (OR 1.41 CI 1.03-1.94) and their lack of trust was greater (OR 1.96, CI 1.45-2.66). They reported more sleep disturbances (OR 2.16, CI 1.58-2.94) and suffered from anxiety (OR 1.74, CI 1.28-2.36). Their dental health was worse (OR 2.44, CI 1.82-3.28) and they had more pain in their hands and legs (OR 1.57, CI 1.16-2.12). Social security recipients were more often humiliated (OR 1.79, CI 1.31-2.44) and exposed to threat (OR 1.69, CI 1.09-2.61). They were less physically active (OR 1.56, CI 1.17-2.08), had a poorer diet (OR 1.95, CI 1.45-2.63) and were more often smokers (OR 3.20, CI 2.37-4.33). IMPLICATION: The challenge for the welfare state consists of recognising the significance of both structural and lifestyle factors as a means of reducing the health gap.

Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years.

OBJECTIVES: To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. STUDY DESIGN: A cohort study with follow-up over 5 years. METHODS: Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. RESULTS: During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. CONCLUSIONS: FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.

Consultations for injuries by frequent attenders are found to be medically appropriate from general practitioners' perspective.

AIMS: A study was carried out to determine whether frequent attenders' (FAs') consultations for injuries are medically appropriate or not. METHODS: A retrospective review was undertaken of medical records in a primary healthcare centre. All injury consultations by frequent attenders and controls during a period of one year were evaluated by two general practitioners (GPs). Outcome variables were: number of injuries, chronic diseases, type of injuries, and their treatments. The GPs made a comprehensive picture of each case and evaluated whether it was medically appropriate to consult a doctor or not. RESULTS: Injuries were 7.2 times more common among frequent attenders compared with the controls. Frequent attenders had significantly more chronic diseases. Mean number of injury consultations was the same for frequent attenders with or without chronic disease. There was no difference concerning medically appropriate consultations between frequent attenders and controls. CONCLUSIONS: Consultations for injuries with frequent attenders were considered medically appropriate. Chronic diseases did not explain the higher injury incidence among frequent attenders. These findings are interesting and contradict the opinion that increased healthcare consumption by FAs is a waste of resources. Our findings may suggest that FAs are more vulnerable individuals.

Characteristics of frequent attenders in different age and sex groups in primary health care.

OBJECTIVE: To compare frequent attenders in different age and sex groups with a control group according to characteristics and use of primary health care. DESIGN: Descriptive study of medical records. SETTING: Primary health care centre. SUBJECTS: 341 frequent attenders, divided by age and sex, were compared with 1025 controls from the same area. MAIN OUTCOME MEASURES: Consultation rate, diagnoses, prescribed medicine, referrals and certificates of illness during one year. RESULTS: Frequent attenders constituted 3.3% of the population but accounted for 25% of all visits to the GP and 44% of all illness certificates allocated. They were given more antibiotic prescriptions and consulted the GP more often for most medical problems. Frequent attenders had a morbidity, with a preponderance of infections at a young age, musculoskeletal and respiratory problems in middle age, and, among the oldest, circulatory, endocrine and musculoskeletal diseases. CONCLUSION: Frequent attenders had a morbidity within different ages similar to that of the controls, but also a higher consulting frequency for most medical problems and a significantly higher consumption of antibiotics. Are frequent attenders more vulnerable individuals and more prone to all kinds of diseases, or do they just consult more often for the usual medical problems?