Biomedical subjects

J Holmen

Publications and source records attributed to J Holmen.

At least 19 recordsLinked to original sources

PubMed2006

Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway.

OBJECTIVE: The aim of this study was to analyse changes in body weight and height, and the changes in the prevalence of overweight and obesity. DESIGN: Prospective population based study with 11-year follow-up. SUBJECTS: Norwegian men (n=21565) and women (n=24337) aged 20 years or more who participated in two health surveys, the first in 1984-1986 and the other in 1995-1997. MEASUREMENTS: Height and weight were measured by using standardised procedures at both surveys, and we computed body mass index (BMI) as weight in kilo divided by the squared value of height in meters. RESULTS: Participants who were younger than 50 years at the first survey showed a large increase in body weight, and men and women aged 20-29 years increased their weight with an average of 7.9 kg and 7.3 kg, respectively. Contradictory, participants who were 70 years or older had on average a weight loss. The prevalence of overweight (BMI=25.0-29.9 kg/m(2)) and obesity (BMI>/=30 kg/m(2)) increased between the surveys, especially in the youngest age groups. Overall, the proportion classified as obese increased from 6.7 to 15.5% among men and from 11.0 to 21.0% among women. Some of this increase was due to a reduction in height, which was most pronounced in the oldest age groups. CONCLUSION: During approximately 10 years, body weight increased in all age groups below 70 years, and the prevalence of overweight and obese persons was approximately 20% higher at the second survey compared with the first survey.

Adult↗

PubMed2005

Change in body mass index and its impact on blood pressure: a prospective population study.

BACKGROUND: Overweight and obesity increase the risk of elevated blood pressure, but the knowledge of the effect of weight change on blood pressure is sparse. OBJECTIVE: To investigate the association between change in body mass index (BMI) and change in diastolic blood pressure (DBP), systolic blood pressure (SBP), and hypertension status. DESIGN: Two population-based cross-sectional studies, one in 1984-86 and the other in 1995-97. SETTING: The Nord-Trondelag Health Study (HUNT). PARTICIPANTS: We included 15,971 women and 13,846 men who were 20 y or older at the first survey, without blood pressure medication at both surveys and without diabetes, cardiovascular disease or dysfunction in daily life at baseline. MEASUREMENTS: Weight, height and blood pressure were measured standardised. Change in BMI was categorised as stable (initial BMI+/-0.1 kg/m2 each follow-up year), increased or decreased, and BMI was categorised by using World Health Organisation's categorisation (underweight BMI: <18.5 kg/m2, normal weight BMI: 18.5-24.9 kg/m2, overweight BMI: 25.0-29.9 kg/m2, obesity BMI> or =30 kg/m2). RESULTS: An increase in BMI and a decrease in BMI were significantly associated with increased and decreased SBP and DBP, respectively, compared to a stable BMI in both genders and all age groups, although the strongest effect was found among those who were 50 y and older. The adjusted odds ratio for having hypertension at HUNT 2 was 1.8 (95% confidence interval (CI): 1.5, 2.2) among women and 1.6 (95% CI: 1.4,1.8) among men aged 20-49 y who increased their BMI compared to those who had stable BMI. A similar, but weaker association was found among women and men aged 50 y or more. The mean change in both SBP and DBP was higher for those who changed BMI category from first to the second survey than for those who were in the same BMI class at both surveys. CONCLUSIONS: Our result supports an independent effect of change in BMI on change in SBP and DBP in both women and men, and that people who increase their BMI are at increased risk for hypertension.

Adult↗

PubMed2005

Weight change and mortality: the Nord-Trøndelag Health Study.

OBJECTIVES: The prevalence of obesity is increasing. Overweight and obese people have increased mortality compared with normal weight people. We investigated the effect of weight change on mortality. DESIGN: Prospective population study. SETTING: We utilized data from two large population-based health studies conducted in 1984-86 and 1995-97 respectively. Cox proportional hazards models were used to calculate mortality rate ratios (RRs) with 95% confidence intervals (CIs) between people with a stable weight and people who lost or gained weight. Subjects. Totally 20,542 men and 23,712 women aged 20 years or more, without cardiovascular disease or diabetes at the first survey and without a history of cancer at the second survey were followed up on all-cause mortality for 5 years after the second survey. RESULTS: We found no association between weight gain and mortality. People who lost weight had a higher total mortality rate compared with those who were weight stable [RR was 1.6 (95% CI: 1.4-1.8) in men and 1.7 (95% CI: 1.5-2.0) in women]. Similar associations were found for cardiovascular and noncardiovascular mortality. Additional analysis showed a linear increase in mortality rates across categories of weight loss for both men and women (P < 0.001). There was a statistically significant interaction between weight change and initial BMI, but only amongst men (P = 0.001). CONCLUSIONS: Weight loss, but not weight gain, was associated with increased mortality amongst men and women. Although underlying undiagnosed disease is the most plausible explanation for this finding, the similar associations found for total mortality, cardiovascular mortality, and noncardiovascular mortality makes the causal pathway somewhat enigmatic.

Adult↗

PubMed2004

Analgesic overuse among subjects with headache, neck, and low-back pain.

OBJECTIVES: To examine the prevalence of chronic headache (> or =15 days/month) associated with analgesic overuse in relation to age and gender and the association between analgesic overuse and chronic pain (i.e., migraine, nonmigrainous headache, neck and low-back pain). METHODS: In the Nord-Trøndelag Health Study 1995 to 1997 (HUNT-2), a total of 51,383 subjects responded to headache questions (Head-HUNT), of which 51,050 completed questions related to musculoskeletal symptoms and 49,064 questions regarding the use of analgesics. RESULTS: The prevalence of chronic headache associated with analgesic use daily or almost daily for > or =1 month was 1% (1.3% for women and 0.7% for men) and for analgesic overuse duration of > or =3 months 0.9% (1.2% for women and 0.6% for men). Chronic headache was more than seven times more likely among those with analgesic overuse (> or =1 month) than those without (odds ratio [OR] = 7.5, 95% CI: 6.6 to 8.5). Upon analysis of the different chronic pain subgroups separately, the association with analgesic overuse was strongest for chronic migraine (OR = 10.3, 95% CI: 8.1 to 13.0), intermediate for chronic nonmigrainous headache (OR = 6.2, 95% CI: 5.3 to 7.2), and weakest for chronic neck (OR = 2.6, 95% CI: 2.3 to 2.9) and chronic low-back (OR = 3.0, 95% CI: 2.7 to 3.3) pain. The association became stronger with increasing duration of analgesic use for all groups and was most evident among those with headache, especially those with migraine. CONCLUSIONS: Chronic headache associated with analgesic overuse is prevalent and especially chronic migraine is more strongly associated with frequent intake of analgesics than other common pain conditions like chronic neck and chronic low-back pain.

Adult↗

PubMed2004

BMI change and leisure time physical activity (LTPA): an 11-y follow-up study in apparently healthy men aged 20-69 y with normal weight at baseline.

OBJECTIVE: To study the association between self-reported leisure time physical activity (LTPA) at baseline and change in body mass index (BMI). DESIGN: Prospective observational study with a 11-y follow-up period. SETTING: A total population-based health survey in one county was performed in 1984-1986 (HUNT 1) and repeated in 1995-1997 (HUNT 2). PARTICIPANTS: In total, 21 685 men participated in both surveys. In the present study, we included only apparently healthy 20-69-y-old men participating in both surveys and who had a normal body weight (BMI 18.5-24.9 kg/m(2)) at baseline-leaving 8305 men for the analyses. In all, 6945 men answered all questions about LTPA and 6749 men had complete data in the multiple analyses. MEASUREMENTS AND MAIN RESULTS: At HUNT 1, the participants answered questions (self-reported) about the intensity, frequency and duration of LTPA. The association between change in BMI and LTPA was investigated in multiple linear regression analyses. Adjusted for smoking, education, age and BMI at baseline, the physical active cohort gained less weight than the inactive cohort. Low, moderate and high levels of LTPA showed a U-shaped effect adjusted for smoking, education, age and BMI at baseline. Adjusted for BMI and age at baseline, the high-intensity part of the physically active cohort gained less weight than the low-intensity group. CONCLUSION: This study has demonstrated a moderate BMI effect of LTPA at the population level; however, even a high level of LTPA did not prevent weight gain during the 11-y follow-up period.

Adult↗

PubMed2003

Analgesic use: a predictor of chronic pain and medication overuse headache: the Head-HUNT Study.

OBJECTIVE: To examine the relation between analgesic use at baseline and the subsequent risk of chronic pain (> or =15 days/month) and the risk of analgesic overuse. METHODS: In total, 32, 067 adults reported the use of analgesics in 1984 to 1986 and at follow-up 11 years later (1995 to 1997). The risk ratios (RR) of chronic pain and RR of analgesic overuse in the different diagnostic groups (i.e., migraine, nonmigrainous headache, neck pain, and low-back pain) were estimated in relation to analgesic consumption at baseline. RESULTS: Individuals who reported use of analgesics daily or weekly at baseline showed significant increased risk for having chronic pain at follow-up. The risk was most evident for chronic migraine (RR = 13.3, 95% CI: 9.3 to 19.1), intermediate for chronic nonmigrainous headaches (RR = 6.2, 95% CI: 5.0 to 7.7), and lowest for chronic neck (RR = 2.4, 95% CI: 2.0 to 2.8) or chronic low-back (RR = 2.3, 95% CI: 2.0 to 2.8) pain. Among subjects with chronic pain associated with analgesic overuse, the RR was 37.6 (95% CI: 21.3 to 66.4) for chronic migraine, 14.4 (95% CI: 10.4 to 19.9) for chronic nonmigrainous headaches, 7.1 for chronic neck pain (95% CI: 5.5 to 9.2), and 6.4 for chronic low-back pain (95% CI: 4.9 to 8.4). The RR for chronic headache (migraine and nonmigrainous headache combined) associated with analgesic overuse was 19.6 (95% CI: 14.8 to 25.9) compared with 3.1 (95% CI: 2.4 to 4.2) for those without overuse. CONCLUSION: Overuse of analgesics strongly predicts chronic pain and chronic pain associated with analgesic overuse 11 years later, especially among those with chronic migraine.

Adult↗

PubMed2003

Clinical relevance of microalbuminuria screening in self-reported non-diabetic/non-hypertensive persons identified in a large health screening--the Nord-Trøndelag Health Study (HUNT), Norway.

AIM: The aim of this study was to investigate the clinical relevance and consequences of screening for microalbuminuria (MA) in a randomly selected, apparently healthy population sample. MATERIAL AND METHODS: A total of 2,113 individuals (> or = 20 years) without known diabetes and treated hypertension, all identified in the large population-based Nord-Trøndelag Health Study (HUNT) 1995-1997, (n = 65,258), delivered 3 morning urine samples for MA analysis. Those with MA, defined as at least 2 out of 3 urine samples with albumin-to-creatinine ratio (ACR) > or = 2.5 mg/mmol, were invited to a second clinical examination. RESULTS: In total, 54 men and 54 women had MA, and 42 men (84%) and 42 women (78%) attended the second examination. All with MA had 1 or more cardiovascular risk factors, like elevated cholesterol, c-peptides and blood pressure, and they were older than those without MA. Ten men (25%) and 19 women (46%), who were defined as MA-positive at the screening, had normal albumin excretion in the overnight collected urine sample in the second clinical examination. Five men (12%) and 2 women (5%) were still followed-up at the hospital out-patient clinic 3 years later. CONCLUSIONS: Several individuals in the second examination had cardiovascular risk factors and other pathology, but the clinical benefit of discovering this was not obvious. Due to low positive predictive value and reduced reliability and validity, MA did not satisfy the criteria for a good screening test in this apparently healthy population.

Adult↗

PubMed2002

Microalbuminuria, cardiovascular disease and risk factors in a nondiabetic/nonhypertensive population. The Nord-Trøndelag Health Study (HUNT, 1995-97), Norway.

OBJECTIVE: Microalbuminuria (MA) as an independent marker of cardiovascular morbidity and mortality in nondiabetic/nonhypertensive individuals is under international debate. The aim of this study was to investigate the associations between MA and known cardiovascular risk factors/markers and disease in a randomly selected nondiabetic/nonhypertensive sample. DESIGN: Cross-sectional study. SETTING: Participants in the population-based Nord-Trøndelag Health Study (HUNT), Norway (n = 65 258). SUBJECTS: A total of 2113 individuals (> or =20 years), randomly selected without diabetes and treated hypertension, delivered three morning urine samples for MA analysis. MAIN OUTCOME MEASURES: MA expressed as albumin-to-creatinine ratio (ACR), cardiovascular risk factors and disease. RESULTS: Increasing age, pulse pressure, systolic (SBP) and diastolic blood pressure (DBP) and coronary heart disease (CHD) significantly predicted MA in men and increasing pulse pressure, SBP and DBP were associated with MA in women, adjusted for other cardiovascular risk factors/markers. After excluding individuals with known CHD and untreated hypertension (SBP > or = 140 mmHg, DBP > or = 90 mmHg) and hence a high total risk of cardiovascular disease (CVD), only increasing age was associated with ACR in men and increasing SBP and pulse pressure in women. Smoking, elevated lipid and glucose levels were strongly associated with MA in individuals with a high total risk of CVD than in individuals with a low total risk. CONCLUSION: MA was associated with increasing blood pressure in both genders, age and CHD in men. Other cardiovascular risk factors/markers might be more influential in predicting ACR variation in nondiabetic/nonhypertensive individuals with a high total risk of CVD than in individuals with a low total risk.

Adult↗

PubMed2002

Gender differences in the impact of adolescent smoking on lung function and respiratory symptoms. the Nord-Trøndelag Health Study, Norway, 1995-1997.

Girls take up smoking at least as frequently as boys. Few studies have focused on gender differences in the impact of adolescent smoking. We evaluated the sex-specific effect of adolescent smoking on respiratory symptoms and lung function. All students in junior high and high schools in Nord-Trøndelag County Norway, 1995-97, were invited to participate in a cross-sectional study. Information on smoking habits and respiratory symptoms was obtained by self-administered questionnaires. Spirometry was performed in accordance with ATS standards. Eight-thousand-three-hundred and five students (83%) completed both questionnaire and spirometry. Among 6811 students aged 13-18 years (50.3% girls) with no history of asthma, 2993 (43.9%) reported never smoking, 665 (98%) reported occasional smoking, and 667 (9.9%) reported daily smoking (mean initiation age: 13.9 years). More boys than girls were heavy smokers. In all smoking categories, smokers reported a higher prevalence of respiratory symptoms than nonsmokers; symptoms increased with smoke burden. Girls reported more symptoms compared to boys with comparable smoke burden. A dose-response relation between smoking and reduced lung function was found only in girls. Girls were more vulnerable than boys to the impact of smoking on respiratory symptoms and lung function.

Adolescent↗

PubMed2002

Blood pressure and risk of headache: a prospective study of 22 685 adults in Norway.

OBJECTIVES: Prevalence studies of the association between blood pressure and headache have shown conflicting results. The aim was to analyse the relation between blood pressure and risk of headache in a prospective study. METHODS: A total of 22 685 adults not likely to have headache, had their baseline blood pressure measured in 1984-6, and responded to a headache questionnaire at follow up 11 years later (1995-7). The relative risk of headache (migraine or non-migrainous headache) was estimated in relation to blood pressure at baseline. RESULTS: Those with a systolic blood pressure of 150 mm Hg or higher had 30% lower risk (risk ratio (RR)=0.7, 95% CI 0.6-0.8) of having non-migrainous headache at follow up compared with those with systolic pressure lower than 140 mm Hg. For diastolic blood pressure, the risk of non-migrainous headache decreased with increasing values, and these findings were similar for both sexes, and were not influenced by use of antihypertensive medication. For migraine, there was no clear association with blood pressure. CONCLUSION: In the first prospective study of blood pressure and the risk of headache, high systolic and diastolic pressures were associated with reduced risk of non-migrainous headache. One possible explanation may be the phenomenon of hypertension associated hypalgesia, which probably involves the baroreflex system influencing nociception in the brain stem or spinal cord.

Adult↗

PubMed2002

Physical exercise, sports, and lung function in smoking versus nonsmoking adolescents.

Associations between adolescent smoking habits and exercise, particularly participation in sports and lung function were studied. All students aged 13-19 yrs in Nord-Trøndelag County, Norway, 1995-1997, were invited to join a cross-sectional study. Information on smoking habits and exercise was obtained by self-administered questionnaire. Spirometry was performed in accordance with American Thoracic Society standards. Of the 6,811 students (aged 13-18 yrs, without asthma), 2,993 (44%) reported never-smoking, and 1,342 (20%) reported current smoking (90% daily). Frequency of physical exercise was inversely associated with smoking, but participants in individual sports with lesser endurance, especially body-building and fighting sports, were more likely to be daily smokers than nonparticipants. Both daily (53%) and occasional smokers (43%) were more likely to have quit sports than never-smokers (26%)). Never-smokers showed a positive dose-response between physical exercise and lung function (forced vital capacity and forced expiratory volume in one second, adjusted for age and height). No similar significant association was observed in daily smokers. These data suggest that smoking habits in different sports should be considered when promoting physical activity as smoking prevention, and sports organizations should include smoking prevention programmes. Adolescents with better lung function may self-select into sports; this possibility needs to be studied in a longitudinal design.

Adolescent↗

PubMed2001

Blood pressure, smoking and body mass in relation to mortality from stroke and coronary heart disease in the elderly. A 10-year follow-up in Norway.

OBJECTIVES: To examine the association between blood pressure, smoking and body mass index (BMI) and cerebro- and cardiovascular mortality in a population of healthy elderly. DESIGN: Ten-year mortality follow-up of elderly men and women who participated in the Nord-Trøndelag Health Study 1984-86. SETTING: Nord-Trøndelag county, Norway. SUBJECTS: 3121 men and 3271 women aged 70 years and older, free from any diagnosed atherosclerotic diseases or diabetes at baseline. MAIN OUTCOME MEASURES: Relative risk of cerebro- and cardiovascular mortality and all-cause mortality according to blood pressure, smoking and BMI. RESULTS: There was a consistent, positive association between systolic and diastolic blood pressure and cerebro- and cardiovascular mortality. The association persisted after adjustment for potential confounding factors, and was strongest for cerebrovascular mortality; the adjusted relative risks for systolic blood pressure categories 160-179 mmHg and > or = 180 mmHg in men were 1.63 (95% confidence interval, CI 1.06-2.53) and 2.19 (95% CI 1.39-3.44) compared to blood pressure < 140 mmHg. In women, the corresponding relative risks were 1.54 (95% CI 0.93-2.56) and 2.12 (95% CI 1.29-3.50). For diastolic blood pressure the adjusted relative risks in categories 100-109 and > or = 110 mmHg in men were 1.88 (95% CI 1.19-2.95) and 3.06 (95% CI 1.79-5.21) compared to pressure <90 mmHg. The corresponding relative risks in women were 1.75 (95% CI 1.05-2.91) and 2.02 (95% CI 1.04-3.93). Current smoking increased cardiovascular mortality in both men and women, and among women, BMI was negatively associated with all-cause mortality. CONCLUSIONS: These findings add to the growing evidence that hypertension is a major risk factor for mortality from stroke and coronary heart disease among the elderly and the very old.

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PubMed2000

[Pharmacological prevention of cardiovascular diseases in general practice].

BACKGROUND: In this paper the Norwegian College of General Practitioners, Working Group on Hypertension report recommendations for primary preventive drug treatment of elevated cardiovascular risk. MATERIAL AND METHODS: Updated metaanalyses and randomised controlled trials are the main basis for the recommendations. The purpose of treating hypertension is prevention of cardiovascular diseases. Drug treatment with documented effect on morbidity and mortality is therefore recommended. We have also evaluated the cost effectiveness of drug treatment. RESULTS: An estimate of the total risk of future cardiovascular disease is a necessary basis for treatment decisions. This paper presents tools for estimating total cardiovascular risk. Drug treatment is recommended if ten-year risk exceeds 20% or blood pressure equals or exceeds 170/100 mmHg. Drug treatments include antihypertensive, antithrombotic, antidiabetic and lipid-lowering drugs with documented effect on hard endpoints. Aspirin, thiazides, betablockers, metformin, calcium blockers, ACE inhibitors and statins are all drugs with documented effects on significant endpoints, but the costs of these treatments differ substantially. INTERPRETATION: Drug treatment to prevent cardiovascular disease should be recommended for patients at significant risk of cardiovascular disease. Drugs with documented effect on morbidity and mortality should be used. Considerations of costs are important in treatment decisions.

Adult↗

PubMed2000

[Life style advice provided by primary health care to prevent cardiovascular diseases].

BACKGROUND: The Working Group on Hypertension of the Norwegian College of General Practitioners reports in this paper on the documentation on behavioural advice in the prevention of cardiovascular disease. Emphasis is given to hypertension. MATERIAL AND METHODS: The recommendations are mainly based on updated metaanalyses and randomised controlled trials. Hypertension is treated to prevent cardiovascular disease; that is why we put emphasis on documentation with significant end points. The validity of the documentation for general practice is assessed. We have also assessed whether certain methods or theories for behavioural change could be helpful to the general practitioner. RESULTS: The value of advice against smoking, dietary advice (increased intake of grain products, vegetables, fruit, poultry and fish), and advice about exercise are well documented and applicable in general practice. Respect for the patient's autonomy and interest in the patients and their health-related habits seem to be important factors for improving doctor's chances of influencing patient behaviour. INTERPRETATION: The value of life-style advice is well documented and should play an important role in clinical strategies to prevent cardiovascular disease in high-risk patients.

Antioxidants↗

PubMed2000

[Treatment of children with asthma--ideals and reality].

Children with bronchial asthma are the largest group of children with chronic disease in general practice. The aim of this study was to obtain information on morbidity, examination, and treatment in children with bronchial asthma. 102 children with current asthma, aged 7-15 years, participated in this study, which used a questionnaire, flow volume spirometry with beta2-agonist reversibility test, and two weeks of registrations of peak flow and symptom score. Most children had mild to moderate asthma; 60% had acceptable asthma control defined by a morbidity index. 64 children used either inhaled steroids or dinatriumcromoglycate prophylactic. 76 children had been examined by a paediatrician. Lung function measurements had been performed in 57 of 69 children with follow-up in general practice during the last 12 months. Allergy tests had been taken of 87 children. With respect to allergen exposure at home, only 30 children reported having an optimal home environment. Despite the extensive follow-up of children with asthma, our study indicates that the asthma control is not up to the standard set by current guidelines. By use of written treatment plans, and increasing knowledge of the disease, triggers and of the treatment of children and their parents, we probably would exploit the potential better. The recommendations and goals of the guidelines should, however, also be evaluated.

Adolescent↗

PubMed2000

Health problems in teenage daily smokers versus nonsmokers, Norway, 1995-1997: the Nord-Trøndelag Health Study.

Increased morbidity among teenage smokers has been reported, but specific current health problems and medication use other than of alcohol and narcotics have received less attention. The aim of this study was to examine the association between health problems and daily smoking in teenagers. Ninety percent of all teenagers attending junior high or high schools participated in a cross-sectional study conducted in Nord-Trøndelag County, Norway, 1995-1997; included were 8,040 students aged 13-18 years. Information on smoking habits, health problems, medication use, and use of health services was obtained in schools by self-administered questionnaire and by interview. Fifty-five percent of boys and 57% of girls had tried smoking, and 9% and 11%, respectively, reported current daily smoking. When compared with boys and girls who had never smoked, daily smoking among both sexes and all age groups was associated with significantly poorer perceived health, respiratory symptoms, headache, neck and shoulder pain, stomachache, nausea, frequent heartbeats, nervousness/restlessness, and sleep problems. Daily smokers used more medications and health services. Daily smoking by adolescents is already associated with multiple somatic health problems. Whether or not the association is causal, daily smoking identifies a group of adolescents with health problems for whom preventive strategies should also include medical and social support.

Adolescent↗

PubMed2000

Adolescent occasional smokers, a target group for smoking cessation? the Nord-Trøndelag Health Study, Norway, 1995-1997.

BACKGROUND: Adolescent smokers are often unsuccessful in quitting and difficult to retain in cessation programs. In health promotion, focusing on the right target groups is essential. Aim. The aim was to examine if adolescent occasional smokers differ from daily smokers, and if possible differences could be useful for targeted smoking cessation programs. METHODS: Ninety-one percent of all teenagers attending junior high or high schools participated in a cross-sectional study, conducted in Nord-Trøndelag County, Norway, 1995-1997, including 8,460 students 13-18 years old. Information on smoking habits, education, after school activities, and parents was obtained by self-administered questionnaires. RESULTS: Fifty-four percent of boys and 57% of girls had tried at least one cigarette. Of these, 36% of boys and 41% of girls were current smokers, half of whom reported occasional smoking. Students who had quit smoking had more often been occasional than daily smokers. Compared to daily smokers, occasional smokers participated in higher academic courses, were more engaged in organized activities and sports, had been drunk less often, and had better family role models. CONCLUSION: Differences support potential utility of focusing on occasional smokers as a special target group in smoking cessation programs.

Adolescent↗

PubMed2000

Implementing clinical guidelines in the treatment of diabetes mellitus in general practice. Evaluation of effort, process, and patient outcome related to implementation of a computer-based decision support system.

OBJECTIVES: To evaluate the implementation of clinical guidelines for diabetes mellitus in general practice with a specific computer-based clinical decision support system (CDSS) as part of the intervention. METHODS: Randomized study with health center as unit. General practice in Sør- and Nord-Trøndelag counties in Norway, 380,000 inhabitants. Seventeen health centers with 24 doctors and 499 patients with diabetes mellitus were in the intervention group and 12 health centers with 29 doctors and 535 patients were in the control group. Main outcome measures were group differences in fractions of patients without registrations (process evaluation) and mean group differences for the same variables (patient outcome evaluation). RESULTS: Statistically significant group differences were experienced for fractions of patients without registration of cigarette smoking (intervention group, 82.6%; control group 94.5%), body mass index (78.2% vs. 93.0%), and sufficient registrations for calculation of risk score for myocardial infarction (91.1% vs. 98.3%); all during 18 months. Large center variations were shown for all variables. The only statistically significant group difference was -2.3 mm Hg (95% CI, -3.8, -0.8) in diastolic blood pressure in favor of the intervention group. Statistically insignificant differences in favor of the intervention group were HbA1c, -0.1% (95% CI, -0.4, 0.1), systolic blood pressure, -1.2 mm Hg (95% CI, -4.4, 2.0). Statistically insignificant differences in favor of the control group were fractions of smokers, +3.0% (95% CI, -4.0, 10.0), body mass index, +0.3 kg/m2 (95% CI, -0.8, 1.4), risk score in female +0.1 (95% CI, -5.1, 5.2), and risk score in male +2.6 (95% CI, -14.2, 19.5). CONCLUSIONS: Implementation of clinical guidelines for diabetes mellitus in general practice, by means of a CDSS and several procedures for implementation, did not result in a clinically significant change in doctors' behavior or in patient outcome.

Aged↗