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Biomedical subjects

L Råstam

Publications and source records attributed to L Råstam.

At least 55 records · Page 3Linked to original sources
PubMed1998

Awareness and treatment of cardiovascular disease risk factors among middle-aged Swedish men and women.

OBJECTIVE: To study awareness and treatment of risk factors for cardiovascular disease in a primary care district where a screening program for hypercholesterolaemia involving one third of the population had been conducted 7 years earlier. DESIGN: A semi-structured telephone survey on four risk factors; blood pressure, serum cholesterol, blood sugar, and smoking habits. SETTING: The study was performed in a defined area in Blekinge county in Sweden. SUBJECTS: A random sample of the general population aged 40-49 years, in total 356 people. MAIN OUTCOME MEASURES: Awareness of individual risk factors, for cardiovascular diseases, on-going medication, and lifestyle changes in order to lower individual risks. RESULTS: A total of 95% had had their blood pressure measured at least once, compared with 69% for serum cholesterol. Twenty-two per cent had at some time been told that they had high blood pressure, and, of these, almost half (44%) received pharmacological treatment. Among the 62 subjects who were informed about hyperlipidaemia only 5% were taking a lipid-reducing drug. Among present smokers, 38% had had at least one quitting episode during the previous 2 years with a median duration of 60 days. CONCLUSION: In a general population there is a difference between blood pressure and cholesterol check-up and medicalization. Screening activities seem to raise the awareness of cardiovascular risk factors in a population, but when evaluating the tendency to change lifestyle the contagious effects of screening activities might be taken into account. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities.

Adult↗
PubMed1998

Socioeconomic inequalities and disability pension in middle-aged men.

BACKGROUND: The issue of inequalities in health has generated much discussion and socioeconomic status is considered an important variable in studies of health. It is frequently used in epidemiological studies, either as a possible risk factor or a confounder and the aim of this study was to analyse the relation between socioeconomic status and risk of disability pension. METHODS: Five complete birth year cohorts of middle-aged male residents in Malmo were invited to a health survey and 5782 with complete data constituted the cohort in this prospective study. Each subject was followed for approximately 11 years and nationwide Swedish data registers were used for surveillance. RESULTS: Among the 715 men (12%), granted disability pension during follow-up, three groups were distinguished. The cumulative incidence of disability pension among blue collar workers was 17% and among lower and higher level white collar workers, 11% and 6% respectively. With simultaneous adjustment for biological risk factors and job conditions, the relative risk for being granted a disability pension (using higher level white collar workers as reference) was 2.5 among blue collar workers and 1.6 among lower level white collar workers. CONCLUSIONS: Socioeconomic status, as defined by occupation, is a risk factor for being granted disability pension even after adjusting for work conditions and other risk factors for disease.

Adolescent↗
PubMed1998

Disability pension in Malmöhus county: aspects on long-term financial effects.

The purpose of this study was to estimate the financial costs of disability pension in order to compare the financial burden and the numerical distribution of disability pension by main diagnostic groups. During three months all new disability pensions (n = 944) granted in Malmöhus county were registered. During a follow-up of approximately two and a half years, 40 subjects died and 15 pensions expired. The predominating diagnoses were musculoskeletal diseases, mental disorders including alcohol dependence, cardiovascular and neurological diseases. To analyse whether these proportions changed when the extent of the pension, age at pension and the retirement allowance were considered, the present value of the total retirement allowances was calculated. The ranking of the four predominating diagnosis categories was not affected by the extent of the pension or the age at which the pension was granted. Thus, musculoskeletal diseases still predominated, although the proportion decreased. Among unemployed subjects, mental disorders made the largest contribution to the total expenditure. The results gained may be used in further research where alternatives to disability pension for different groups of patients and/or diagnoses are investigated.

Adolescent↗
PubMed1997

Allergic disease, immunoglobulins, exposure to mercury and dental amalgam in Swedish adolescents.

High-dose exposure to inorganic mercury in man can influence the immune system and in rare cases cause immune-related disease. Some experimental animals also react with autoimmunity after low doses of inorganic mercury. Glomerulonephritis and an increased formation of immunoglobulin type E (IgE) are characteristic of these reactions. A recent study of 15-year-old adolescents demonstrated an association between immunoglobulin type A (IgA) and mercury concentration in plasma (P-Hg). There was also an association between allergic disease and IgA levels. The present study included 54 male and 23 female 19-year-old students who were recruited from a cohort that had been previously defined in a survey of allergic disease. Of the students, 39 (51%) had asthma, allergic rhinoconjunctivitis or eczema. Similar amalgam burden and P-Hg levels were observed in students with (n = 39) and without (n = 38) allergic disease (P = 0.48 and P = 0.98, respectively). As expected, IgE levels were significantly higher in the group with allergic disease (P = 0.006), but there was no association between P-Hg and IgE. The P-Hg levels were very low (median 1.50 nmol/l) and correlated significantly (r = 0.31) with the small number of amalgam surfaces (P = 0.007). Thirty-seven students had no amalgam fillings. P-Hg levels did not associate significantly with IgA, but did so with IgG2 (r = 0.33; P = 0.003). No conclusive correlation was observed between IgG2 and amalgam fillings. The findings of this study in 19-year-old subjects differ from earlier data obtained in a sample 4 years younger. The possibility of chance in the association between P-Hg levels and IgG2 must, however, be considered.

Adolescent↗
PubMed1997

The discursive formation of health. A study of printed health education material used in primary care.

This study analyses printed educational material on cholesterol, food and health-related lifestyle changes used in primary care in southern Sweden. Two theoretically grounded perspectives are used: orientation of knowledge and rhetoric. According to the first one, the material contained many examples of abstract and detailed knowledge, such as tables of energy contents, and a little less of action-oriented and detailed knowledge, such as food recipes. We also found a few examples of comprehensive, abstract knowledge, such as theoretic explanations. Action-oriented and comprehensive knowledge, relating health to-lifestyle, were rare. The rhetoric style of the material was generally dominated by plain facts, without any identified voice (i.e. sender) or any emotional orientation. Overall, information was not related to 'the voice of the life-world' but to 'the voice of medicine', and it was in character more general than specific.

Books↗
PubMed1997

Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia.

OBJECTIVE: To monitor changes in family physicians' reported practice on hypertension and hypercholesterolaemia. DESIGN: Random samples of physicians were selected for telephone interviews on their practice regarding cut-off levels and pharmacological treatment of hypertension and hypercholesterolaemia, related to a case scenario of a 48-year-old man, in 1989, 1991 and 1993. SETTING: Primary care facilities in southern Sweden. SUBJECTS: Specialists in family medicine, employed in public primary health care. Participation rates were in 187/201 (93%) in 1989, 236/264 (89%) in 1991 and 257/298 (86%) in 1993. MAIN OUTCOME MEASURES: Cut-off levels and drug treatment preferences for hypertension and hypercholesterolaemia. RESULTS: During the period 1989-1993, decreasing mean cut-off levels for pharmacological treatment of hypertension (P < 0.001) were reported, below the levels of the guidelines. Although betablockers were first choice drug in all three surveys, the proportion preferring this has diminished (P < 0.001), whilst the proportions preferring ACE-inhibitors and calcium channel blockers have increased (P < 0.001 and P = 0.02, respectively). For drug treatment of hypercholesterolaemia, the mean cut-off level remained close to guidelines in all three surveys. The proportion of physicians suggesting resins and nicotinic acid as first choice drug had decreased (P < 0.001 and P = 0.03, respectively), whilst the proportion preferring statins and fibrates had increased (P < 0.001 and P = 0.048, respectively). CONCLUSION: Practice guidelines on hypertension and hypercholesterolaemia have not had the desired impact on physicians' reported practice. The reason for this might be that physicians did not value the guidelines as adequate tools for practice, or that the methods for dissemination, implementation, and maintenance of guidelines were not appropriate.

Anticholesteremic Agents↗
PubMed1997

Understanding the unperceivable: ideas about cholesterol expressed by middle-aged men with recently discovered hypercholesterolaemia.

OBJECTIVE: We aimed to describe the perception of hypercholesterolaemia among middle-aged, urban men who had recently received the diagnosis of moderate hypercholesterolaemia. METHOD: Within a project screening for risk factors for coronary heart disease among 453 men, 63 were identified as moderately hypercholesterolaemic. Among these, 62 agreed to tape-recording and transcription of the first counselling on lipid-lowering, supplied by a registered nurse. The counselling was tailored to fit the needs of the individual patient, taking a starting point in whatever questions the patient expressed. The transcripts of the counselling sessions were analysed for their content. RESULTS: Five major themes were addressed by the men. It was hard to understand and accept the concept of hypercholesterolaemia, as the men did not feel unwell, and thus they did not receive any cues to taking action. Obesity and smoking was regarded as causes of hypercholesterolaemia, although the link between life-style and cholesterol level was unclear. Some men were aware of heredity traits of hypercholesterolaemia. Treatment suggestions included weight reduction and drug treatment, although there were ambiguous feelings towards drugs. Numerous misconceptions about diet were found. Many men expressed resistance to life-style changes and questioned the benefits of risk reduction. Information about hypercholesterolaemia was regarded as unreliable, as different sources gave incongruent information, and the information from individual sources changed over time. CONCLUSION: Unless medical professionals counselling patients for asymptomatic risk factors make efforts to disclose patients' conceptions of the condition, patients may misunderstand and counselling may become ineffective.

Adult↗
PubMed1997

Serum sialic acid and its correlates in community samples from Akita, Japan and Minneapolis, USA.

OBJECTIVE: The concentration of serum total sialic acid (S-TSA) is one recently investigated risk marker for cardiovascular mortality and atherosclerosis. Since the mortality from coronary heart disease is higher in the United States than in Japan, one could expect the S-TSA to be higher among Caucasian US citizens than among Japanese citizens, a hypothesis that is tested in this study. DESIGN: Cross-sectional study of population-based samples of Japanese and US Caucasian men and women. SETTING: The rural community Akita, Japan, and the suburbs of Minneapolis, Minnesota. SUBJECTS: These were 75 consecutive men and women from Akita and Minneapolis respectively aged 47-69 years in 1990. People who had smoked cigarettes during the past 5 years; who had a history of diabetes mellitus, liver disease, coronary heart disease, or stroke; or who were taking anticoagulants were excluded. OUTCOME MEASURES: Serum total sialic acid levels in male and female Japanese and US Caucasian subjects with adjustment for age, systolic blood pressure, fibrinogen, triglycerides and in women also for menopausal status. Race and sex-specific correlations with serum total sialic acid for selected cardiovascular risk markers. RESULTS: The entire sialic acid distributions were shifted to the right in Caucasian men and women compared to Japanese men and women. The mean +/- standard deviation concentrations of S-TSA were 54.1 +/- 5.3 mg/dl in Japanese men and 58.7 +/- 5.6 mg/dl in Caucasian men (P < 0.001). In women, the concentrations were 54.8 +/- 5.1 and 63.1 +/- 6.0 mg/dl respectively (P < 0.001). S-TSA level correlated significantly and positively with fibrinogen levels in Caucasian and Japanese men and women and with triglyceride levels in Caucasian and Japanese men and in Caucasian women but not in Japanese women. After adjustment for age, systolic blood pressure, fibrinogen, triglycerides and menopausal status, the sialic acid levels were 2.2 (P = 0.009) and 6.2 (P < 0.001) mg/dl higher in Caucasian compared to Japanese men and women respectively. CONCLUSIONS: Higher S-TSA levels in Caucasians living in Minneapolis compared to Japanese living in Akita, Japan is in concordance with the higher cardiovascular mortality in the US. Differences in S-TSA levels may reflect international differences in the prevalence of atherosclerosis.

Aged↗
PubMed1997

The association between serum sialic acid and asymptomatic carotid atherosclerosis is not related to antibodies to herpes type viruses or Chlamydia pneumoniae. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

BACKGROUND: Total serum sialic acid is a recently investigated marker for cardiovascular mortality and carotid atherosclerosis. This study tested the hypothesis that past infection by Herpes simplex type 1 or type 2 viruses or Cytomegalovirus or Chlamydia pneumoniae accounts for the association between serum total sialic acid and atherosclerosis. METHODS: Population-based samples of men and women living in four US communities were used in a cross-sectional study. Cases and matched controls were defined by B-mode ultrasound measurements of carotid and popliteal arterial wall thickness. In all, there were 267 case control pairs with information about antibody titres to viruses and 256 pairs with information about antibody titres to Chlamydia pneumoniae. RESULTS: Serum total sialic acid (S-TSA) level was significantly higher in cases with carotid atherosclerosis compared to their controls. The odds ratio for carotid atherosclerosis associated with sialic acid level above 75th percentile was 1.73 (95% confidence interval [CI]: 1.02-2.95) in the sample with information about antibodies to viruses and 1.70 (95% CI: 1.00-2.93) in the sample with information about antibodies to C. pneumoniae. Adjustment for titres of antibodies to viruses and C. pneumoniae had no impact on the relation between sialic acid and carotid atherosclerosis. CONCLUSIONS: From these results, it seems unlikely that previous infection by any of these micro-organisms accounts for the relation between S-TSA level and carotid atherosclerosis.

Aged↗
PubMed1997

Health beliefs and heart disease risk among middle-aged Swedish men. Results from screening in an urban primary care district.

OBJECTIVE: To study the relationship between individual health beliefs and risk factors for coronary heart disease. DESIGN: Health beliefs indices, formed by factorial analysis of ratings of statements on health related matters in a questionnaire, were related to risk factors for coronary heart disease, assessed with physical examinations and self reports of medical history and habits. SETTING: An urban primary care district in Malmö, Sweden. SUBJECTS: A random sample of middle-aged men, invited to a health check-up. RESULTS: The participation rate was 453/705 (64%). "Perceived threat to health caused by illness" was positively related to previous information on high blood pressure, high plasma cholesterol, and/or diabetes (p = 0.01). In a model of logistic regression, adjusted for age, cohabitation, and previous medical history, health belief index on "threat to health" was related to low exercise habits (RR = 1.06, CI 1.01, 1.12). "Perceived control over illness" was related to high alcohol consumption (RR = 0.86, CI 0.75, 0.97), smoking (RR = 0.89, CI 0.79, 0.99), and high diastolic blood pressure (RR = 0.84, CI 0.75, 0.95). CONCLUSION: This cross-sectional study demonstrates relations between health beliefs, previous health-related experiences, and risk behaviour. To explore the causality of the former, longitudinal studies of changes in health beliefs after medical information are required.

Analysis of Variance↗
PubMed1996

Acute glomerulonephritis, Henoch-Schönlein purpura and dental amalgam in Swedish children: a case-control study.

The issue of adverse health effects from dental amalgam and the concurrent low-dose exposure to inorganic mercury have been scrutinized by several Swedish expert groups during the past years. Only rarely have amalgam fillings in children been related to health effects. Experimental studies in genetically disposed animals have shown that low doses of inorganic mercury can induce autoimmune glomerulonephritis. The present case-control study included 31 children with acute glomerulonephritis and 33 with Henoch-Schönlein purpura retrieved from an in-patient register for the period 1973-1992 at the county hospital in Halmstad, Sweden. The median age was 10 and 9 years, respectively, for the two diagnostic groups. Dental clinics reported amalgam burden of the patients during the year before the date of diagnosis. Corresponding data were obtained for three randomly selected controls for each case, drawn from the case records of the same dental clinics, with matching for age and sex. Odds ratios (95% confidence interval) were 1.42 (0.49, 4.11) for Henoch-Schönlein purpura, 0.59 (0.25, 1.38) for acute glomerulonephritis and 0.84 (0.40, 1.75) for both diseases combined. The results of this study did not indicate increased disease risk in relation to amalgam burden.

Adolescent↗
PubMed1996

Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study.

OBJECTIVE: To analyse the association between use of antihypertensive treatment, diastolic blood pressure, and long term incidence of ischaemic cardiac events in elderly men. DESIGN: Population based cohort study. Baseline examination in 1982-3 and follow up for up to 10 years. SETTING: Malmŏ, Sweden. SUBJECTS: 484 randomly selected men born in 1914 and living in Malmŏ during 1982. MAIN OUTCOME MEASURES: Observational comparisons of incidence rates and rate and hazard ratios of ischaemic cardiac events (myocardial infarction or death due to chronic ischaemic cardiac disease). RESULTS: The crude incidence rate of ischaemic cardiac events was higher in those subjects who were taking antihypertensive drugs than in those who were not (rate ratio 2.6 (95% confidence interval 1.7 to 3.9)). After adjustment for potential confounders (differences in baseline smoking habits, blood pressure, time since diagnosis of hypertension, ischaemic or other cardiovascular disease, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus, obesity, and raised serum creatinine concentration) this rate was reduced but still raised (hazard ratio 1.9 (1.0 to 3.7)). In men with diastolic blood pressure > 90 mm Hg, antihypertensive treatment was associated with a twofold increase in the incidence of ischaemic cardiac events (rate ratio 2.0 (1.1 to 3.6)), which vanished after adjustment for potential confounders (hazard ratio 1.1 (0.5 to 2.6)). In those subjects with diastolic blood pressure < or = 90 mm Hg, antihypertensive treatment was associated with fourfold increase in incidence (rate ratio 3.9 (2.1 to 7.1)), which remained after adjustment for potential confounders (hazard ratio 3.8 (1.3 to 11.0)). CONCLUSION: Antihypertensive treatment may increase the risk of myocardial infarction in elderly men with treated diastolic blood pressures < or = 90 mm Hg.

Aged↗
PubMed1996

Community education for cardiovascular disease prevention. Morbidity and mortality results from the Minnesota Heart Health Program.

The Minnesota Heart Health Program was a community trial of cardiovascular disease prevention methods that was conducted from 1980 to 1990 in three Upper Midwestern communities with three matched comparison communities. A 5- to 6-year intervention program used community-wide and individual health education in an attempt to decrease population risk. A major hypothesis was that the incidence of validated fatal and nonfatal coronary heart disease and stroke in 30- to 74-year-old men and women would decline differentially in the education communities after the health promotion program was introduced. This hypothesis was investigated using mixed-model regression. The intervention effect was modeled as a series of annual departures from a linear secular trend after a 2-year lag from the start of the intervention program. In the education communities, 2,394 cases of coronary heart disease and 818 cases of stroke occurred, with 2,526 and 739 cases, respectively, being seen in the comparison communities. The overall decline in coronary heart disease incidence was 1.8 percent per year in men (p = 0.03) and 3.6 percent per year in women (p = 0.007). For stroke, there were no significant secular trends. The authors recently published findings showing minimal effects of sustained intervention on risk factor levels. In the current report, there was no evidence of a significant intervention effect on morbidity or mortality, either for coronary heart disease or for stroke.

Adult↗
PubMed1996

Body mass index and disability pension in middle-aged men--non-linear relations.

BACKGROUND: Obesity has, in a number of studies, been found to correlate to disability and mortality, primarily due to diseases of the circulatory and musculoskeletal systems. In addition, an excess mortality among underweight subjects has been observed in previous studies. METHODS: Five complete birth-year cohorts (1926-1930) of male residents in Malmö (n = 7697) were invited to the survey at the Department of Preventive Medicine, Malmö General Hospital, and 5926 (77%) attended with complete data. Each subject was followed from inclusion, defined by the date of examination, until the end of the calendar year when he turned 58, a total study period of approximately 11 years. Data on about 300 questionnaire items and laboratory tests were determined at the health survey visit. Nationwide Swedish data registers were used for surveillance. RESULTS: Of the participants, 4.7% were underweight, 37.7% overweight, 7.3% obese and 50.3% normal weight; 849 (14.3%) had been granted disability pension at the end of follow-up, 717 after screening. After adjustment for smoking there was a J-shaped relation between body mass index (BMI) and incidence of disability pension, the relative risk ( with the normal group as reference) among underweight men being 1.9. For the overweight subjects it was 1.3 and for the obese 2.8, all differences were significant. Disease of the musculoskeletal and circulatory systems and mental disorders accounted for 67.2% of all main diagnoses resulting in disability pensions during follow-up. A total of 377 (6.4%) men died during follow-up. Diseases of the circulatory system, neoplasms, injury/poisoning and diseases of the respiratory system accounted for 91.8% of the deaths. CONCLUSIONS: Both underweight, overweight and obesity were related to risk of disability pension, with a J-shaped risk relationship.

Body Mass Index↗
PubMed1996

Association between serum sialic acid concentration and carotid atherosclerosis measured by B-mode ultrasound. The ARIC Investigators. Atherosclerosis Risk in Communities Study.

BACKGROUND: Previous studies have shown that the serum level of sialic acid is associated positively with mortality from coronary disease and stroke. In this study its relation with carotid atherosclerosis was evaluated. METHODS: From the Atherosclerosis Risk in Communities (ARIC) Study, 323 cases with carotid intima-media wall thickness above the 90th percentile (measured with B-mode ultrasound) were matched 1:1 with controls without atherosclerosis. Serum sialic acid, plasma LDL and HDL cholesterol, serum insulin concentrations, blood pressure, antihypertensive medication use, and smoking status were used to assess the independent contribution of the sialic acid level to carotid atherosclerosis. RESULTS: The mean (SD) serum sialic acid concentration was 75.0 (9.7) mg/dl in cases and 70.7 (8.9) mg/dl in controls (P = 0.0001). In a conditional logistic model with adjustment for age, LDL-cholesterol, HDL-cholesterol, serum insulin, smoking and hypertension, the odds ratio associated with sialic acid above the 75th percentile (> or = 78.3 mg/dl) versus below was 1.65 with a 95% confidence interval of 1.01-2.70. CONCLUSION: The sialic acid level is correlated with the presence of carotid atherosclerosis, independently of major cardiovascular disease risk factors. The biological mechanism behind this association is not resolved.

Arteriosclerosis↗