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Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Lönnberg, G., Norberg, M., . . . Carlberg, B. (2020). Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control. JAMA Network Open, 3(1), Article ID e1918625.
Open this publication in new window or tab >>Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control
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2020 (English)In: JAMA Network Open, ISSN 2574-3805, Vol. 3, no 1, article id e1918625Article in journal (Refereed) Published
Abstract [en]

Importance: Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.

Objective: To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.

Design, Setting, and Participants: This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.

Exposures: An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).

Main Outcomes and Measures: Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.

Results: A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.

Conclusions and Relevance: This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

Place, publisher, year, edition, pages
American Medical Association, 2020
National Category
General Practice Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-167169 (URN)10.1001/jamanetworkopen.2019.18625 (DOI)31913490 (PubMedID)
Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2020-01-10Bibliographically approved
Lindahl, B., Norberg, M., Johansson, H., Lindvall, K., Ng, N., Nordin, M., . . . Schulz, P. J. (2020). Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk. European Journal of Preventive Cardiology, 27(2), 209-215
Open this publication in new window or tab >>Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk
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2020 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 27, no 2, p. 209-215Article in journal (Refereed) Published
Abstract [en]

Aims: Health literacy, the degree to which individuals understand and act upon health information, may have a pivotal role in the prevention of cardiovascular disease (CVD), with low health literacy potentially explaining poorer adherence to prevention guidelines. We investigated the associations between health literacy, ultrasound-detected carotid atherosclerosis and cardiovascular risk factors.

Methods: Baseline data (cross-sectional analysis) from a randomized controlled trial, integrated within the Västerbotten Intervention Program, Northern Sweden, was used. We included 3459 individuals, aged 40 or 50 years with ≥1 conventional risk factor or aged 60 years old. The participants underwent clinical examination, blood sampling, carotid ultrasound assessment of intima-media wall thickness (CIMT) and plaque formation, and answered a questionnaire on health literacy – the Brief Health Literacy Screen. The European Systematic Coronary Risk Evaluation and Framingham Risk Score were calculated.

Results: About 20% of the participants had low health literacy. Low health literacy was independently associated with the presence of ultrasound-detected carotid artery plaques after adjustment for age and education, odds ratio (95% confidence interval) 1.54 (1.28–1.85), demonstrating a similar level of risk as for smoking. Health literacy was associated with CIMT in men. Low health literacy was associated with higher CVD risk scores. Sensitivity analyses with low health literacy set to 9% or 30% of the study sample, respectively, yielded essentially the same results.

Conclusions: Low health literacy was independently associated with carotid artery plaques and a high level of CVD risk scores. Presenting health information in a fashion that is understood by all patients may improve preventive efforts.

Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
Health literacy, cardiovascular risk scores, carotid artery plaque, ultrasound
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-165791 (URN)10.1177/2047487319882821 (DOI)000491457000001 ()31615294 (PubMedID)2-s2.0-85074364646 (Scopus ID)
Available from: 2019-12-03 Created: 2019-12-03 Last updated: 2020-03-23Bibliographically approved
Granlund, L. E., Ramnemark, A., Andersson, C., Lindkvist, M., Norberg, M. & Fhärm, E. (2020). Vitamin D status was not associated with anxiety, depression, or health-related quality of life in Middle Eastern and African-born immigrants in Sweden. Nutrition Research, 75, 109-118
Open this publication in new window or tab >>Vitamin D status was not associated with anxiety, depression, or health-related quality of life in Middle Eastern and African-born immigrants in Sweden
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2020 (English)In: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 75, p. 109-118Article in journal (Refereed) Published
Abstract [en]

Active vitamin D is a neurosteroid that may modulate brain function. Associations between vitamin D deficiency and depression and anxiety have been demonstrated. We hypothesized that there was an association between anxiety, depression, and health-related quality of life (HRQOL) and vitamin D status. To test this hypothesis, we examined the association between anxiety, depression, and HRQOL and 25-hydroxyvitamin D (25[OH]D) concentrations in the Middle Eastern and African-born immigrant population. All immigrants aged 25-65 years, born in 9 African or Middle Eastern countries, and living in 3 districts in Umea (n = 1306) were invited, with 195 English- or Swedish-speaking immigrants (104 men and 91 women) participated. Anxiety and depression were measured using the Hospital Anxiety and Depression scale. HRQOL was measured using EuroQoL-5 Dimension 3 Level Questionnaire and EuroQoL Visual Analogue Scale. Serum 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. Associations were determined using logistic and linear regression. Analyses were adjusted for sex, age, origin, socioeconomic factors, lifestyle, chronic diseases, and obesity. In total, 71% had 25(OH)D less than 50 nmol/ L and 11% had 25(OH)D less than 25 nmol/L. Anxiety, depression, and HRQOL were not associated with 25(OH)D in the immigrant population. Anxiety was common in female immigrants from the Middle East (32.7%); and after adjustment, lower 25(OH)D concentrations were associated with higher risk of anxiety (25[OH]D <= 49 nmol/L vs 25[OH] D >= 50 nmol/L: odds ratio 23.2 [95% confidence interval 1.97 - 271.9] P = .012) in this subgroup only; however, reverse causality could not be excluded. In conclusion, the study showed no association between depression, anxiety, or HRQOL and vitamin D status in the immigrant population.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Vitamin D deficiency, 25(OH)D, Cross-sectional study, Anxiety, Depression, Health-related quality of life, Immigrant
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-170510 (URN)10.1016/j.nutres.2020.02.006 (DOI)000528187700010 ()32120223 (PubMedID)
Available from: 2020-05-11 Created: 2020-05-11 Last updated: 2020-05-11Bibliographically approved
Ljungberg, J., Johansson, B., Engström, K. G., Norberg, M., Bergdahl, I. A. & Söderberg, S. (2019). Arterial hypertension and diastolic blood pressure associate with aortic stenosis. Scandinavian Cardiovascular Journal, 53(2), 91-97
Open this publication in new window or tab >>Arterial hypertension and diastolic blood pressure associate with aortic stenosis
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 2, p. 91-97Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Due to age-related differences in aortic valve structure, it is likely that the pathophysiology of aortic stenosis (AS) and associated risk factors differ between age groups. Here we prospectively studied the influence of traditional cardiovascular risk factors on AS development requiring surgery among patients without concomitant coronary artery disease (CAD) and stratified for age.

DESIGN: This study included 322 patients, who had prior to surgery for AS participated in population-based surveys, and 131 of them had no visible CAD upon preoperative coronary angiogram. For each case, we selected four referents matched for age, gender, and geographic area. To identify predictors for surgery, we used multivariable conditional logistic regression with a model including arterial hypertension (or measured blood pressure and antihypertensive medication), cholesterol levels, diabetes, body mass index (BMI), and smoking.

RESULTS: In patients without CAD, future surgery for AS was associated with arterial hypertension and elevated levels of diastolic blood pressure in patients younger than 60 years at surgery (odds ratio [95% confidence interval]), (3.40 [1.45-7.93] and 1.60 [1.09-2.37], respectively), and with only impaired fasting glucose tolerance in patients 60 years or older at surgery (3.22 [1.19-8.76]).

CONCLUSION: Arterial hypertension and elevated diastolic blood pressure are associated with a risk for AS requiring surgery in subjects below 60 years of age. Strict blood pressure control in this group is strongly advocated to avoid other cardiovascular diseases correlated to hypertension. If hypertension and elevated diastolic blood pressure are risk factors for developing AS requiring surgery need further investigations. Notably, elevated fasting glucose levels were related to AS requiring surgery in older adults without concomitant CAD.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Aortic stenosis, bicuspid aortic valve, diabetes, hypertension, valve disease surgery
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159471 (URN)10.1080/14017431.2019.1605094 (DOI)000469026200007 ()31109205 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20140799Swedish Heart Lung Foundation, 20120631Swedish Heart Lung Foundation, 20100635Västerbotten County Council, VLL-548791
Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-06-17Bibliographically approved
Pujilestari, C. U., Nyström, L., Norberg, M. & Ng, N. (2019). Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia. Obesity Research and Clinical Practice, 13(5), 462-468
Open this publication in new window or tab >>Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia
2019 (English)In: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 13, no 5, p. 462-468Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels.

Methods: In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals’ waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability.

Results: A significant positive association was observed between waist circumference and disability at the baseline (β = 0.066; p < 0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β = 0.094; p < 0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities.

Conclusions: An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Abdominal obesity, Waist circumference, Disability, Older people, Indonesia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-165103 (URN)10.1016/j.orcp.2019.07.004 (DOI)000492674200007 ()31474381 (PubMedID)
Available from: 2019-11-13 Created: 2019-11-13 Last updated: 2019-11-13Bibliographically approved
Lundgren, A., Nyman, E., Norberg, M., Fhärm, E., Näslund, U., Wester, P. & Grönlund, C. (2019). Bilateral carotid intima media thickness (cIMT) and plaque measurements was stronger associated with cardiovascular risk factors than unilateral measurements: Results from the VIPVIZA trial. Paper presented at Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology,, Paris, FRANCE AUG 31-SEP 04, 2019.. European Heart Journal, 40, 2036-2036
Open this publication in new window or tab >>Bilateral carotid intima media thickness (cIMT) and plaque measurements was stronger associated with cardiovascular risk factors than unilateral measurements: Results from the VIPVIZA trial
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2019 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, p. 2036-2036Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-168153 (URN)10.1093/eurheartj/ehz745.0290 (DOI)000507313001859 ()
Conference
Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology,, Paris, FRANCE AUG 31-SEP 04, 2019.
Note

 Supplement: 1. Meeting Abstract: P3416.

Available from: 2020-03-18 Created: 2020-03-18 Last updated: 2020-03-18Bibliographically approved
Blomstedt, Y., Norberg, M., Ng, N., Nyström, L., Boman, K., Lönnberg, G., . . . Weinehall, L. (2019). Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al [Letter to the editor]. BMC Public Health, 19(1), Article ID 1095.
Open this publication in new window or tab >>Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1095Article in journal, Letter (Refereed) Published
Abstract [en]

An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.

Keywords
Prevention, Community intervention, Evaluation, CVD
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-163072 (URN)10.1186/s12889-019-7444-3 (DOI)000480751900003 ()31409308 (PubMedID)
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2020-05-20Bibliographically approved
Näslund, U., Lundgren, A., Vanoli, D. & Norberg, M. (2019). Is intima-media thickness a predictor for cardiovascular risk?: Authors' reply [Letter to the editor]. The Lancet, 394(10196), 381-381
Open this publication in new window or tab >>Is intima-media thickness a predictor for cardiovascular risk?: Authors' reply
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, no 10196, p. 381-381Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-162305 (URN)10.1016/S0140-6736(19)30343-5 (DOI)000478698300018 ()31379329 (PubMedID)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2020-05-19Bibliographically approved
Näslund, U., Ng, N., Wennberg, P. & Norberg, M. (2019). Patient-doctor engagement in cardiovascular prevention: Authors' reply [Letter to the editor]. The Lancet, 394(10199), E27-E27
Open this publication in new window or tab >>Patient-doctor engagement in cardiovascular prevention: Authors' reply
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, no 10199, p. E27-E27Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-164539 (URN)10.1016/S0140-6736(19)31335-2 (DOI)000483011200007 ()31448748 (PubMedID)
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2020-05-15Bibliographically approved
Sjölander, M., Carlberg, B., Norberg, M., Näslund, U. & Ng, N. (2019). Prescription of lipid-lowering drugs increases following receipt of a pictorial representation of patients´carotid ultrasound examinations. Research in Social and Administrative Pharmacy, 15(12), E49-E49
Open this publication in new window or tab >>Prescription of lipid-lowering drugs increases following receipt of a pictorial representation of patients´carotid ultrasound examinations
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2019 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 15, no 12, p. E49-E49Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background and objectives: We evaluated whether a pictorial representation of asymptomatic atherosclerosis based on carotid ultrasound examinations given to the participants and their physicians had an impact on the proportion of participants receiving prescriptions for lipid-lowering drugs during the following 465 days. The overall aim of the study was to optimize cardiovascular disease (CVD) prevention.

Methods: This study was performed within a CVD screening and prevention program in Vasterbotten County, Sweden 2013-2016. 3532 par- € ticipants were randomly assigned 1:1 to receive or not receive a simplified picture of an ultrasound scan by mail plus a phone call including a health dialogue with a trained nurse. The picture indicated vascular age and the presence of plaques, and was also sent to participants’ physicians. The control group received no information about the ultrasound. Data on prescriptions was collected from the County Council database.

Results: During the first 465 days, prescriptions of lipid-lowering drugs were higher in the intervention group compared with the control group among men (34.2% vs 21.3%, p<0.001) and women (25.8% vs 15.2% p<0.001). Corresponding proportions for first prescriptions were 19.2% vs 6.0% (p<0.001) and 16.6% vs 5.7% (p<0.001), respectively. Similar patterns were observed for participants with and without plaque, but with a higher proportion among those with plaque. Cholesterol level, diabetes, prescription of antihypertensives and previous myocardial infarction were in a multivariable logistic regression model associated with first prescriptions. Although prescriptions increased over the study period, 56% of participants with known plaque were not prescribed any lipid-lowering drug.

Conclusion: Provision of pictorial information on vascular age and carotid plaque based on ultrasound examination increased physician prescriptions of lipid-lowering drugs within the following 465 days.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:umu:diva-166811 (URN)10.1016/j.sapharm.2019.09.006 (DOI)000500574500051 ()
Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2020-01-03Bibliographically approved
Projects
Direct visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention. A population based pragmatic randomised controlled trial within ordinary care [2013-02708_VR]; Umeå UniversityVIsualiZation of Asymptomatic atherosclerotic disease for optimun cardiovascular prevention ? VIPVIZA ? a RCT nested in routine care in Västerbotten Intervention Programme, Sweden [2016-01891_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2475-7131

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