Aims: To describe a self-administered preventive tool dealing with risk factors for cardiovascular
disease and its effectiveness to involve persons in need of life style changes. To evaluate the feasibility
of implementing a preventive primary care program consisting of a screening questionnaire and a selfadministered
health profile. To involve motivated individuals in need of lifestyle changes and to
evaluate the effects after 1 year. To explore potential effects of physical activity on well-being among
women in a population based study with a 32 year perspective. To study the incidence of first ever
nonfatal and fatal stroke over 32 years with focus on stroke subtype, by consolidating endpoints and
associations with risk factors in the same population study.
Method: A model for structured preventive work in primary care was developed and tested at one public
primary care center. The model included a screening questionnaire offered to consecutive patients
between 18-65 years of age followed by a self-administered health profile and follow up.
Subsequently an intervention study was applied on eight public primary care centers. Patients aged 18-
79 years were presented a screening questionnaire, and then they were offered a health profile, blood
pressure and blood glucose check and a health dialogue. Main outcome measures were motivation
level, negative lifestyle factors in the screening questionnaire and changes in blood pressure, pglucose,
body mass index (BMI) and lifestyle factors at 1-year follow-up. In the Population Study of
Women in Gothenburg (PSWG) with 1 462 women cross-sectional and prospective analyses were
carried out. Physical activity was defined in three levels, “low”, “intermediate”, “high” and
well-being was based on self-reported well-being using a Likert –type 7-point scale. In PSWG main
types of first-ever stroke and fatal stroke were identified and validated. Risk factors like smoking,
physical inactivity, BMI, waist-hip-ratio (WHR), blood pressure, perceived mental stress and low
education at baseline were selected. Association with atrial fibrillation (AF), diabetes and myocardial
infarction was tested as survival time free from stroke.
Results: Subjects with less favorable life style chose to participate. Good agreement was seen for selfestimation
in screening questions and grading in the basal health profile (I). Subjects with less
favorable lifestyle and higher motivation chose to participate. At 1-year follow- up significant
reductions in BMI, WHR, waist circumference, blood pressure and p-glucose were observed (II).
Strong associations were seen between level of physical activity and well-being cross-sectionally and
similar associations were observed when relating physical activity at baseline to subsequent well-being
after 12, 24 and 32- years. Linear correlations were seen between changes in the individual´s physical
activity level and simultaneous changes in experience of well-being (III). There were 184 (12.6%)
cases of first ever stroke and18% of them were fatal. The validation process diminished unspecified
stroke diagnosis from 37% to 11%. Significant association with ischemic stroke was seen for high
BMI, smoking and low education. Survival analysis showed significant negative correlation between
stroke and diabetes as well as stroke and atrial fibrillation (IV).
Conclusions: A pedagogic model engaging motivated individuals was feasible to implement in
ordinary primary care. Weight, BMI, waist circumference, waist-hip ratio, blood pressure and pglucose
were significantly improved after one year suggesting applicability in life style modification.
Strong associations were seen between leisure time physical activity level and reported well-being
both cross-sectionally and prospectively. Increased physical activity in sedentary individuals appears
to promote health and well-being. Diagnoses from the National Patient Registry could be validated to
improve data quality by increasing specified diagnoses. Low education was associated with ischemic
stroke. Smoking and BMI were associated to higher stroke risk.
Keywords: Life style, prevention, promotion, risk factors, primary health care, health profile, public
health, self-reported health, wellbeing, stroke, incidence, women.||sv
|dc.relation.haspart||I. Blomstrand a et al.Low-budget method for lifestyle improvement in primary care. Experiences from the Göteborg Health Profile Project. Scandinavian Journal of Primary Health Care.2005;23:82-87 ::PMID::16036546||sv
|dc.relation.haspart||II. Blomstrand A et al. Implementation of a low-budget, lifestyle-improvement method in an ordinary primary healthcare setting:a stepwise intervention study. BMJ Open. 2012;00:e001154. ::PMID::22874629||sv
|dc.relation.haspart||III. Blomstrand A et al. Effects of leisure-time physical activity on well-being among women: a 32-year perspective. Scandinavian Journal of Public Health. 2009;37:706-712. ::PMID::19622547||sv
|dc.relation.haspart||IV. Blomstrand A et al. Stroke incidence and association with risk factors in women- a 32-year follow-up of the Prospective Population study of women in Gothenburg. Submitted||sv
|dc.subject||Lifestyle, prevention, promotion, risk factors,primary health care,health profile, public health,self-reported health,well-being, stroke, incidence, women||sv
|dc.title||Life style intervention in primary care and aspects on stroke prevention||sv
|dc.type.degree||Doctor of Philosophy (Medicine)||sv
|dc.gup.origin||University of Gothenburg. Sahlgrenska Academy||sv
|dc.gup.department||Institute of Medicine. Department of Public Health and Community Medicine||sv
|dc.gup.defenceplace||Torsdagen den 3 april 2014, kl 9.00, hörsal 2119, Hälsovetarbacken, Arvid Wallgrens Backe, hus 2, Göteborg||sv