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Background: Hypertension is a common disease accounting for the highest number of lost healthy life years globally and is strongly associated with 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.Method: 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”. Conclusions: 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.

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

Håkan Bergh,1,2 Margit Albrektson,3 Clovis Kastberg,4 Amir Baigi,1,2 Lennart Hedström3 1School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; 2Department of Research & Development Unit, Hospital Varberg, Region Halland, Sweden; 3Public Dental Services, Västra Vall, Varberg, Sweden; 4Tre Tandläkare, Varberg, SwedenCorrespondence: Håkan Bergh, School of Public Health and Community Medicine, Institute of Medicine, P.O. Box 463, Gothenburg, 405 30, Sweden, Email hakan.e.bergh@gmail.com Lennart Hedström, Public Dental Service, Västra Vallgatan 14, Varberg, S-43244, Region Halland, Sweden, Email h.lennart.hedstrom@gmail.comObjective: 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 &boxh; − 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 &boxh; − 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 &boxh; − 1.46), a greater waist/hip ratio 0.92 cm/cm vs 0.90 cm/cm (95% CI − 0.03 &boxh; − 0.01), and a higher BMI 26.6 kg/m2 vs 26.0 kg/m2 (95% CI − 1.11 &boxh; − 0.03). The following associations with SV were found in multivariate analysis: hypertension OR=1.6 (95% CI 1.19 &boxh;2.13), a high systolic BP OR =1.5 (95% CI 1.11 &boxh;2.13), a high fP-glucose OR= 1.8 (95% CI 1.03 &boxh;3.21), a low HDL OR= 1.8 (95% CI 1.15 &boxh;2.92), a greater waist circumference OR= 1.68 (95% CI 1.10 &boxh;2.58), a greater waist/hip ratio OR=2.21 (95% CI 1.36 &boxh;3.58), and a higher BMI OR=1.05 (95% CI 1.02 &boxh;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.Keywords: sublingual varices, cardiovascular riskfactors

Objective To study white-coat hypertension (WCHT, blood pressure ≥140/90 mmHg in a clinic and normal blood pressure

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.

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.

Marie Bräutigam Ewe,1 Marie Lydell,2 Håkan Bergh,1,3 Cathrine Hildingh,2 Amir Baigi,1,3 Jörgen Månsson1 1Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; 2CVHI-Centre of Research on Welfare, Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, Sweden; 3Research and Development Unit Halland, Region of Halland, Halmstad, Sweden 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. Keywords: lifestyle, overweight, primary health care, weight loss

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.