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Objective To evaluate the effect of an individual health dialogue on health and risk factors for ischemic heart disease in addition to that of a community based strategy. Method Inhabitants in four communities in the area of Skaraborg, Sweden were invited to a health examination including a health dialogue both at the age of 30 and 35 (target communities). In another four communities inhabitants were invited only at the age of 35 (reference communities). Health and risk factors in 35-year old inhabitants in the target communities who participated in the health dialogue in 1989–1991 and 1994–1996 were analysed and compared with 35-year olds in the reference communities participating during the same periods of time. Results Inhabitants in communities where there had been a previous individualised health intervention programme had, on the community level, a more favourable development concerning dietary habits, mental stress, body mass index, waist circumference, cholesterol, blood pressure and metabolic risk profile compared to inhabitants in communities with only a community based health intervention programme. Conclusions An individual lifestyle oriented health dialogue supported by a global health and risk assessment pedagogic tool seems to be more effective than a community health strategy only.

Objective The purpose of the study was to explore the relationship of weight and length at birth to diabetes in adult life and to all-cause mortality. Special attention was taken to potential confounding factors as age, family history, education, socio-economic group, physical inactivity, smoking, blood pressure, serum lipids and obesity. Research design and methods A longitudinal population study consisting of a representative sample of 1381 women aged 38–54 started in Gothenburg, Sweden, in 1968–1969 monitoring for diabetes mellitus and overall mortality over 32 years. Original delivery records were retrieved for 61.2% of the women. Death certificates were obtained for 99.3% the women who died during the 32-year follow-up period. Results We observed an inverse statistically significant relationship between birth weight and 32-year diabetes incidence independent of age, the highest incidence 16.3% in the lowest quartile of birth weight compared to 9.2% in the highest quartile. The relationship remained when controlling for the following covariates: education, socio-economic group, physical activity, smoking, systolic blood pressure, adult body mass index (BMI), waist–hip ratio, serum triglycerides and cholesterol. When overweight women (BMI ≥ 25) were excluded from the statistical analyses birth weight was even stronger related to the incidence of diabetes, 12.8% in lowest quartile and 5.7% in the highest quartile of birth weight independent of birth length, education, socio-economic group, physical activity, smoking, systolic blood pressure, body mass index, waist–hip ratio, blood glucose, serum triglycerides and cholesterol. Length at birth was a predictor for diabetes independent of age plus adult body mass index (BMI) and smoking but not independent of age only. No significant associations were observed between birth factors as birth weight and birth length and overall mortality during the 32-year of follow-up. Conclusions A low birth weight seems to be a risk factor for diabetes in adult women independent of age and most of the established risk factors for diabetes.

Avoiding patient's and doctor's delay is important for the detection of cancer. In order to study the possibilities for shortening the delay, without causing anxiety, an educational programme for early detection of cancer (EPEDC) was worked out, aimed to be evaluated at the community level. A community with 77,100 inhabitants, was informed about cancer symptoms in a letter. Participants who observed the cancer symptoms, described in the letter, were invited to visit the health centres, where they were interviewed and examined according to a specially designed schedule. Guidelines for taking care of these participants were also worked out. Fifteen previously unknown cancers were detected. By means of a telephone interview and a questionnaire the reactions to the EPEDC were studied. The results indicate that it is possible to inform and educate the population about cancer symptoms without causing anxiety on condition that there is an organisation which can be contacted without delay by subjects with potential cancer symptoms.

Methylmercury in serum (S-MeHg) was assessed from serum concentrations of total (S-TotHg) and inorganic mercury (S-InoHg), determined by cold vapor-atomic absorption spectrometry. The samples were collected from 135 women on two occasions, in 1968-1969 and 1980-1981. In a subgroup of 29 women, an association was found between S-MeHg and the amount of fish consumed in 1968-1969 (r = 0.38, P = 0.04). The association was stronger (r = 0.50; P = 0.006) when the individuals' mean S-MeHg from 1968-1969 and 1980-1981 were plotted vs fish consumption 1968-1969. In the group, as a whole, there was an association between S-InoHg and number of dental amalgam surfaces, in both 1968-1969 (r = 0.48, P = 0.0001) and 1980-1981 (r = 0.57, P < 0.0001). The S-InoHg increased by approximately 0.1 nmol/L per amalgam tooth surface, corresponding to an uptake of approximately 0.2 microgram/day per amalgam surface, but with considerable interindividual differences. The levels were lower in 1980-1981 than in 1968-1969 for both MeHg and InoHg. The medians and ranges (nmol/L) were for MeHg 1968-1969: 3.6 (0.3-11.9); MeHg 1980-1981, 2.0 (-0.4-8.7); InoHg 1968-1969, 3.3 (0.7-11.8); InoHg 1980-1981, 1.7 (0.1-11.8); TotHg 1968-1969, 7.2 (1.9-18.8); and TotHg 1980-1981, 3.9 (1.0-14.2). The decrease in S-MeHg is probably due to a decreased consumption of MeHg via contaminated fish. The decrease in S-InoHg may reflect a decrease in environmental exposure, but the possibility of contamination of the 1968-1969 samples at sampling and/or storage cannot be excluded.

Department of Primary Health Care, Sahlgrenska University Hospital, Goteborg University, Gothenburg, Sweden. OBJECTIVE: To investigate the relationship between reproductive history and body composition. DESIGN: Prospective population study in Sweden. SUBJECTS: 1462 randomly selected women representing five separate age cohorts (38, 46, 50, 54 and 60 at the 1968-1969 baseline examination) have been followed longitudinally. MEASUREMENTS: Relative weight, fat distribution, and fat cellularity were related to menarche, parity, lactation, menopause and oestrogen medication. RESULTS: Age of menarche did not show any association with subsequent fat distribution, nor did length of lactation time. On the other hand parity was positively associated to total as well as central obesity, and lactation time was positively associated to abdominal fat cell diameter. Premenopausal women showed higher mean body weight and hip circumference than postmenopausal women of the same age. Change from pre- to postmenopausal status was associated with increase of waist circumference as well as reduction of hip circumference, resulting in an increased waist-hip ratio (WHR). Oestrogen replacement suggested some postponement of this increase. CONCLUSION: Parity and menopause are the reproductive factors most associated with gradual changes in body fat distribution. Oestrogen medication seems to play an additional role in diminishing waist circumference increase and could thus contribute to decreased cardiovascular morbidity in women. PMID: 8653141 [PubMed - indexed for MEDLINE]

Dietary intake as initially estimated in a cross-sectional study has been related to the 12-y incidence of diabetes mellitus in a prospective study of 1462 women. In addition, all 50-y-old women (n = 352) were subjected to an intravenous glucose tolerance test. Because of the sampling procedure and a high participation rate the participants were representative of middle-aged women in the general population. No differences of statistical significance were observed concerning intake of energy and different nutrients. Neither did the number of meals nor the longest time between meals differ between women who developed diabetes and those who did not. Women with impaired glucose tolerance who developed diabetes did not differ from those who did not develop diabetes, concerning dietary intake. Body mass index was significantly higher in women who developed diabetes compared with other women. No specific dietary recommendations can be based on the results of this study.

As one phase of a comprehensive population study of women, bone density was determined in the third lumbar vertebra by dual photon absorptiometric technique. The method involves the use of two radionuclides, which both emit gamma radiation but with different energies (241Am with 59.6 keV and 137Cs with 662 keV). Women in three age strata were studied: 46, 54 and 62 yr. All women aged 46 were still menstruating, while the age strata 54 and 62 were subdivided into two groups: those who still menstruated or had been postmenopausal for a short time and those who had been postmenopausal for many years. The bone mineral content was higher in premenopausal or recently postmenopausal 54-yr-old women than in women of the same age who had been postmenopausal for a long time (P less than 0.01). A similar trend was found for women aged 62 (P less than 0.10). The differences could not be explained by differences in other factors studied, such as body weight, body height, smoking habits or physical activity. No significant differences were found when women with similar menopausal status in different age groups were compared.

A review of the literature indicates that hormone replacement therapy (HRT) in post-menopausal women not only reduces the frequency of hot flushes and sweating episodes but also has a protective effect as regards the post-menopausal osteoporotic process. However, it has not yet proved possible to arrive at any conclusions concerning the overall effect of HRT on either ischaemic heart disease and other cardiovascular problems or the risk of developing malignant neoplastic disease. Nevertheless, there is evidence that oestrogen replacement in combination with a progestogen will reduce the risk of endometrial and breast cancer. There is a clear need for additional knowledge and it would therefore seem ethically appropriate to carry out an intervention study in order to determine whether women in general or specific groups in particular would benefit from long-term HRT. Such a study would seem especially urgent, since fractures of the neck of the femur and other osteoporotic manifestations are likely to be a major problem among women in the future.

In a prospective study of a population sample of women, the erythrocyte sedimentation rate (ESR) was studied in relation to the incidence of myocardial infarction, angina pectoris, stroke and intermittent claudication. ESR could not be proved to be predictive of these manifestations of cardiovascular disease. Similar results were obtained when the population was studied cross-sectionally. The ESR was higher in women with hyperlipidaemia (serum triglyceride ⩾ 2.0 mmol/1 or serum cholesterol ⩾ 9 mmol/1), in women with arterial hypertension (treated or untreated, with systolic blood pressure ⩾ 160 mm Hg or diastolic blood pressure > 95 mm Hg or both) and in overweight women (women within the upper 10 centiles of weight index) compared to women of the same age in the population sample who did not fulfill the criteria according to the above definitions. ESR was similar in hyperuricaemic women (upper 5 centiles of serum uric acid) and in those who were not hyperuricaemic. No association was found between smoking habits and ESR. Weak correlations were found between ESR and serum triglycerides, serum cholesterol and serum uric acid, respectively. Although some correlations were found, ESR cannot replace other examinations in the search for risk factors for cardiovascular disease.