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To explore hypertension management in primary healthcare (PHC). Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021. Seventy-six PHCCs in eight regions of Sweden. Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up. The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p < 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300–11300) patients. The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension. Hypertension is mainly handled in primary healthcare (PHC), and this study shows important dissimilarities in organization and clinical management. Several variants in techniques and measurements of blood pressure were found between PHC centres. Lifestyle, clinical and laboratory assessments decreased at follow-ups compared to at diagnosis, specifically for lipids, microalbuminuria and electrocardiograms. Nearly half of the PHC centres reported that they had dedicated hypertension teams. [ABSTRACT FROM AUTHOR]

Snus is a common tobacco product in Sweden, but the cardiovascular risk profile for snus users is less known than for cigarette smokers. We examined the association of snus use with lipid status, particularly in comparison to non-tobacco use and cigarette smoking, using data from 5930 men in the Northern Sweden MONICA study. Tobacco use was self-reported in 1986 to 2014 (24.4% used snus) and blood samples were collected at the same time. Harmonized analyses on non-high-density lipoprotein (non-HDL) cholesterol, HDL cholesterol, and triglycerides were conducted in 2016 to 2018. Three hundred eighty-one snus users had also been examined more than once, allowing us to study the effect of discontinued use (achieved by 21.0%). In multivariable linear regression models, snus use was associated with higher HDL cholesterol and triglyceride concentrations compared to non-tobacco use (p values ≤ 0.04), and it was associated with higher HDL cholesterol concentrations and lower triglyceride concentrations compared to cigarette smoking (p values ≤ 0.02). Snus use was not associated with non-HDL cholesterol concentrations, irrespective of the comparison group (p values ≥ 0.07). There was no indication that higher intensity of snus use led to a worse lipid profile, given that high-consumers had higher HDL cholesterol concentrations than low-consumers (p value = 0.02), or that discontinuation of snus use led to a better lipid profile, given that continued users had lower triglyceride concentrations than discontinued users (p value = 0.03). Further studies are needed to confirm or refute our findings. [ABSTRACT FROM AUTHOR]

Objective: To assess linguistic development in patients with mild and moderate Alzheimer's disease (AD) who underwent treatment with a drug and regularly performed language activities. Methods: For 12 months, five patients with mild-to-moderate AD participated in a Stimulation-Activation-Training programme (SAT) including pragmatic, semantic, writing, conversation and counting sessions. A computer with exercise programs and a keyboard with a printer were used as complements to ordinary stationery. The linguistic competence was assessed using a standardized assessment tool. Results: The assessment indicated preservation or slight changes of the patients'' linguistic competence over the period and greater confidence in the management of the language. The personal computer system was a well accepted novelty. Conclusion: The documented approach, SAT training interlaced with everyday life tasks, may be helpful in maintaining and improving remaining language functions in patients with mild or moderate AD. [ABSTRACT FROM AUTHOR]

AbstractObjectives:To assess which alternative treatment strategies are optimum in terms of cost-effectiveness (EUR/patient treated to target, EUR/PTT) in lowering cholesterol in high-risk patients with elevated LDL-cholesterol (LDL-C) in Sweden.Methods:A probabilistic cost-effectiveness model was developed to estimate the mean expected costs and proportion of patients reaching goal attainment (defined as LDL-C ≤2.5mmol/L [96.5mg/dL]) at some point in time within a 52-week period following the initiation of statin therapy. Eight different statin treatment strategies were evaluated. Key data sources used in the modeling were the scientific literature, hospital tariffs and medicine price databases.Results:Depending on baseline LDL-C and the willingness-to-pay per additional PTT, the cost-effective alternative is always found among four out of the eight assessed treatment strategies (i.e. Simva10Simva20Simva40, Rosu10, Simva20Rosu10Rosu20Rosu40, or Simva20Simva40Rosu20Rosu40). An important finding was that when LDL-C level exceed 4.0mmol/L (154mg/dL) and when willingness to pay is less than 500 EUR per additional PTT, the optimal treatment strategy would be to initiate cholesterol-lowering treatment directly with rosuvastatin 10mg.Conclusions:The results of this study indicate that the optimal approach to initiate lipid-lowering therapy would be to treat patients with the lower baseline LDL-C levels with the least costly treatment strategies, while initiating lipid-lowering treatment with a high-potency statin (rosuvastatin) in patients with moderately high or high baseline LDL-C levels. This recommendation can be assumed to be relevant particularly when the fact that after treatment initiation the majority of Swedish patients will not have any changes in their lipid-lowering medication or dose is taken into account. Finally, since only the short-term results are presented here, it would be valuable to conduct further studies of the long-term cost-effectiveness of different statin treatment strategies that focus on treatment persistence and LDL-C goal attainment in real practice. [ABSTRACT FROM AUTHOR]

Background. It is of importance to study the risk factor control in treated hypertensives (tHT), both longitudinally within one country and between neighbouring countries, as hypertensive patients still run an increased cardiovascular risk in spite of treatment. Methods. In sample of 1135 tHT from Estonia and a similar number of age- and sex-matched Swedish tHT, the control of blood pressure and other cardiovascular risk factors were assessed as part of national surveys in primary health care. Data were retrieved form consecutive patients visiting primary health care centres all over each country. Results. The mean age of male patients (n = 421) was 50 years and for female patients (n = 714) it was 52 years. tHT from Sweden were more likely to be in better control of blood pressure and risk factor levels than corresponding Estonian patients, matched for age and gender. However, there was a significantly (p = 0.0003) higher rate of smoking in Swedish female patients (22.4%) than in corresponding Estonian patients (16.0%). More Swedish women than men were prescribed thiazide diuretics, but fewer were prescribed angiotensin-converting enzyme (ACE) inhibitors. No similar Estonian data were available. Conclusion. Most cardiovascular risk factors were better controlled in the Swedish hypertensives, except for a higher smoking prevalence in Swedish female patients. This could be related not only to differences in clinical practice, but also influenced by social and lifestyle factors. [ABSTRACT FROM AUTHOR]

Background: There is a shortage of reference values for cardiovascular risk factors such as serum lipids, glucose and insulin related to biological, social and lifestyle factors for Swedish children and adolescents. Such values are needed for planning and evaluation of public health activities, and for clinical use.Design and Methods: Data for this cross-sectional, school-based study were collected during a school year (September to May). A random sample of 1137 girls and boys aged 9 and 15 years from two locations in central Sweden participated in the study, and blood samples were taken from 969 of them.Methods: Fasting serum blood samples were analysed for triglycerides, total cholesterol, high-density lipoprotein cholesterol, glucose and insulin. Physical examination included measurement of height, weight and pubertal status. Questionnaires provided family background data. Total physical activity was measured by accelerometer registration.Results: Serum levels differed significantly between age and gender groups and were correlated to pubertal status. Neither genetic nor socio-economic background nor smoking status influenced the serum levels. Insulin levels were elevated in subjects with a body mass index in the highest decentile, compared with the levels in the rest of the subjects. The insulin levels were inversely associated with total physical activity, and physical activity varied with season.Conclusions: Pubertal status (biological age) should to be considered in the interpretation of serum values in schoolchildren rather than chronological age. The interpretation of insulin values should include both body mass index and physical activity level, and perhaps also season. Previously described regional differences in serum lipid levels in Swedish adults seem to be present also in children. [ABSTRACT FROM AUTHOR]

Objective - To study the value of screening for thyroid function in a screening program for hyperlipidaemia. Design - A screening study in primary health care. Setting - All individuals in a defined rural area, Söderåkra, Sweden, aged 40-59 years were invited to a screening programme at the local primary health care centre. Participants - 782 individuals were invited for screening. Blood samples were obtained from 88% of the invited males and from 92% of the females. Main outcome measures - Thyroid function tests (thyroid stimulating hormone (TSH) and free T4), serum lipids (total-cholesterol, HDL-cholesterol, LDL-cholesterol and s-triglycerides), b-glucose and body anthropometry (body mass index and waist to hip circumference) were measured. Results – 0.57% of males and 1.13% of females showed evidence of hypothyroidism as defined by a TSH value greater than 3.75 mU/l of those with s-cholesterol concentration above 7 mmol/l. In addition, higher TSH values in females were associated with higher s-cholesterol, s-LDL-cholesterol and s-triglycerides. Conclusion – It seems appropriate to screen for hypothyroidism in females with s-cholesterol above 7.0 mmol/l. [ABSTRACT FROM AUTHOR]