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The early identification of individuals at risk of fear of falling after stroke is crucial in order to individualise preventive actions and interventions. The aim of this study was to identify the incidence of, and baseline factors in acute stroke that are associated with fear of falling at 6 months after stroke. Fear of falling was assessed by one question, which was answered by 279 of 452 eligible individuals. Univariable and multivariable logistic regression analyses were performed to determine the factors that were associated with fear of falling. The dependent variable was fear of falling at 6 months after stroke. The independent variables were related to function, activity and participation, including personal and environmental factors. Fear of falling was reported by 117 (41.9%) individuals. Poor postural control in acute stroke, measured using the modified version of the Postural Assessment Scale for Stroke Patients (odds ratio [OR]: 2.60, 95% confidence interval [CI]: 1.26–5.36), and being physically inactive prior to the stroke, measured using the Saltin-Grimby Physical Activity Scale (OR: 2.04, 95% CI: 1.01–4.12), were found to be associated with fear of falling at 6 months after stroke. The findings in this study are useful in clinical practice to optimise rehabilitation after stroke.

Background A declining trend in mean cholesterol levels and smoking has been observed in high-income western countries during the last few decades, whereas obesity rates have increased. Simultaneously, mortality from coronary heart disease has decreased. The aim of the present study was to determine whether the trends in cardiovascular risk factors have continued in successive cohorts of middle-aged women over a period of 34 years. Methods Six population-based, cross-sectional samples of women (n = 2294) mean age: 49.8 years (range: 45–54), living in Gothenburg, Sweden, were investigated between 1980 and 2014. Results Body mass index (BMI) increased over time, with a mean BMI of 24.7 kg/m2 in 1980 to 25.7 kg/m2 in 2013–2014, corresponding to a weight gain of 4.5 kg, together with an increase in the proportion of obese individuals (BMI ≥ 30 kg/m2) from 10.4 to 16.6% (p = 0.0012). The proportion of smokers and women with hypertension decreased from 34.5 to 12.8% (p = 0.0006) and from 37.7 to 24.5% (p p p Conclusion The trend towards increasing obesity, more leisure-time physical activity and less smoking remains, while the decrease in serum cholesterol appears to have abated.

Objective: To determine the incidence of physical inactivity and factors prior to stroke and in acute stroke that are associated with physical inactivity 1 year after stroke Design: Prospective longitudinal cohort Patients: A total of 190 consecutively included individuals with acute stroke Methods: A follow-up questionnaire, relating to physical activity level using the Saltin-Grimby Physical Activity Scale, was sent to participants in the Fall Study of Gothenburg 1 year after stroke. Predictors of physical inactivity at baseline were identified using univariable and multivariable logistic regression analyses. Results: Physical inactivity 1 year after stroke was reported by 70 (37%) of the 190 patients who answered the questionnaire and was associated with physical inactivity before the stroke, odds ratio (OR) 4.07 (95% confidence interval (95% CI) 1.69–9.80, p = 0.002); stroke severity (assessed by National Institutes of Health Stroke Scale (NIHSS), score 1–4), OR 2.65 (95% CI) 1.04–6.80, p = 0.042) and fear of falling in acute stroke, OR 2.37 (95% CI 1.01–5.60, p = 0.048). Conclusion: Almost 4 in 10 participants reported physical inactivity 1 year after stroke. Physical inactivity before the stroke, stroke severity and fear of falling in acute stroke are the 3 main factors that predict physical inactivity 1 year after stroke. Lay Abstract After a stroke, there is a risk of becoming physically inactive, which could affect one’s health. In order to create a rehabilitation plan with individualized preventive actions and interventions against physical inactivity, it is important, early after stroke onset, to identify patients who are at risk of becoming physically inactive. Previous studies of the early prediction of physical inactivity are few in number, with small sample sizes. This research on 190 individuals describes which factors prior to and in acute stroke (which is the first week after stroke) are associated with physical inactivity 1 year after stroke. The results showed that physical inactivity before stroke, stroke severity, and a fear of falling in acute stroke are associated with physical inactivity 1 year after stroke.

To identify whether, and to what extent, treatment with cardiovascular drugs and neurotropic drugs are associated with postural control and falls in patients with acute stroke.Observational cohort study.A stroke unit at a university hospital.A consecutive sample of patients (N=504) with acute stroke.Not applicable.Postural control was assessed using the modified version of the Postural Assessment Scale for Stroke Patients. Data including baseline characteristics, all drug treatments, and falls were derived from medical records. Univariable and multivariable logistic regression and Cox proportional hazards models were used to analyze the association of drug treatment and baseline characteristics with postural control and with falls.In the multivariable logistic regression analysis, factors significantly associated with impaired postural control were treatment with neurotropic drugs (eg, opioids, sedatives, hypnotics, antidepressants) with an odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.01-2.97, P=.046); treatment with opioids (OR 9.23, 95% CI, 1.58-54.00, P=0.014); age (OR 1.09, 95% CI, 1.07-1.12, P.0001), stroke severity, which had a high National Institutes of Health Stroke Scale-score (OR 1.29, 95% CI, 1.15-1.45, P.0001), and sedentary life style (OR 4.32, 95% CI, 1.32-14.17, P=.016). No association was found between neurotropic drugs or cardiovascular drugs and falls.Treatment with neurotropic drugs, particularly opioids, in the acute phase after stroke, is associated with impaired postural control. Since impaired postural control is the major cause of falls in patients with acute stroke, these results suggest opioids should be used with caution in these patients.

Background: Before implementation of the new scale, the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS), to clinical practice, it is fundamental to analyze i...

Background and Purpose— To further improve preventive strategies against stroke, there is a need for epidemiological long-term studies. The study aimed at a prospective investigation of stroke determinants in the general male population. Methods— During a period of 48 years, from 50 to 98 years of age, a population-based sample of 854 men was followed using repeated medical examinations, lifestyle questionnaires, data from hospital records and the National Cause of Death Register. Results— Determinants of ischemic stroke were atrial fibrillation (hazard ratio [HR], 6.61; 95% CI, 4.47–9.77); mother dead from cardiovascular disease (HR, 1.53; 1.09–2.17); high education (HR, 0.81; 0.69–0.96); and high physical activity level during leisure time (HR, 0.68; 0.50–0.93). For hemorrhagic stroke heart rate (HR, 1.04; 1.01–1.06) and mother dead from stroke (HR, 3.56; 1.43–8.87) constituted an increased risk. Statistically significant determinants for all stroke were atrial fibrillation (HR, 5.34; 3.68–7.75); high diastolic blood pressure (HR, 1.02; 1.01–1.03); high body weight (HR, 0.96; 0.94–0.99); high educational level (HR, 0.79; 0.68–0.92); wide waist circumference (HR, 1.04; 1.01–1.07); smoking (HR, 1.25; 1.06–1.48); mother dead from cerebrovascular disease (HR, 1.43; 1.05–1.94); and diabetes mellitus (HR, 1.65; 1.02–2.68). Of all men diagnosed with atrial fibrillation, 88% had a stroke during follow-up. Conclusions— Atrial fibrillation was by far the strongest determinant of stroke during 48 years of follow-up in a male population sample followed until the age of 98 years. The results warrant improved prophylaxis through intense treatment of modifiable determinants.

Objective To determine the frequency of, and factors associated with, physical inactivity 6 months post-stroke. Design Prospective longitudinal cohort. Patients A total of 215 consecutively included individuals with mild acute stroke from the Fall Study of Gothenburg. Methods Physical activity level was assessed using the 4-level Saltin-Grimby Physical Activity Scale. Associations between independent variables and the dependent variable physical inactivity 6 months post-stroke were identified using univariable and multivariable logistic regression analyses. Results At 6 months post-stroke, 81 individuals (37.7%) reported physical inactivity. Physical inactivity at 6 months after a mild stroke were associated with: stroke severity, odds ratio (OR) 1.29 (95% confidence interval (95% CI) 1.01-1.66, p = 0.043); physical inactivity prior to stroke, OR 2.89 (95% CI 1.39-6.04, p = 0.0046); moderate postural control, OR 6.71 (95% CI 2.48-18.16, p = 0.0002); poor postural control, OR 2.55 (95% CI 1.19-5.48, p = 0.016); and number of drugs in acute stroke, OR 1.20 (95% CI 1.06-1.35, p = 0.0046). Conclusion In this exploratory study, almost 40% of subjects reported physical inactivity 6 months after an acute mild stroke. Predictors of physical inactivity were physical inactivity before stroke and greater stroke severity, impaired postural control and a higher number of drugs in acute stroke.

To identify the occurrence of recurrent falls and the determinants in the acute phase poststroke that are associated with recurrent falls within the first year poststroke.Prospective follow-up study.Stroke unit and community.Patients (N=504) with acute stroke.Not applicable.The dependent variable was recurrent falls, defined as ≥2 falls, within the first year poststroke. The independent baseline variables were related to function, activity, participation, personal and environmental factors, and comorbidity and were assessed within 4 days after admission to a stroke unit. Fall data were registered at the stroke unit, and self-reported fall data were collected during follow-up using a standardized questionnaire. Determinants of recurrent falls were identified using univariable and multivariable logistic regression analyses.Within 12 months poststroke, 95 of 348 participants (27%) had experienced recurrent falls. Poor postural control (odds ratio [OR] 5.85; 95% confidence interval [CI], 2.84-12.02; P.0001), moderate postural control (OR 2.41; 95% CI, 1.21-4.80; P=.012), and using a walking aid in the acute phase (OR 2.51; 95% CI, 1.45-4.36; P=.0010) are statistically significant determinants that are associated with recurrent falls within the first year poststroke. The determinant of using a walking aid appears to be primarily driven by those younger than 80 years. In addition to impaired postural control and using a walking aid, a fall at the stroke unit is a determinant associated with recurrent falls after discharge within 6 months poststroke.More than 1 in 4 individuals with stroke experienced recurrent falls within the first year poststroke. Impaired postural control, using a walking aid in the acute phase, and fall during hospitalization are determinants associated with recurrent falls during follow-up. The determinants differ somewhat at different ages.

Objectives Most previous studies of incidence rates of stroke are from register studies, while data from prospective cohort studies are limited. The aim of the present study was to describe hazard rates, prevalence and cumulative proportion free from stroke during a lifelong follow-up of a representative sample of middle-aged men sampled from the general population. Methods A population-based sample of 855 men, all born in 1913, was investigated at 50 years of age and followed up with repeated medical examinations at age 54, 60, 67, 75 and 80. Data from hospital records and the Cause of Death Register were collected, and all stroke events during 48 years of follow-up were registered. Medical records were scrutinized in order to confirm and validate the stroke diagnoses. Results One man was excluded because of stroke prior to baseline, while 176 of the remaining 854 men (20.7%) suffered a first-ever stroke during follow-up. The total 5-year stroke risk (hazard rate) increased with age, from 3.54 (95% CI: 0-7.55) per 1000 persons at risk at age 50 years, to 119.05 (95% CI: 45.39-192.70) at age 90 years. The stroke prevalence peaked at age 80 and older, with about 120 cases per 1000 years of observation. The survival rate (cumulative proportion free from stroke) at age 98 was 50.0%. Conclusion One out of five men in this population sample suffered a stroke of any type during follow-up from 50 to 98 years of age and the cumulative incidence was close to 50%.

Background Declining response rates in population surveys may decrease the representativeness and introduce bias in survey results. This study investigated sociodemographic differences in response rates and methods in a population survey in Sweden. Methods The study is based on a large population survey conducted in five counties in Mid-Sweden in 2017. Three age-specific questionnaires for persons 18-29, 30-69 and 70 years or older were designed to study living conditions, life style factors and health. The sample was random and stratified by gender, age group and municipality, and comprised 78 000 persons 18 years or older. Up to two reminders were sent, the last reminder consisted of a short version of the questionnaire. The survey could be answered using a written questionnaire or on-line. The web-questionnaire was available in Swedish and English. Results The overall response rate was 44% with the lowest participation rate in ages 18-29 years (26%) and highest in ages 70-84 years (70%). Women, persons with high educational level, and persons born in Sweden were more prone to respond than others. Those aged 18-29 years were overrepresented in the sample and the participation rate would have been 46% if the sample had been unstratified by age. The majority of the respondents answered the written questionnaire, even though it was more common that younger people responded via the web compared to older people. In total, 8% of the respondents replied to the short form and this was most common (17%) among those born outside the Nordic countries. Conclusions In line with previous research, the results indicate large sociodemographic differences in response rates. The response methods also vary between sociodemographic groups, and knowledge about these differences may be helpful when designing future population surveys. Key messages The response rate was higher among older people, women, persons with high educational level, and persons born in Sweden than among other groups. Persons born outside the Nordic countries were most prone to respond to the short form and younger people replied more often to the web-questionnaire than older people.

Introduction: It is important to early after stroke identify those individuals at risk of falling and the key determinants of falling after discharge from the hospital, as that knowledge may offer possibilities for early preventive actions. The aim was to investigate the occurrence of at least two falls within the first year after stroke onset after discharge from a stroke unit, and to identify factors in the acute phase after stroke that predict these recurrent falls. Subjects: A total of 490 consecutive individuals with acute stroke, median aged 77 (IQR 67-84) years, of whom 248 (50.6%) were men. Methods: The dependent variable was recurrent falls within the first year after stroke onset after discharge from a stroke unit. Fall data was collected at six and 12 months after stroke onset using a standardized questionnaire. The independent baseline variables were related to function, activity, participation, environmental factors and personal factors and assessed within four days after admission to the stroke unit. The association between baseline variables and recurrent falls was examined using univariable and multivariable logistic regression analyses. Results: Within six and 12 months after stroke onset, 67 of 376 respondents (18%) and 80 of 348 respondents (23%), respectively, had experienced recurrent falls after discharge. Poor postural control, assessed using the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS), (SwePASS score ≤ 24) [odds ratio (OR) 4.23, 95% confidence interval (CI) 1.99-9.03, p=0.0002]; moderate postural control (SwePASS score 25-30) [OR 2.75, 95% CI 1.34-5.64, p=0.0057] and use of a walking aid [OR 2.05, 95% CI 1.16-3.60, p=0.013] were independent early predictors of recurrent falls after discharge within the first 12 months after stroke onset. In addition to these determinants, also fall in hospital [OR 2.48, 95% CI 1.16-5.31, p=0.019] was a predictor of recurrent falls during the first six months. Conclusion: Recurrent falls after discharge from a stroke unit within the first year after stroke onset were experienced by nearly one-quarter of the individuals and predicted by poor and moderate postural control and the use of a walking aid during the acute phase after a stroke.

Objective: To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12 months after stroke onset, following discharge from inpatient rehabilitation. Design: Prospective follow-up study. Setting: Stroke unit and outpatient department. Subjects: A total of 490 individuals with acute stroke. Methods: Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at three months after discharge and six and 12 months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12 months were investigated using univariable and multivariable regression analyses. Main measures: The endpoint was a self-reported fall. Results: Within three months after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12 months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07–7.45, P Conclusion: Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12 months after stroke onset.

Background and Purpose- To further improve preventive strategies against stroke, there is a need for epidemiological long-term studies. The study aimed at a prospective investigation of stroke determinants in the general male population. Methods- During a period of 48 years, from 50 to 98 years of age, a population-based sample of 854 men was followed using repeated medical examinations, lifestyle questionnaires, data from hospital records and the National Cause of Death Register. Results- Determinants of ischemic stroke were atrial fibrillation (hazard ratio [HR], 6.61; 95% CI, 4.47-9.77); mother dead from cardiovascular disease (HR, 1.53; 1.09-2.17); high education (HR, 0.81; 0.69-0.96); and high physical activity level during leisure time (HR, 0.68; 0.50-0.93). For hemorrhagic stroke heart rate (HR, 1.04; 1.01-1.06) and mother dead from stroke (HR, 3.56; 1.43-8.87) constituted an increased risk. Statistically significant determinants for all stroke were atrial fibrillation (HR, 5.34; 3.68-7.75); high diastolic blood pressure (HR, 1.02; 1.01-1.03); high body weight (HR, 0.96; 0.94-0.99); high educational level (HR, 0.79; 0.68-0.92); wide waist circumference (HR, 1.04; 1.01-1.07); smoking (HR, 1.25; 1.06-1.48); mother dead from cerebrovascular disease (HR, 1.43; 1.05-1.94); and diabetes mellitus (HR, 1.65; 1.02-2.68). Of all men diagnosed with atrial fibrillation, 88% had a stroke during follow-up. Conclusions- Atrial fibrillation was by far the strongest determinant of stroke during 48 years of follow-up in a male population sample followed until the age of 98 years. The results warrant improved prophylaxis through intense treatment of modifiable determinants.

INTRODUCTION Blood pressure development after acute stroke is inadequately studied. The objectives of this study were to describe SBP development among patients in the acute phase after stroke, and to investigate whether intensified antihypertensive treatment during this phase was associated with short-term prognosis regarding the risk of falling. PATIENTS AND METHODS This observational study is a sub-study of the Fall Study of Gothenburg and included 421 consecutive patients admitted to a stroke unit. Medical records were studied for blood pressure measurements, antihypertensive treatment and falls. Random coefficient models for repeated measures data was used to study change in SBP. Univariable Cox proportional hazards model was used for estimation of predictors' effect on time to first fall within first 10 days. RESULTS During the first two days after stroke onset, mean SBP for all stroke patients decreased by 14.9 mmHg (95% CI 12.3-17.4, P

Objective There is an evidence-practice gap in assessment of the upper extremities during acute and subacute stroke rehabilitation. The aim of this study was to target this gap by describing and evaluating the implementation of, and adherence to, an evidence--based clinical practice guideline for occupational therapists and physiotherapists. Methods The upper extremity assessment implementation process at Sahlgrenska University Hospital comprised 5 stages: mapping clinical practice, identifying evidence-based outcome measures, development of a guideline, implementation, and evaluation. A systematic theoretical framework was used to guide and facilitate the implementation process. A survey, answered by 44 clinicians (23 physiotherapists and 21 occupational therapists), was used for evaluation. Results The guideline includes 6 primary standard-ized assessments (Shoulder Abduction, Finger Extension (SAFE), 2 items of the Actions Research Arm Test (ARAT-2), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Box and Block Test (BBT), 9-Hole Peg Test (9HPT), and grip strength (Jamar hand dynamometer)) per-formed at specified time-points post-stroke. More than 80% (35 to 42) clinicians reported reported being content with the guideline and the implementation process. Approximately 60-90% of the clinicians reported good adherence to specific assessments, and approximately 50% report-ed good adherence to the agreed time-points. Comprehensive scales were more difficult to implement compared with the shorter screening scales. High levels of work rotation among staff, and the need to prioritize other assessments during the first week after stroke, hindered to implementation. Conclusion The robustness of evidence, adequate support and receptive context facilitated the implementation process. The guideline enables a more structured, knowledge-based and consistent assessment, and thereby supports clinical decision-making and patient involvement.

Background There is limited research concerning the physical activity levels over time of people who have survived stroke. Objective The study objectives were: (1) to describe self-reported physical activity levels at 3, 6, and 12 months after stroke onset and (2) to analyze whether there was an association between self-reported physical activity level and postural control. Design This was an observational and longitudinal study. Methods Ninety-six participants with a first-ever stroke were assessed for self-reported physical activity levels with the Physical Activity Scale for the Elderly (PASE) in the first year after stroke. Postural control also was assessed with the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS). Results The raw median PASE scores at 3, 6, and 12 months after stroke were 59.5, 77.5, and 63.5, respectively. The model-estimated relative changes in mean PASE scores (as percentages) followed the same pattern, independent of age, sex, and SwePASS scores. Between 3 and 6 months after stroke, PASE scores increased by 32%, with no significant change between 3 and 12 months and between 6 and 12 months after stroke. For each unit increase in the SwePASS score at baseline, there was a 13% increase in the PASE score during follow-up. Limitations The sample size was limited. Although the PASE is based on the metabolic equivalent of the task, the actual physiological intensity of a person's performance of the activities is unknown. Conclusions Self-reported physical activity levels were low in the first year after stroke. Good postural control in the first week after stroke onset was positively correlated with higher levels of self-reported physical activity in the first year after stroke.

Objective Little is known about which factors are associated with a patient's fear of falling (FoF) after acute stroke. The aim of this study was to investigate baseline variables and their association with FoF during rehabilitation in acute stroke. Patients and methods The study population consisted of the 462 patients with acute stroke who were admitted to a stroke unit, included in the observational study "The Fall Study in Gothenburg (FallsGOT)" and were able to answer a single question: "Are you afraid of falling?" (Yes/No). To analyze any association between FoF and clinical variables, univariable and multivariable stepwise multiple logistic regression analyses were performed. Results In the stepwise multivariable regression analysis, only female sex (OR = 2.25 [95% confidence interval (CI) 1.46-3.46, p = 0.0002]), the use of a walking aid (OR 3.40, [95% CI 2.12-5.43, p 0.0001]), and postural control as assessed with the SwePASS total score were statistically significant associated with FoF. Among patients with a SwePASS score of 24 or less, the OR was 9.41 [95% CI 5.13-17.25, p 0.0001] for FoF compared to patients with a SwePASS score of 31 or above; among the patients with a SwePASS score of 25-30, the OR was 2.29 [95% CI = 1.36-3.83, p = 0.0017]. Conclusions Our findings provide valuable insight for those involved in stroke rehabilitation during the acute phase after stroke. FoF is associated with poor postural control, female sex and the use of a walking aid.

This study aimed to investigate incidence of falls and different baseline variables and their association with falling during hospitalization in a stroke unit among patients with acute stroke.Prospective observational study.A stroke unit at a university hospital.A consecutive sample of stroke patients, out of which 504 were included, while 101 declined participation.The patients were assessed a mean of 1.7 days after admission and 3.8 days after stroke onset.The primary end-point was any fall, from admission to the stroke unit to discharge. Factors associated with falling were analysed using univariable and multivariable Cox hazard regression analyses. Independent variables were related to function, activity and participation, as well as personal and environmental factors.In total, 65 patients (13%) fell at least once. Factors statistically significantly associated with falling in the multivariable analysis were male sex (hazard ratio (HR): 1.88, 95% confidence interval (CI): 1.13-3.14, P = 0.015), use of a walking aid (HR: 2.11, 95% CI: 1.24-3.60, P = 0.006) and postural control as assessed with the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS). No association was found with age, cognition or stroke severity, the HR for low SwePASS scores (⩽24) was 9.33 (95% CI: 2.19-39.78, P = 0.003) and for medium SwePASS scores (25-30) was 6.34 (95% CI: 1.46-27.51, P = 0.014), compared with high SwePASS scores (⩾31).Postural control, male sex and use of a walking aid are associated with falling during hospitalization after acute stroke.

Background A previous small-sample (N.=150) Rasch analysis of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) suggested problems regarding response categories and redundant items that need confirmation in larger samples with more severe strokes. Aim The aim of this study was to evaluate the measurement properties of the SwePASS in patients with acute stroke. Design A multicenter, cross-sectional study. Setting Two stroke units in Western Sweden. Population The study cohort included 250 consecutive inpatients undergoing rehabilitation after acute stroke. Methods The SwePASS assessments were performed once within the first four days after admission to the stroke units. The data were analyzed according to the Rasch measurement model regarding targeting, model fit, reliability, response category function, local dependence and differential item functioning. Results Postural control of 250 patients (median age, 76.5 years) was assessed with the SwePASS within median of two days after admission to the stroke units. The SwePASS covered a continuum of different levels of postural control, but had suboptimal targeting with insufficient representation of lower and higher levels of postural control. The reliability was high, the item fit statistics were generally acceptable and there was no differential item functioning by sex, age and stroke localization. However, response categories did not function as expected for four of the 12 SwePASS items and five items exhibited local dependency. Conclusions The SwePASS exhibited several promising measurement properties. To improve the scale, poor targeting, illogical response categories and local dependency should be addressed. Clinical rehabilitation impact The SwePASS provides valuable clinical information regarding postural control in the acute phase after stroke.

Low aerobic capacity has been associated with increased mortality in short-term studies. The aim of this study was to evaluate the predictive power of aerobic capacity for mortality in middle-aged men during 45-years of follow-up.The study design was a population-based prospective cohort study.A representative sample from Gothenburg of men born in 1913 was followed from 50-99 years of age, with periodic medical examinations and data from the National Hospital Discharge and Cause of Death registers. At 54 years of age, 792 men performed an ergometer exercise test, with 656 (83%) performing the maximum exercise test.In Cox regression analysis, low predicted peak oxygen uptake ([Formula: see text]), smoking, high serum cholesterol and high mean arterial blood pressure at rest were significantly associated with mortality. In multivariable analysis, an association was found between predicted [Formula: see text] tertiles and mortality, independent of established risk factors. Hazard ratios were 0.79 (95% confidence interval (CI) 0.71-0.89; p 0.0001) for predicted [Formula: see text], 1.01 (1.002-1.02; p 0.01) for mean arterial blood pressure, 1.13 (1.04-1.22; p 0.005) for cholesterol, and 1.58 (1.34-1.85; p 0.0001) for smoking. The variable impact (Wald's χ(2)) of predicted [Formula: see text] tertiles (15.3) on mortality was secondary only to smoking (31.4). The risk associated with low predicted [Formula: see text] was evident throughout four decades of follow-up.In this representative population sample of middle-aged men, low aerobic capacity was associated with increased mortality rates, independent of traditional risk factors, including smoking, blood pressure and serum cholesterol, during more than 40 years of follow-up.

Background: The non-response rates in surveys are increasing which is problematic as it means that a progressively smaller proportion of the population represents the majority, and it is uncertain how health survey results are affected. This follow-up was performed on the non-responders to the postal questionnaire in the public health survey Life and Health, conducted in Orebro County Council, Sweden, where large differences in response rates had been found between different socio-demographic groups and geographical areas. The main objective was to analyse non-response bias regarding self-rated health. Methods: This follow-up study was conducted as a census to all non-responders in the area that had the lowest response rate and, in one other geographical area used as a control. It was carried out by telephone interviews, 49.3% (580 individuals) answered the follow-up. The outcome variable was self-rated health, a main variable in public health surveys. Differences in response patterns between responders and initial non-responders were approximated by prevalences with confidence intervals and adjusted odds ratios. Results: Poor health was more common in the initial non-response group than among the responders, even with consideration given to sex, age, country of birth and education. However, good health was equally common among responders and initial non-responders. Conclusions: Public health surveys can be biased due to certain groups being under-represented or not represented at all. For this reason, in repeated public health surveys, we recommend selective follow-ups of such groups at regular intervals.

Introduction/Background Only a few studies have investigated the occurrence and the determinants of falls after stroke based on variables assessed during the acute phase. In the effort to prevent falls after stroke, however, it is valuable to already during hospitalisation be able to predict the risk of falling after discharge. This study aimed to investigate the incidence and the determinants of self-reported falls the first year after discharge from a stroke unit after acute stroke. Material and method In this prospective, longitudinal and observational sub study, a one-year follow-up of the recently published FallsGOT, the primary endpoint was any fall during the first year after discharge from a stroke unit. Within four days after admission to a stroke unit, assessments of baseline variables were performed. At twelve months after discharge, data collection of self-reported falls was conducted using a standardized questionnaire. Of the consecutive sample of 504 patients with acute stroke, 435 individuals were eligible for follow-up at twelve months, of which 348 (80%) answered the questionnaire. Results Of the respondents, 140 (40%) experienced at least one fall during the first year after discharge from the stroke unit. In the multivariable analysis, impaired postural control as assessed with the Swedish modified version of Postural Assessment Scale for Stroke Patients (SwePASS) OR: 3.90 (95% CI: 2.06–7.41, P Conclusion Postural control and use of a walking aid acute after stroke in a stroke unit predicted falls during the first year after discharge from a stroke unit.

M. Lindén-Boström & C. Persson & M. Berglund: Risk consumption of alcohol among older people – results from a Swedish population study Aim The aim of this study was to describe risk consumption of alcohol among older people and relate it to living conditions, health behaviour, social support and health. Method We used data from Life & Health 2008, a postal questionnaire to inhabitants aged 18–84 in 55 municipalities in central Sweden. The study population included 40 267 respondents aged 18–84 and 21 326 respondents aged 55–84. The overall response rate was almost 60 per cent, a figure that differed between age groups with the highest rate, >70 per cent, among respondents aged 65–79. The first three questions in the AUDIT questionnaire were used to estimate risk consumption. They were also analysed separately to describe different patterns of alcohol consumption. Results In the 65–75 age group, 2.7 per cent of men and 1.9 per cent of women could be defined as risk consumers of alcohol. In the 76–84 age group, the corresponding figure is less than 1 per cent for both sexes. Risk consumption is related to high education, smoking, use of snuff, physical inactivity, psychological distress and use of tranquilisers. Conclusion Targeted preventive strategies need to be developed to tackle risk consumption among older people.

Background The modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) is a new ordinal outcome measurement designed to assess postural control in patients with stroke. Before implementation of SwePASS into the clinical setting, it is necessary to know its measurement properties. Thus, the aim of the study was to evaluate the measurement properties of the SwePASS. Methods Rasch analysis, based on data of 150 SwePASS assessments was made the first week after stroke onset. The measurement properties referred to were unidimensionality, local independence, invariance, category function, targeting of persons and items and the reliability. Results The initial analysis showed disordered thresholds in four items. After adjustment of the scoring categories, this was resolved. However, analyses of local dependency revealed correlations between two of the items. These two items were collapsed into one. After adjustments, the person separation index that acts as an indicator of the whole model fit was 0.96. The adjusted SwePASS is a global scale that works the same way regardless of gender, age and location of stroke lesion. Overall, the population had better postural control than was targeted with the items in the scale. Conclusions Rasch analysis of the adjusted SwePASS showed that the scale was unidimensional. In SwePASS, equal capacity in postural control provides the same response to an individual item in patients with stroke, regardless of gender, age and location of stroke lesion. Regarding clinical implications, before introducing SwePASS in clinical routine and to confirm the results, further research including a larger sample with poorer postural control is suggested.

Background Poor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990s. There is a need for a better understanding of the area for planning preventive activities and health care. Methods The study is based on a postal survey questionnaire sent to a random sample of men and women aged 18–84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models. Results About 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65–74 years. Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms. Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms. Conclusion Our results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors.

Background A frequently used clinical test to assess mobility after stroke is the Timed Up & Go. Knowledge regarding whether or not the Timed Up & Go is able to detect change over time in patients with stroke, whether improvements in mobility exist after the first three months and whether or not longitudinal change in mobility after stroke depend on the patients’ age, is limited or unclear. The objectives were to investigate the distribution-based responsiveness of the Timed Up & Go (TUG) during the first three months after a first event of stroke, to measure the longitudinal change in TUG time during the first year after stroke and to establish whether recovery in TUG time differs between different age groups. Methods Ninety-one patients with first-ever stroke were assessed using the Timed Up & Go at the 1st week and at 3, 6 and 12 months after stroke. The non-parametric sign-test, the parametric t-test and a mixed model approach to linear regression for repeated measurements (Proc mixed) were used for the statistical analyses. Results The median TUG time was reduced from 17 to 12 seconds (p

Background A modified version of Postural Assessment Scale for Stroke Patients (PASS) was created with some changes in the description of the items and clarifications in the manual (e.g. much help was defined as support from 2 persons). The aim of this validation study was to assess intrarater and interrater reliability using this modified version of PASS, at a stroke unit, for patients in the acute phase after their first event of stroke. Methods In the intrarater reliability study 114 patients and in the interrater reliability study 15 patients were examined twice with the test within one to 24 hours in the first week after stroke. Spearman's rank correlation, Kappa coefficients, Percentage Agreement and the newer rank-invariant methods; Relative Position, Relative Concentration and Relative rank Variance were used for the statistical analysis. Results For the intrarater reliability Spearman's rank correlations were 0.88-0.98 and k were 0.70-0.93 for the individual items. Small, statistically significant, differences were found for two items regarding Relative Position and for one item regarding Relative Concentration. There was no Relative rank Variance for any single item. For the interrater reliability, Spearman's rank correlations were 0.77-0.99 for individual items. For some items there was a possible, even if not proved, reliability problem regarding Relative Position and Relative Concentration. There was no Relative rank Variance for the single items, except for a small Relative rank Variance for one item. Conclusions The high intrarater and interrater reliability shown for the modified Postural Assessment Scale for Stroke Patients, the Swedish version of Postural Assessment Scale for Stroke Patients, with traditional and newer statistical analyses, particularly for assessments performed by the same rater, support the use of the Swedish version of Postural Assessment Scale for Stroke Patients, in the acute stage after stroke both in clinical and research settings. In addition, the Swedish version of Postural Assessment Scale for Stroke Patients was easy to apply and fast to administer in clinic.

Background In previous public health surveys large differences in health have been shown between citizens living in different neighbourhoods in the Örebro municipality, which has about 125000 inhabitants. The aim of this study was to investigate the determinants of health with an emphasis on the importance of neighbourhood characteristics such as the influence of neighbourhood social cohesion and social capital. The point of departure in this study was a conceptual model inspired by the work of Carpiano, where different factors related to the neighbourhood have been used to find associations to individual self-rated health. Methods We used data from the survey 'Life & Health 2004' sent to inhabitants aged 18-84 years in Örebro municipality, Sweden. The respondents (n = 2346) answered a postal questionnaire about living conditions, housing conditions, health risk factors and individual health. The outcome variable was self-rated health. In the analysis we applied logistic regression modelling in various model steps following a conceptual model. Results The results show that poor self-rated health was associated with social capital, such as lack of personal support and no experience of being made proud even after controlling for strong factors related to health, such as age, disability pension, ethnicity and economic stress. Also the neighbourhood factors, housing area and residential stability were associated with self-rated health. Poor self-rated health was more common among people living in areas with predominately large blocks of flats or areas outside the city centre. Moreover, people who had lived in the same area 1-5 years reported poor health more frequently than those who had lived there longer. Conclusions The importance of the neighbourhood and social capital for individual health is confirmed in this study. The neighbourhoods could be emphasized as settings for health promotion. They can be constructed to promote social interaction which in turn supports the development of social networks, social support and social capital - all important determinants of health.