[Quality assurance of secondary prevention of coronary artery disease. Ongoing project offers possibilities for improved treatment]. / Kvalitetssäkring av sekundärprevention vid kranskärlssjukdom. Pågående projekt skapar möjligheter till förbättrad behandling.

Regional programs for secondary prevention of coronary artery disease have been under development for nearly a decade in Sweden. To achieve maximum adherence these programs were created in close collaboration between hospital and primary care physicians. The programs are local applications of national guidelines and aim to support compliance among both patients and physicians. In January 1998 the Swedish Society of Cardiology and the Swedish Association of General Practice launched a program for quality control and quality assurance of these initiatives. So far, 51 of 79 districts have joined the program. Patients' diaries used for risk factor registration contain 7 report cards on the management of risk factors and medication. These cards are sent to a central registry upon release from the hospital, after 3-6 months, and annually for 5 years. Results from the first year point to differences between the various districts with respect to compliance with both local programs and European guidelines. Overall, results are promising and indicate that this program is successful and leads to improved management of patients with coronary artery disease.

Evaluation of "Live for Life", a health promotion programme in the County of Skaraborg, Sweden.

STUDY OBJECTIVE: To evaluate a health promotion programme, combining a population and individual based strategy, in the County of Skaraborg, Sweden, with special attention to outcome. DESIGN: The evaluation was subdivided into structure, process and outcome. The evaluation procedure as a total is described here, but the results presented refer only to outcome. In order to study the potential effect of the individually based health examination, 35 year old subjects who had participated five years previously were in 1994-1996 compared with 35 year old subjects who had not participated before, and compared with their own values five years earlier. The results during 1995-1996 were compared with those of 1989-1990 for corresponding ages in order to study the effect of, particularly, the population based strategy. SETTING: The County of Skaraborg in the south western part of Sweden with about 270 000 inhabitants. In addition to population strategy, involving the total county, men and women aged 30 and 35 years were invited to an individually based examination. MAIN RESULTS: Factors related to body weight increased during the study period, while other factors mostly changed in the direction wanted. As a whole the changes were rather modest. There were favourable changes in lifestyle variables, for example, concerning smoking and dietary habits. CONCLUSIONS: There were beneficial effects from the health promotion programme, but there is a need for continuous improvement of methods of intervention referred to lifestyle.

Quality improvement in primary health care using computerised journal, exemplified by a smoking cessation programme for diabetic patients.

OBJECTIVE: To study the possibility of using the computerised journal for quality improvement in diabetes care. DESIGN: The computerised journal was used to reach all diabetic smokers aged 30-75 years and to invite them to a structured smoking cessation programme. The follow-up time was 18 months. SETTING: Habo, a Swedish community with 9600 inhabitants, with one primary health care centre. SUBJECTS: 147 subjects, aged 30-75 years, were registered with the diagnosis of diabetes mellitus in the computerised journal at the primary health care centre. Altogetber 25 of these patients were registered as smokers in the journal. All of them were invited to a smoking cessation group. RESULTS: Information about smoking habits in the journal was available for all but 11%. After 18 months' follow-up, 9 of the 14 patients (64%) who started in the smoking cessation group had become non-smokers. Of those 11 subjects who did not attend the group, 6 had stopped smoking during the follow-up time in spite of not participating in the structured programme. CONCLUSION: The computerised journal is a useful tool for quality improvement, giving the opportunity for directed preventive efforts on selected patient groups.

Cardiovascular risk during early adult life. Risk markers among participants in "Live for Life" health promotion programme in Sweden.

STUDY OBJECTIVE: To study differences in cardiovascular lifestyle risk factors and biological risk markers in early adult life, with special attention to age and sex differences. Lifestyle cardiovascular risk factors included dietary habits, physical inactivity, smoking, alcohol habits, psychosocial strain, and mental stress. Biological risk markers included anthropometric variables, arterial blood pressure, and serum cholesterol concentration. DESIGN: A combined individual and community based preventive programme, including health examinations. SETTING: All communities in the County of Skaraborg in south western Sweden. PARTICIPANTS: Altogether 12,982 men and women aged 30 or 35 years who underwent health examinations over seven years. MAIN RESULTS: In both sexes, biological risk markers studied were worse in 35 year old subjects than in 30 year olds. Furthermore, a larger proportion of men aged 35 years were smokers and were physically inactive compared with 30 year old men. However, dietary habits were better in both sexes in the upper age group. At both ages there were also significant differences between men and women. Women, compared with men, had better dietary habits and lower alcohol consumption but smoked more and experienced greater mental stress and psychosocial strain. All biological risk markers were worse in men than in women at both ages studied. During the observation period, some improvement of the health profile of the participants was observed, indicating a beneficial effect of the intervention programme. CONCLUSIONS: The results indicate that the risk of cardiovascular disease, as assessed from studying lifestyle and biological risk markers, increases early in life, suggesting that preventive measures should start early.

Results from an intervention programme dealing with cardiovascular risk factors. Experiences from a study of men aged 33-42 in Habo, Sweden.

OBJECTIVE: To evaluate the long-term effect of a health examination and intervention programme in a Swedish community. DESIGN: A health examination was carried out with the purpose of improving cardiovascular risk factors. A health profile was created as an educational tool, by means of which a nurse discussed the results of the health examination with the participants. Follow-up studies were carried out after 1 year and after 3-6 years. PARTICIPANTS: All men aged 33-42 living in a Swedish community (Habo) were invited to the health examination. Altogether 652 participated, corresponding to a participation rate of 86.1%. MAIN RESULTS: In the 1-year follow-up study, improvement with respect to cardiovascular risk factors was seen in a high-risk group (n = 161) for systolic blood pressure and lifestyle factors such as alcohol consumption, smoking, mental stress, mental health, and for the sum of risk points according to the health profile. Corresponding improvement was not seen in other men of similar age in the same community who had not participated in the health survey. In the 3-6 year follow-up only minor improvements remained, mainly for blood pressure and sum of risk points. CONCLUSION: Even if the results are rather promising in the short run, it seems urgent to make the methods for improving cardiovascular risk factors better, especially with regard to long-term results.

Interrelation between risk factors for cardiovascular disease in men aged 33-42. A study from Habo in Skaraborg County, Sweden.

OBJECTIVES: The main purpose was to study associations between different risk factors for coronary heart disease in order to find out whether such associations already exist during the fourth decade of life. SETTING: A study carried out by the primary healthcare staff in the community of Habo in Skaraborg County in south-western Sweden. SUBJECTS: All men living in Habo aged 33-42 years who were willing to participate in the study--in total 652 men (participation rate 86%). MAIN OUTCOME MEASURES: Risk factors for coronary heart disease considered as markers of lifestyle: body-mass index as a measure of general obesity, waist-to-hip circumference ratio as a measure of central obesity, arterial blood pressure, serum cholesterol concentration and serum triglyceride concentration. RESULTS: There were statistically significant correlations between all the factors analysed including anthropometric data, blood pressure and serum lipids. CONCLUSIONS: The results indicate associations between different risk factors at an early age and emphasises the need for a multifactorial view on risk as early as at the ages which were the focus of this study.

A study of men aged 33-42 in Habo, Sweden with special reference to cardiovascular risk factors. Design, health profile and characteristics of participants and non-participants.

An intervention study of men living in the Community of Habo in southwestern Sweden has been carried out. All men aged 33-42 and living in the community were invited. Altogether 652 men participated. The study included a questionnaire, an interview made by a nurse, anthropometric measurements, blood pressure measurements, measurements of respiratory function and work performance capacity, and blood sampling for chemical analyses. The participation rate was high, 86.1%, after one mail invitation even considering the fact that two reminders were sent. Most of the non-participants had recently been in contact with the health care organisation, either because they were high-consumers of health care, or because they had attended a health examination at work. A health profile was worked out comprising 11 different potential risk factors for coronary heart disease. This health profile turned out to be a useful educational tool when discussing the results of the examination with the participants. Risk points were given according to certain predetermined criteria. The distribution of risk factors was similar in the different ages studied. Most of the participants had at least one risk factor as defined, but many of them had two or more risk factors.

Endoscopic findings in patients with ulcer-like dyspepsia.

One hundred and sixty-seven patients in a single general practice who presented with ulcer-like dyspepsia were offered an upper gastrointestinal fibre endoscopy. Twenty-two patients had a peptic ulcer while only three had a gastric ulcer. One patient had a carcinoma of the cardia, one an adenocarcinoma in the body of the stomach and one a carcinoma at the ampulla of Vater. In another 55 patients the main findings at endoscopy were edema/reddening or erosions in the antral or duodenal mucosa. Endoscopic findings were normal in 46 patients. Malignancies were found only in patients over 50 years of age and only 4 ulcers were seen in patients under 40. The clinical findings of presence of night pain, pain relief after food intake and history of peptic ulcer were more common in patients with an existing peptic ulcer than in those with a normal endoscopy.