Patients' thoughts about assessment of fracture risk in a dental setting using FRAX-a qualitative interview study.

FRAX is a tool based on questions that identifies persons at risk of fragility fractures. We interviewed patients about their thoughts on doing FRAX in a dental setting. They were generally positive but had some concerns that need to be considered before introducing FRAX in a dental setting. PURPOSE: To investigate patients' thoughts about assessing the risk of fragility fractures using the FRAX tool in a dental setting. Sweden has a high incidence of fragility fractures, but many of these are preventable. The most common method for identifying persons with a high risk of sustaining fragility fractures is FRAX, a validated instrument for assessing the risk of suffering fragility fractures within 10 years. In the Nordic countries, most of the adult population has regular contact with their dentist, which could be useful in identifying high-risk individuals. METHODS: A qualitative inductive approach to content analysis, with individual semi-structured interviews, was used. Seven women and three men, aged 65-75 years, were interviewed and assessed with FRAX. RESULTS: An overarching theme was that patients considered a FRAX assessment in the dental setting a good service but doubted that the dentists would have the interest, time, and knowledge to do it. The patients had little knowledge and experience of osteoporosis and fragility fractures. They were positive towards assessing the fracture risk with the FRAX instrument. If they were found to have a high fracture risk, they expected the dentist to send a referral for further investigation and to collaborate in the risk assessment with their family physician. They thought risk assessment in a dental context would be a good service if the fee was the same as that in primary care. CONCLUSION: Most participants were positive about having FRAX and other health assessments done in the dental clinic, but this study shows that patients have concerns that need to be addressed before introducing FRAX in this context.

Long term association of hip fractures by questions of physical health in a cohort of men and women.

We do not know if fracture predicting factors are constant throughout life, if they can be assessed earlier in life, and for how long. The aim was to study the association between questions about health status and mobility and fragility fractures in a cohort during a 35-year follow-up. A cohort of 16,536 men and women in two age groups, 26-45 and 46-65 years old, who answered five questions of their physical health status in postal surveys in 1969-1970. We obtained data on hip fractures from 1970 to the end of 2016. We found most significant results when restricting the follow-up to age 60-85 years, 35 for the younger age group and 20 years for the older. Men of both age groups considered "at risk" according to their answers had a 2.69 (CI 1.85-3.90)- 3.30 (CI 1.51-7.23) increased risk of having a hip fracture during a follow-up. Women in the younger age group had a 2.69 (CI 1.85-3.90) increased risk, but there was no elevated risk for women in the older age group. This study shows that questions/index of physical health status may be associated with hip fractures that occur many years later in life, and that there is a time span when the predictive value of the questions can be used, before other, age-related, factors dominate. Our interpretation of the results is that we are studying the most vulnerable, who have hip fractures relatively early in life, and that hip fractures are so common among older women that the questions in the survey lose their predictive value.

Two methods of evaluating mandibular trabecular pattern in intraoral radiographs and the association to fragility fractures during a 47-year follow up.

In this longitudinal cohort study, we explored the association of fragility fractures to sparse trabecular bone pattern in intraoral radiographs using two methods, a visual and a semi-automated. Our aim was to study both sexes and to include younger age-groups, during a follow-up time of 47 years. The cohort consisted of 837 men and women aged 18-65 years, with intraoral radiographs from 1970-1971. The trabecular pattern was assessed in the mandibular premolar region with a visual and a semi-automated method. Data on fragility fractures were acquired from the Swedish National Patient Register for 47 years of follow-up time. Sparse trabecular pattern was found in 2.2% of the cohort using the visual method, and 18% were deemed at 'risk of osteoporosis' using the semi-automated method. A total of 132 individuals suffered at least one fragility fracture during the follow-up period. We found no significant association between fractures and sparse trabecular pattern using either method. This study shows that visual assessment, as a predictor of future fractures, may not be a suitable method for individuals of all ages and sexes. As for the semi-automated method, there is still very limited evidence for its fracture predictive ability.

Validity of daily self-pulse palpation for atrial fibrillation screening in patients 65 years and older: A cross-sectional study.

BACKGROUND: The European Society of Cardiology guidelines recommend (Class IA) single-time-point screening for atrial fibrillation (AF) using pulse palpation. The role of pulse palpation for AF detection has not been validated against electrocardiogram (ECG) recordings. We aimed to study the validity of AF screening using self-pulse palpation compared with an ECG recording conducted at the same time using a handheld ECG 3 times a day for 2 weeks. METHODS AND FINDINGS: In this cross-sectional screening study, patients 65 years of age and older attending 4 primary care centers (PCCs) outside Stockholm County were invited to take part in AF screening from July 2017 to December 2018. Patients were included irrespective of their reason for visiting the PCC. Handheld intermittent ECGs 3 times per day were offered to patients without AF for a period of 2 weeks, and patients were instructed in how to take their own pulse at the same time. A total of 1,010 patients (mean age 73 years, 61% female, with an average CHA2DS2-VASc score 2.9) participated in the study, and 27 (2.7%, 95% CI 1.8%-3.9%) new cases of AF were detected. Anticoagulants (ACs) could be initiated in 26 (96%, 95% CI 81%-100%) of these cases. A total of 53,782 simultaneous ECG recordings and pulse measurements were registered. AF was verified in 311 ECG recordings, of which the pulse was palpated as irregular in 77 recordings (25%, 95% CI 20%-30% sensitivity per measurement occasion). Of the 27 AF cases, 15 cases felt an irregular pulse on at least one occasion (56%, 95% CI 35%-75% sensitivity per individual). 187 individuals without AF felt an irregular pulse on at least one occasion. The specificity per measurement occasion and per individual was (98%, 95% CI 98%-98%) and (81%, 95% CI 78%-83%), respectively. CONCLUSIONS: AF screening using self-pulse palpation 3 times daily for 2 weeks has lower sensitivity compared with simultaneous intermittent ECG. Thus, it may be better to screen for AF using intermittent ECG without stepwise screening using pulse palpation. A limitation of this model could be the reduced availability of handheld ECG recorders in primary care centers.

Assessment of N-terminal pro-B-type natriuretic peptide level in screening for atrial fibrillation in primary health care.

BACKGROUND: Atrial fibrillation (AF), an important cause of thromboembolic events, is often silent and intermittent, thus presenting a diagnostic challenge. The aim of this study was to assess whether the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to the presence of AF and thereby might be used to facilitate screening programs for AF in primary care. METHODS: This was a cross sectional screening study. A population of 70-74-year-old individuals registered at a single primary care center in Stockholm were invited to AF screening. Intermittent ECG recording, 30 seconds twice a day using a hand-held device over 2 weeks, was offered to participants without previously known AF. Of the 324 participating persons, 34 patients had already known AF and 16 new cases of AF were detected by screening. Plasma NT-proBNP was measured in patients with previously known AF, newly detected AF, and 53 control participants without AF. FINDINGS: The median NT-proBNP was 697 ng/L in patients with previously known AF, 335 ng/L in new cases of AF, and 146 ng/L in patients without AF. After adjustment for several clinical variables and morbidities, the differences of median NT-proBNP levels were statistically significant between cases of previously known AF and new cases of AF as well as between new cases of AF and those without AF. The area under receiver operating characteristic curve of detection of new AF was 0.68 (95% CI 0.56 to 0.79) yielding a cut-off point of 124 ng/L with 75% sensitivity, 45% specificity, and 86% negative predictive value. CONCLUSIONS: The NT-proBNP plasma levels among patients with known AF are higher than those with newly detected AF, and the latter have higher levels than those without AF. Therefore NT-proBNP might be a useful screening marker for the detection of AF and its persistence.

Feasibility and outcomes of atrial fibrillation screening using intermittent electrocardiography in a primary healthcare setting: A cross-sectional study.

BACKGROUND: Atrial fibrillation (AF) is a major risk factor for ischemic stroke unless treated with an anticoagulant. Detecting AF can be difficult because AF is often paroxysmal and asymptomatic. The aims of this study were to develop a screening model to detect AF in a primary healthcare setting and to initiate oral anticoagulant therapy in high-risk patients to prevent stroke. METHODS: This was a cross-sectional study. All 70- to 74-year-old individuals registered at a single primary healthcare center in Stockholm were invited to participate in AF screening upon visiting the center during a ten-month period. Those who did not have contact with the center during this period were invited to participate by letter. Thirty-second intermittent ECG recordings were made twice a day using a handheld Zenicor device over a 2-week period in participants without AF. Oral anticoagulant therapy was offered to patients with newly detected AF. FINDINGS: Of the 415 eligible individuals, a total of 324 (78.1%) patients participated in the study. The mean age of the participants was 72 years, 52.2% were female, and the median CHA2DS2-VASc score of the participants was 3. In the target population, 34 (8.2%) individuals had previously diagnosed AF. Among participants without previously known AF, 16 (5.5%) cases of AF were detected. The final AF prevalence in the target population was 12%. Oral anticoagulant therapy was successfully initiated in 88% of these patients with newly detected AF. CONCLUSIONS: The AF screening project exhibited a high participation rate and resulted in a high rate of newly discovered AF; of these newly diagnosed patients, 88% could be treated with an oral anticoagulant.

The Relationship of Alcoholism and Alcohol Consumption to All-Cause Mortality in Forty-One-Year Follow-up of the Swedish REBUS Sample.

OBJECTIVE: The purpose of this study was to examine the effects of alcoholism, alcohol consumption amount, and alcohol consumption pattern on mortality in a general population sample. METHOD: This study used a 1970 prospective population sample (double-phase random sample) of 2,300 individuals ages 18-65 years in Stockholm County, which was also linked to mortality registers. A total of 1,895 individuals participated in a semi-structured, baseline psychiatric interview with a psychiatrist and social worker. Alcoholism and other mental disorders were recorded according to the eighth revision of the International Classification of Diseases (ICD-8). Information on the usual amount and frequency of alcohol consumption was collected at the psychiatric interview. Mortality up to year 2011 was assessed with Cox proportional hazard regression models. RESULTS: At baseline, there were 65 men and 21 women diagnosed with alcoholism. During followup, there were 873 deaths in the study population of 1,895. Alcoholism was associated with increased mortality rate. Former drinkers, but not never-drinkers, also had increased risk for mortality compared with moderate drinkers. We found no associations between heavy consumption and mortality. Frequent heavy episodic drinking was uncommon but related to mortality before, but not after, adjusting for an alcoholism diagnosis. CONCLUSIONS: Our results demonstrated that alcoholism­but not a reported high consumption of alcohol or frequent heavy episodic drinking­predicted a long-term risk of death.

Blood pressure measures and their predictive ability of cardiovascular mortality: a 26-year follow-up.

OBJECTIVE(S): Our aim was to calculate the predictability of different blood pressure measures for cardiovascular mortality in a cohort of both men and women. We also aimed to determine whether clinically applicable cut-off levels for cardiovascular mortality risk of these measures work well. MATERIALS AND METHODS: A healthcare need investigation from the 1970s was used. Participants aged 46-65 were included, n=788 (390 men and 398 women). The following blood pressure measures were studied: systolic, diastolic, mean, mid, and pulse pressure. The participants were followed for 26 years with respect to cardiovascular mortality through the Swedish Cause-of-Death Register. Isolated diastolic hypertension failed to show significant associations with cardiovascular mortality. RESULTS: Combined systolic and diastolic hypertension showed twice as high cardiovascular mortality in men and women compared with those with normal blood pressure. Mid arterial blood pressure showed increased significant hazard ratios for all three grades of hypertension in men and for grades 2 and 3 in women with good predictability (area under the curve=0.72 and 0.80, respectively). CONCLUSIONS: Mid arterial blood pressure is strongly associated with cardiovascular mortality. Additional studies in larger populations and with a wider age range comparing mid arterial blood pressure with clinically useful cut-offs of other blood pressure measures are required to corroborate our findings.

Health factors and longevity in men and women: a 26-year follow-up study.

Health factors have the power to prevent and postpone diseases and death; however, studies using the same methodology in both men and women are sparse. We aimed to study the ability of health factors to prevent mortality in a population-based, 26-year follow-up of Swedish men and women. During 1969-70, a health-screening programme was offered to a stratified sample of 3,064 individuals aged 18-64 years to estimate health-care needs. Missing data (largely according to protocol) for physical fitness, BMI, and smoking habits left 935 subjects, 463 men and 472 women. Alcohol consumption in grams per week and BMI was calculated. Tobacco smoking was recorded as yes/no. Multivariate analysis was performed by Cox regression with age adjusted hazard ratios (HR) and 95% confidence interval (CI). Moderate alcohol consumption did not lead to any decrease in mortality. Having two health factors halved the mortality risk in men and women (hazard ratio (HR) 0.52, confidence interval (CI) 0.39-0.70). A further risk reduction was seen in men with three health factors (HR 0.17, CI 0.074-0.41). Men had about 70 per cent higher risk of mortality compared with women after adjustments for all health factors (HR 1.67, CI 1.26-2.23). Men compared to women had greater benefit of all three health factors. This in combination with the overall higher mortality risk in men makes a healthy lifestyle more important for them. The benefit of moderate alcohol consumption could not be detected in this study, and may be explained by an unhealthy drinking pattern in Sweden.

Effect of heart-rate recovery on long-term mortality among men and women.

The objective was to estimate the effect of heart-rate recovery (HRR) among men and women on total mortality during long-term follow-up. During 1969-70, a health-screening program was offered to a population sample of 3064 individuals aged 18-64 years to estimate the needs of health-care (participants 2446, i.e. 80%). An exercise test was performed on 513 men and 553 women. Mortality was followed up until 1996. Multivariate analysis was performed by Cox regression; the first model adjusted for age, the second also for heart rate, hypertension and blood glucose, and the third also for BMI, smoking, physical fitness and expected level of healthcare, with hazard ratios (HR) and 95% confidence interval (CI). Low HRR among men was defined as the lower three quartiles, and among women as the lower two quartiles. HR for low HRR in age-adjusted model among men was 2.41 (95% CI 1.29-3.52) and among women 2.04 (95% CI 1.25-3.34), and in full model among men 2.09 (95% CI 1.06-4.11), and among women 1.72 (95% CI 0.98-3.00). With this study added to the bulk of knowledge, low HRR may be regarded as an independent risk factor for mortality.

Cardiovascular and total mortality in men and women with different blood pressure levels--A 26-year follow-up.

AIM: Our aim was to study different levels of high blood pressure and normal blood pressure (reference) to calculate the hazard ratios (HRs) for cardiovascular and total mortality in men and women with adjustments for many covariates. METHODS: A health-screening program was offered to a population-based sample in Stockholm County to estimate healthcare needs (a proxy for co-morbidity). Blood pressure measurements (mmHg systolic/diastolic) were available for 2280 participants (74%). Mortality was followed up for 26 years. RESULTS: HRs with confidence intervals (CI) were calculated. The HR for all-cause mortality in those with very high blood pressure, > or =160 and/or 95, was 1.93 (1.38-2.70) in men and 2.29 (1.42-3.69) in women. High blood pressure (> or = 140 and/or 90 but <160 and 95 cmHg) and prehypertension (> or = 130 and/or 85 but <140 and 90) were significant in women but not in men. Diagnosed hypertension with antihypertensive treatment adjusted for blood pressure level was non-significant in all models. CONCLUSION: Very high blood pressure was an independent risk factor for both total and cardiovascular mortality in both men and women after adjustments for all covariates including healthcare need. Hypertension seems just as important to treat in individuals with co-morbidities.

Sex differences in risk factor control of treated hypertensives: a national primary healthcare-based study in Sweden.

BACKGROUND: To evaluate potential sex differences, this study aimed to investigate blood pressure and lipid control and other risk factors for cardiovascular disease in treated hypertensive (tHT) patients from primary healthcare. DESIGN AND METHODS: This cross-sectional survey of tHT patients was carried out between 2002 and 2005 by 264 primary care physicians from Sweden who consecutively recruited 6537 tHT patients (48% men and 52% women) from medical records. RESULTS: tHT men more often reached the treatment goal for systolic/diastolic blood pressure, less than 140/90 mmHg, than tHT women (30 vs. 26%, P<0.01). Men had lower systolic blood pressure than women, however, women had lower diastolic blood pressure and higher pulse pressure. More tHT women had total cholesterol>or=5.0 mmol/l than corresponding men (75 vs. 64% P<0.001). Men more often had diabetes (25 vs. 20% P<0.001), left ventricular hypertrophy (20 vs. 16% P<0.001), and microalbuminuria (24 vs. 16% P<0.001). Women were more often treated with diuretics (64 vs. 48%) and beta-receptor blockers (54 vs. 51%), and men more often treated with angiotensin-converting enzyme inhibitors (27 vs. 18%), calcium channel blockers (34 vs. 26%), and lipid-lowering drugs (34 vs. 29%). CONCLUSION: A need still exists for more intensified treatment of elevated blood pressure and hypercholesterolemia, especially in women. In hypertensives of both sexes, smoking and other risk factors also need to be addressed to reduce the risk of cardiovascular disease.

Effect of heart rate on long-term mortality among men and women.

OBJECTIVE: This study aims at estimating the effect of high heart rate on total mortality during a long-term follow-up among men and women. During the years 1969-70, a stratified sample of 32,185 individuals aged 18-64 years was drawn from the population in Stockholm County (response rate 87%). A sub-sample, stratified by predicted health care needs, was invited to the health-screening program, and an extensive health examination performed on 2445 individuals out of 3064 individuals. An exercise test was performed on 1054 subjects. Complete data were available for 989 subjects, 490 men and 499 women. METHODS: Participants were followed up in the National Cause of Death Register up to the end of 1996. Multivariate analysis was performed adjusting for cardio-respiratory fitness, expected level of care need, obesity, smoking and hypertension. RESULTS: Among men, high heart rate (above 75 beats/minute) was associated with excess mortality, HR 1.63 (95% CI 1.30-2.03) in the age-adjusted model, and HR 1.57 (95% CI 1.05-2.35) in the full model. Among women, no significant excess risk was found, HR 1.18 (95% CI 0.89-1.58) in the age-adjusted model. CONCLUSIONS: High heart rate is an independent mortality risk marker for men but not for women.

The association between low fasting blood glucose value and mortality.

Earlier studies and reviews have shown an association between high fasting blood glucose levels (FBG) and increased mortality. Less is known about the association between low FBG and mortality. This study aimed at reviewing the literature on this topic. A search was performed primarily of Medline through PubMed, and secondarily by searching other databases and using the information from articles already found. Altogether 5 articles meeting the quality demands of the search were found, all supporting the association between low FBG and increased all-cause mortality, with multivariate adjusted hazard ratios between 1.2 and 3.2. Another 22 articles not fulfilling the quality criteria were studied, and actually no study contradicted this association. Most studies were focused on the relation between high FBG and mortality, and did not analyze the association between low FBG and mortality specifically, hence explaining the low number of conclusive articles focusing on this. Thus we conclude, that low FBG is associated with increased mortality, but the cause of this association is unclear. We hypothesize, that low FBG could be a marker of low fat-free mass and low nutrition intake. This topic needs further studies.

Neighborhood violent crime and unemployment increase the risk of coronary heart disease: a multilevel study in an urban setting.

Little is known about the association between neighborhood social disorganization and coronary heart disease (CHD). This study used the theoretical frameworks of the Chicago school and the Stirling County group in order to analyze the impact of neighborhood violent crime and neighborhood unemployment on CHD in an urban setting, the capital of Sweden. The entire population of Stockholm County aged 35-64 years on January 1, 1998 was included in the study. All individuals were followed for CHD until December 31, 1998. Small area neighborhood units were used to define neighborhoods. The neighborhood-level variables were calculated as rates of violent crime or unemployment in the small area neighborhood units, categorized in quintiles. Multilevel logistic regression was used to estimate odds ratios and neighborhood-level variance in three different models. When rates of neighborhood violent crime or neighborhood unemployment increased, the risk of CHD increased among both women and men. In neighborhoods with the highest rates of violent crime (quintile 5), the odds ratios were 1.75 (CI=1.37-2.22) and 1.39 (CI=1.19-1.63) for women and men, respectively. In neighborhoods with the highest unemployment rates, the corresponding odds ratios were 2.05 (CI=1.62-2.59) and 1.50 (CI=1.28-1.75). These average neighborhood effects on CHD (fixed effects) remained almost unaltered after inclusion of the individual-level variables. The neighborhood-level variance indicated significant differences in CHD between neighborhoods, and the neighborhood-level and individual-level variables partly explained the variance between neighborhoods (random effects). Public safety and social stability in socially disorganized neighborhoods need to be improved in order to promote cardiovascular health.

Hypertensive smokers have a worse cardiovascular risk profile than non-smokers in spite of treatment--a national study in Sweden.

Smoking is a well-established risk factor for cardiovascular disease. Studies have indicated that smoking may outweigh the benefit of blood pressure (BP) control. Our aim was to compare cardiovascular risk factors in smokers vs non-smokers from a national sample of treated hypertensives. Data were collected on smoking habits, BP control, total and low-density lipoprotein (LDL) cholesterol, diabetes, left ventricular hypertrophy (LVH), and microalbuminuria (MA), from records of 4424 consecutive patients by 189 physicians. All technical methods were local. Treated hypertensives who smoked had microalbuminuria significantly more often than non-smokers, 26.2% vs 20.5% (p<0.05), and a higher proportion of smokers were suboptimally controlled (DBP > or = 90 mmHg), 32.7% vs 25.0% (p<0.01). Smoking males had a higher prevalence of LVH (25.7% vs 20.1; p<0.05), microalbuminuria (29.7% vs 24.7%; p<0.01), and a higher proportion of subjects with uncontrolled systolic BP (> or = 140 mmHg) (72.8% vs 68.9%; p<0.01). Both DBP and total cholesterol were higher in smoking vs non-smoking females. An increased prevalence of LVH and microalbuminuria was independently associated with smoking. In summary, smokers with treated hypertension show a higher proportion of LVH (men), microalbuminuria and worse diastolic BP control than non-smokers. This may hypothetically reflect either less compliance with drug treatment in smokers or that smoking impairs the pharmacological effects of antihypertensive drugs.

Gender differences in risk factor control and treatment profile in diabetes: a study in 229 swedish primary health care centres.

OBJECTIVE: To measure the risk factors and treatment profile of diabetes patients treated in primary health care (PHC) in order to evaluate potential gender differences. DESIGN: Cross-sectional survey of consecutive diabetes patients. SETTING: 229 PHC centres in Sweden. SUBJECTS: 5082 men and 4293 women with diabetes were investigated (1998-2001). MAIN OUTCOME MEASURES: Glycaemic control (HbA1c), blood pressure, lipid levels, prevalence of left ventricular hypertrophy and microalbuminuria. Proportions of patients with previous ischaemic heart disease (IHD) and specific drug treatment. RESULTS: Male patients generally had better blood pressure ( < 140 and/or 85 mmHg) and glycaemic (HbA1c < 6.5%) control than corresponding female patients (44% and 59%, versus 40% and 54% in the 60-75 year age group; p < 0.01). Females showed higher levels of total (p < 0.01) and HDL cholesterol (p < 0.05) than males in all age groups. No gender difference was detected for LDL cholesterol levels in the younger or elderly patients, but in the age group 60-75 years female patients had significantly higher mean LDL cholesterol level than male patients (3.3 vs 3.2 mmol/L; p < 0.05). Previously known manifestations of IHD were more common (p < 0.01) in male patients. CONCLUSION: Elderly male patients with diabetes had a more favourable risk factor control than corresponding female patients.

Effects of alcohol consumption on female fertility during an 18-year period.

OBJECTIVE: To investigate the long-term effects of alcohol consumption on female fertility. DESIGN: Prospective study of a random sample of 7,393 women, selected from the 445,000 inhabitants of Stockholm County, Sweden, in 1969. Self-estimated alcohol consumption was obtained from postal questionnaires. Data on hospitalizations for pregnancy outcomes including infertility examinations were analyzed until 1987. SETTING: Healthy women in Stockholm County, Sweden. PATIENT(S): Seven thousand three hundred ninety-three women in the age range 18-28 years. MAIN OUTCOME MEASURE(S): Rates of hospitalization for deliveries, miscarriages, legal abortions, extrauterine pregnancies, pelvic inflammatory disease, endometriosis, and infertility examinations were analyzed in relation to the intake of alcohol. RESULT(S): Two hundred fifty-two women underwent infertility examinations. High consumers had an increased risk for such examinations, as compared with moderate consumers: relative risk ratio (RR) = 1.59 (95% confidence interval [CI]: 1.09-2.31); and low consumers had a decreased risk (RR = 0.64; CI: 0.46-0.90). Moreover, for both high and low consumers we observed a significantly lower number of first and second partus. Rates of miscarriage, extrauterine pregnancy, and pelvic inflammatory disease did not differ between high and low consumers of alcohol. CONCLUSION(S): High alcohol consumption was associated with increased risk of infertility examinations at hospitals and with lower numbers of first and second partus. It may be important for the female partner in an infertile couple to limit alcohol intake or to not drink at all.

Influence of different types of alcoholic beverages on self-reported health status.

AIMS: This study investigated the effect of the consumption of wine, beer and spirits on self-reported health status. METHODS: A sample of 14950 individuals was randomly selected from the total population register in Sweden in 1996-97. Their self-reported health status and consumption of wine, beer and spirits were assessed at face-to-face interviews. RESULTS: Of 11606 individuals in the age range 16-84 years, 2659 reported a poor health status. Consumption of wine was associated with a decreased odds ratio (OR) (0.56; 95% confidence interval (CI) 0.50-0.63) for poor, self-reported health status, as compared with non-users. Consumers of fortified wine, beer, strong beer and hard liquor had a similar, self-reported health status to that of non-consumers. The results were adjusted for age, sex and total alcohol consumption. Adjustments for body-mass index, smoking, educational level and physical activity did not change the results. The relationship between poor self-reported health status and intake of wine had a form similar to a 'U' with the lowest OR among individuals consuming small to moderate amounts of wine. CONCLUSIONS: The study shows that a moderate consumption of wine was associated with a positive effect on the self-reported health status. Factors related to lifestyle may be underlying causes.