Life style intervention in primary care and aspects on stroke prevention

Abstract

ABSTRACT Aims: To describe a self-administered preventive tool dealing with risk factors for cardiovascular disease and its effectiveness to involve persons in need of life style changes. To evaluate the feasibility of implementing a preventive primary care program consisting of a screening questionnaire and a selfadministered health profile. To involve motivated individuals in need of lifestyle changes and to evaluate the effects after 1 year. To explore potential effects of physical activity on well-being among women in a population based study with a 32 year perspective. To study the incidence of first ever nonfatal and fatal stroke over 32 years with focus on stroke subtype, by consolidating endpoints and associations with risk factors in the same population study. Method: A model for structured preventive work in primary care was developed and tested at one public primary care center. The model included a screening questionnaire offered to consecutive patients between 18-65 years of age followed by a self-administered health profile and follow up. Subsequently an intervention study was applied on eight public primary care centers. Patients aged 18- 79 years were presented a screening questionnaire, and then they were offered a health profile, blood pressure and blood glucose check and a health dialogue. Main outcome measures were motivation level, negative lifestyle factors in the screening questionnaire and changes in blood pressure, pglucose, body mass index (BMI) and lifestyle factors at 1-year follow-up. In the Population Study of Women in Gothenburg (PSWG) with 1 462 women cross-sectional and prospective analyses were carried out. Physical activity was defined in three levels, “low”, “intermediate”, “high” and well-being was based on self-reported well-being using a Likert –type 7-point scale. In PSWG main types of first-ever stroke and fatal stroke were identified and validated. Risk factors like smoking, physical inactivity, BMI, waist-hip-ratio (WHR), blood pressure, perceived mental stress and low education at baseline were selected. Association with atrial fibrillation (AF), diabetes and myocardial infarction was tested as survival time free from stroke. Results: Subjects with less favorable life style chose to participate. Good agreement was seen for selfestimation in screening questions and grading in the basal health profile (I). Subjects with less favorable lifestyle and higher motivation chose to participate. At 1-year follow- up significant reductions in BMI, WHR, waist circumference, blood pressure and p-glucose were observed (II). Strong associations were seen between level of physical activity and well-being cross-sectionally and similar associations were observed when relating physical activity at baseline to subsequent well-being after 12, 24 and 32- years. Linear correlations were seen between changes in the individual´s physical activity level and simultaneous changes in experience of well-being (III). There were 184 (12.6%) cases of first ever stroke and18% of them were fatal. The validation process diminished unspecified stroke diagnosis from 37% to 11%. Significant association with ischemic stroke was seen for high BMI, smoking and low education. Survival analysis showed significant negative correlation between stroke and diabetes as well as stroke and atrial fibrillation (IV). Conclusions: A pedagogic model engaging motivated individuals was feasible to implement in ordinary primary care. Weight, BMI, waist circumference, waist-hip ratio, blood pressure and pglucose were significantly improved after one year suggesting applicability in life style modification. Strong associations were seen between leisure time physical activity level and reported well-being both cross-sectionally and prospectively. Increased physical activity in sedentary individuals appears to promote health and well-being. Diagnoses from the National Patient Registry could be validated to improve data quality by increasing specified diagnoses. Low education was associated with ischemic stroke. Smoking and BMI were associated to higher stroke risk. Keywords: Life style, prevention, promotion, risk factors, primary health care, health profile, public health, self-reported health, wellbeing, stroke, incidence, women.