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Background

Physical inactivity is a major public health concern worldwide. Psychological distress is linked to physical inactivity, which increases the risk of several diseases. Women tend to be more physically inactive than men. Moreover, physical inactivity increases with age in both sexes. Therefore, this study aimed to investigate the association between psychological distress and physical inactivity in adults aged ≥ 65 years, the role of psychosocial factors and explore sex-based differences.

Methods

This study included 14,213 older adults, comprising 7,069 women (52%) (median age = 75 years), who responded to a survey questionnaire sent to a random population sample in Mid-Sweden in 2022. The response rate in the population aged ≥ 65 years was 61%. The association between psychological distress as defined by the Kessler-6 and physical inactivity (< 150 min/week of physical activity) was analyzed using binary logistic regression, adjusting for sex, age, country of birth, educational level, and psychosocial factors.

Results

Overall, 30% of the participants reported psychological distress, and 45% were physically inactive. Psychological distress and physical inactivity were significantly associated (p < 0.001), being more common among women (p < 0.001). In the fully adjusted model, the Odds Ratio (OR) for physical inactivity was 1.46 (95% confidence interval (CI) 1.43–1.50) for women and 1.70 (95% CI: 1.65–1.74) for men regarding moderate psychological distress and 2.87 (95% CI: 2.72–3.04) for women and 2.43 (95% CI: 2.28–2.58) for men regarding serious psychological distress. Not participating in social activities in the last 12 months was associated with physical inactivity in both women and men.

Conclusions

Psychological distress is significantly associated with physical inactivity among older adults. Participation in social activities was identified as an essential factor in addressing physical inactivity. Social connections and physical inactivity are important factors to consider when supporting older adults’ mental health. Public health interventions should promote and raise awareness of physical and mental health as well as the social dimensions of aging, while also considering age and sex-based differences.

Background Obesity, assessed by body mass index (BMI), is an established risk factor for 13 cancers. We aimed toidentify further potential obesity-related cancers and to quantify their association with BMI relative to that ofestablished obesity-related cancers.

Methods Using Cox regression models on 4,142,349 individuals in Sweden (mean age 27.1 years at weight mea-surement), we calculated hazard ratios (HRs) for the association between BMI and the risk of 122 cancers and cancersubtypes, grouped by topography and morphology. Cancers with a positive association (i.e., HR >1) at an alpha-level of0.05 for obesity (BMI >= 30 kg/m(2)) vs. normal weight (BMI 18.5-24.9 kg/m(2)) or per 5 kg/m2higher BMI, for whichobesity is not an established risk factor, were considered potentially obesity related.

Findings After 100.2 million person-years of follow-up, 332,501 incident cancer cases were recorded. We identified 15cancers in men and 16 in women as potentially obesity related. These were cancers of the head and neck,gastrointestinal tract, malignant melanoma, genital organs, endocrine organs, connective tissue, andhaematological malignancies. Among these, there was evidence of differential associations with BMI betweensubtypes of gastric cancer, small intestine cancer, cervical cancer, and lymphoid neoplasms (P values forheterogeneity in HRs <0.05). The HR (95% confidence interval) per 5 kg/m(2)higher BMI was 1.17 (1.15-1.20) in men and 1.13 (1.11-1.15) in women for potential obesity-related cancers (51,690 cases), and 1.24 (1.22-1.26) in menand 1.12 (1.11-1.13) in women for established obesity-related cancers (84,384 cases).

Interpretation This study suggests a large number of potential obesity-related cancers could be added to alreadyestablished ones. Importantly, the magnitudes of the associations were largely comparable to those of the alreadyestablished obesity-related cancers. We also provide evidence of specific cancer subtypes driving some associationswith BMI. Studies accounting for cancer-specific confounders are needed to confirm thesefindings.

Background

Depression is common in older adults and is related to reduced quality of life and functional ability as well as increased mortality and morbidity. Current guidelines recommend psychological treatments for the treatment of depression in adults. Studies show that about 30% of older adults with depression in Sweden receive pharmacological treatment and about 3% receive psychological treatment. However, a majority receive no treatment at all. There is a need for effective and scalable psychological treatment options for older adults with depression in primary care. Behavioural activation is an extensively evaluated, effective, and relatively simple treatment for depression that can be delivered by health care professionals without comprehensive training in psychological treatment.

Methods

We will conduct a randomised controlled 2-armed parallel group multicentre trial comparing treatment as usual in primary care to a five-session telephone-delivered behavioural activation treatment as add on to treatment as usual. The current trial is open labelled. In all, 250 older adults (>= 65 years) with depression will be recruited from primary healthcare centres in three Swedish regions. The primary outcome is depressive symptoms measured with the Montgomery Åsberg Depression Rating Scale - Self rating version (MADRS-S) after treatment and at 3- and 6-month follow-up. Secondary outcomes include depression diagnoses, activity level (self-rated and measured with accelerometer), and self-rated anxiety, daily functioning, quality of life, self-efficacy, and loneliness.

Discussion

There is a need for fully powered studies of brief behavioural activation for older adults with depression delivered by telephone in a primary care context. This study has the potential to improve first-line treatment of depression in older adults in primary care, consequently reducing morbidity and mortality within this population. Increasing the availability and accessibility to effective psychological treatment for depression in older adults is needed to meet future demographic changes.

Trial registration

ClinicalTrials.gov: NCT06284889. Registered February 28, 2024.

Objectives: We examined how asymptomatic metabolic syndrome (MetS) in midlife affects cardiovascular (CV) morbidity and all-cause mortality later in life and studied difference in time to event and from the individual components related to MetS.

Design: Population-based matched cohort study including data from a screening programme for identification of CV risk factors.

Setting: Primary care, County of Vastmanland, Sweden.

Participants: All inhabitants turning 40 or 50 years between 1990 and 1999 were invited to a health screening. Total 34 269 (60.1%) individuals completed the health examination. Participants that met a modified definition of MetS were individually matched to two controls without MetS with regard to age, sex and date of health examination.

Interventions: None.

Main outcome measures: CV events and all-cause mortality from the index examination to June 2022.

Results: All 5084 participants with MetS were matched to two controls. There were 1645 (32.4%) CV events in the MetS group and 2321 (22.8%) CV events for controls. 1317 (25.9%) MetS and 1904 (18.7%) control subjects died. The adjusted HRs (aHR) for CV event and death were significantly higher when MetS was present (aHR) 1.39*** (95% CI 1.28 to 1.50) and 1.27*** (95% CI 1.16 to 1.40) respectively. The factor analysis identified three dominating factors: blood pressure, cholesterol and blood glucose. Mean time for first CV event and death was 2.6 years and 1.5 years shorter respectively for participants within the highest quartile compared with participants with lower mean arterial blood pressure (MAP). The aHR for each 10 mm Hg increased MAP were 1.19*** (95% CI 1.15 to 1.23) for CV event and 1.16*** (95% CI 1.11 to 1.21) for death.

Conclusion: The risk of a CV event and premature death is significantly increased when MetS is present. Early detection of metabolic risk factors, especially, high blood pressure, opens a window of opportunity to introduce preventive treatment to reduce CV morbidity and all-cause mortality.

Introduction: The metabolic syndrome (MetS) represents a cluster of risk factors that predict cardiovascular disease (CVD) and type 2 diabetes. Early detection of MetS opens up for a successful treatment of the cardiovascular (CV) risk factors involved, hopefully leading to later advent of CVD in the general population.

Purpose: In this long-term, population-based study we aimed to investigate how presence of MetS, in middle-aged men and women, was associated with all-cause mortality and non-fatal CVD later in life.

Methods: Between 1990 -1999 a screening program was conducted among 40- and 50-year-old inhabitants in the County of Västmanland, Sweden. Data on lifestyle habits and socio-economic status were collected. Total cholesterol, fasting blood glucose, blood pressure, weight, height, waist and hip circumference were measured. Individuals that met three or more of the following risk factors were classified with MetS: waist circumference: ≥102 cm (men) and ≥88 cm (women), total cholesterol: ≥6.1 mmol/ l, blood pressure: ≥130 and/ or ≥85 mm Hg (or previous diagnosis of hypertension) or fasting plasma glucose: ≥5.6 mmol/ l (or previous diagnosis of type 2 diabetes). A control group was identified with individuals from the same population, without MetS diagnosis. Each participant with MetS was matched to two controls regarding sex, age and date for the health examination. The association between midlife MetS and all-cause mortality and non-fatal CV events (stroke and myocardial infarction) was adjusted for age, sex, smoking, physical inactivity, educational level, BMI, hip circumference and living alone or with family members. Multivariable cox regression and Kaplan-Meier analyses were used.

Results: A total number of 5084 individuals met the criteria for MetS and a control group of 10 168 individuals was identified. The median (Q1, Q3) follow-up time was 27 years (24.6, 30.1), corresponding to 130 820 and 269 696 person-years at risk in the MetS and the control group respectively. During follow up, 1317 MetS and 1904 control subjects died, implying 10 deaths in the MetS group and 7 deaths in the controls per 1000 person-years at risk (fig. 1). Cox analysis showed increased mortality in the MetS group compared to the controls, hazard ratio (HR) 1.30 (95% CI: 1.20-1.40); p<0.001. Non-fatal CV events in the MetS group and in the controls were 32.4% vs 22.8%, respectively (p<0.001); HR 1.35 (CI;1.25–1.46) (fig 2). Median time (Q1, Q3) for first non-fatal CV event was 16.8 years (9.9,22.3) in the MetS group and 19.1 (12.2, 23.6) for the controls.

Conclusions: Results from this long-term, population-based study underline that the risk of non-fatal CVD and all-cause mortality was significantly higher in individuals with asymptomatic MetS. Present results support previous studies that early identification of MetS with screening programs might open a window of opportunity for prevention of CVD and premature death in the general population.

Background

Lifestyle habits are important factors in the development of non-communicable diseases. Different ways of providing counselling in primary care to promote healthier lifestyle habits have been launched and evaluated in recent years. It is important to provide an insight into what makes lifestyle counselling useful for patients and healthcare providers.

Objective

The overall aim of this study was to explore patients ' and community health nurses '(CHNs) experiences of lifestyle counselling in primary care to support healthier lifestyle habits.

Methods

Patients and CHNs were interviewed, face to face. Sixteen patients (eight men, eight women, aged 51-75 years) diagnosed with hypertension or type 2 diabetes mellitus and three CHNs participated. Data material was analysed with qualitative content analysis to explore the participants experiences of lifestyle counselling. Results The theme demonstrates that lifestyle counselling is a long-term commitment based on partnership between patients and CHNs. Five categories describe this partnership: respect and mutual interest, understanding of illness, measurements and goal setting, long-term support, and a structure to support counselling within the primary care unit.

Conclusion

The results from this study are consistent with and add to previous understanding of how lifestyle counselling can be performed successfully in the context of primary health care. The results emphasize that lifestyle counselling should encompass a partnership based on mutual respect, recognition of the patient as the expert on his/her current life situation, and the need for both parties to engage in the process of lifestyle change.

Practice implications

A structured lifestyle program with five counselling sessions within primary care was experienced as helpful for enhanced lifestyle habits and considered to be feasible by both patients and CHNs.

While the effects of lifestyle habits on hypertension or type 2 diabetes mellitus (T2DM) are well established, few lifestyle programmes in primary care directed towards patients with high cardiovascular risk have been evaluated.

Aims To describe and elaborate on how participation in a 1-year lifestyle programme supported changes in lifestyle habits and altered the risk of cardiovascular disease (CVD) as well as explore patients’ and community health nurses’ (CHNs’) experiences of lifestyle change and counselling.

Methods The 1-year lifestyle programme consisted of five appointments with a CHN for patients diagnosed with hypertension, T2DM or impaired glucose tolerance (n = 448). Focuse was on lifestyle habits that were related to patients’ diagnosis. Different behaviour change techniques were used to support lifestyle changes. Blood sampling and anthropometrical measurements were obtained at baseline and 1-year follow-up. The design of Studies I and II was observational and based on data that were consecutively collected between 2009 and 2014, whereas Studies III and IV had a qualitative design. Qualitative content analyses were performed based on data from individual interviews with patients (n = 16) and a focus group interview of CHNs (n = 3).

Results Study I: Favourable changes in physical activity, dietary habits and smoking were detected after participation in the programme. Study II: Significant improvements were demonstrated for all cardiovascular risk factors and the estimated 10-year CVD risk after participation in the programme. Study III: Patients’ experiences of lifestyle changes indicated that increased knowledge of lifestyle habits, gaining trust in oneself and support from others were important elements in the adoption of lifestyle changes. Study IV: The informants expressed that counselling should be based on a partnership, include goal setting and repeated measurements, and incorporate long-term support after the completion of the lifestyle programme.

Conclusion This thesis adds to the knowledge on how lifestyle counselling can be designed and implemented in primary care. The findings show that patients with a new diagnosis of hypertension or T2DM are at high risk for future CVD and a structured lifestyle programme can contribute to improved lifestyle habits and a reduced 10-year CVD risk.

Objective Despite knowledge of the effect of lifestyle changes in preventing cardiovascular disease, a large proportion of people have unhealthy lifestyle habits. The aim of our study is a) to explore the experiences of participants at high risk of CVD of lifestyle change after participation in a one-year structured lifestyle counselling programme and b) to link the techniques and strategies used by the participants to the processes of the transtheoretical model of behaviour change (TTM). Design A qualitative explorative design was used to collect data on participants' experiences. An abductive content analysis was conducted using the processes within TTM for the deductive analysis. Setting Patients that participated in a one-year lifestyle counselling programme in Swedish primary care, were interviewed. Subjects Eight men and eight women, aged 51-75 years, diagnosed with hypertension or type 2 diabetes mellitus. Main outcome measures Experiences of lifestyle change in patients at high cardiovascular risk. Results The analysis yielded four dimensions that assisted lifestyle change: 'The value of knowledge', 'Taking control', 'Gaining trust in oneself' and 'Living with a chronic condition'. The theme 'It's up to me' illustrated that lifestyle change was a personal matter and responsibility. Conclusion Enhanced knowledge, self-efficacy, support from others and the individual's insight that it was his/her own decisions and actions that mattered were core factors to adopt healthier lifestyle habits. Practice Implications:Although lifestyle change is a personal matter, the support provided by primary healthcare professionals and significant others is essential to increase self-efficacy and motivate lifestyle change.

Background: Despite well-known preventive effects for future cardiovascular disease (CVD) risk through lifestyle changes, scientific evaluations of lifestyle programmes in primary care are scarce. Moreover, structured lifestyle counselling is still not integrated in everyday clinical practice. We aimed to evaluate change in cardiovascular risk factors and Framingham 10-year risk score of developing CVD in men and women at high cardiovascular risk after participation in a structured lifestyle programme over 1 year. A single-group study was carried out with a 1-year follow-up including before and after measurements.

Methods: The lifestyle programme comprised five appointments to a district nurse over 1 year, focussing on lifestyle habits based on motivational interviewing. Fasting blood samples and anthropometric measurements were obtained at baseline and 1-year follow-up. The 10-year risk of CVD was calculated according to Framingham general CVD risk score.

Results: A total of 404 patients were included in the study. There was a positive change over 1 year in the total study population for all risk factors evaluated. This included improvements in weight, waist circumference, blood pressure, blood lipids, and fasting glucose. The 10-year risk of developing CVD decreased for the total population from 24.8% to 21.4% at 1 year, equivalent to a 14% decrease.

Conclusions: A structured lifestyle programme in primary care contributes to significant improvements of cardiovascular risk factors and the reduction of 10-year risk for CVD for both men and women at high cardiovascular risk.

Background. Physical activity, healthful dietary habits, and not smoking are associated with reduced cardiovascular morbidity and mortality. However, few studies have examined how counselling to improve poor lifestyle habits might be carried out in clinical practice. In Swedish primary care, structured lifestyle counselling is still not integrated into everyday clinical practice. The aim of the present study was two-fold: (1) to describe a novel lifestyle intervention programme in primary care; and (2) to evaluate change in unhealthy lifestyle habits over 1 year in men and women with high cardiovascular risk who participated in the lifestyle intervention programme. Method. A single-group study with a 1-year follow-up was carried out. A total of 417 people was enrolled, median age 62 years (54% women), with either hypertension (69%), type 2 diabetes mellitus, or impaired glucose tolerance. The 1-year intervention included five counselling sessions that focused on lifestyle habits, delivered by a district nurse with postgraduate credits in diabetes care and the metabolic syndrome. All patients were offered in-depth counselling for one or more lifestyle habits when needed. Lifestyle habits were assessed by a questionnaire at baseline and 1-year follow-up. Total change was assessed using a nine-factor unhealthy lifestyle habit index. Results. Favourable, significant changes were observed for physical activity, dietary habits, smoking, and stress over 1 year. Similar improvements were seen for both sexes and type of diagnosis. Conclusions. The results support the utility of a multifactorial, structured approach to change unhealthy lifestyle habits for cardiovascular risk prevention in a primary care setting.