风险分布的转变：瑞典心血管疾病预防项目中一项社区干预的结果
Shifting the distribution of risk: results of a community intervention in a Swedish programme for the prevention of cardiovascular disease.
作者信息
Weinehall L, Westman G, Hellsten G, Boman K, Hallmans G, Pearson T A, Wall S
机构信息
Department of Epidemiology and Public Health, Umeå University, Sweden.
出版信息
J Epidemiol Community Health. 1999 Apr;53(4):243-50. doi: 10.1136/jech.53.4.243.
STUDY OBJECTIVE
To examine the impact of a systematic risk factor screening and counselling carried out by family physicians and family nurses within the larger framework of a community intervention programme for the prevention of cardiovascular disease (CVD).
DESIGN
Quasi-experimental study comparing trends in an intervention area with those in a reference area.
SETTING
A Northern Sweden municipality (5500 inhabitants) constituted the intervention area while the Northern Sweden region (510,000 inhabitants) served as the reference area.
PARTICIPANTS
All 30, 40, 50, and 60 year old inhabitants were invited each year from 1985 to 1992. Among 2046 eligible 1893 participated (92.5%), which formed eight independent cross sections. One cross section, 1986, was re-surveyed forming a panel.
MAIN RESULTS
In the cross sections, mean total cholesterol was reduced from 7.09 to 6.27 mmol/l for men (p < 0.001) and from 7.13 to 5.89 mmol/l for women (p < 0.001) and mean systolic blood pressure from 132.2 to 123.7 mm Hg for men (p < 0.05) and from 129.2 to 122.0 mm Hg for women (p < 0.001) during the eight years. Body mass index (BMI) increased from 25.6 to 26.2 for men (p < 0.05) and from 25.0 to 25.5 for women (NS). A corresponding reduction in cholesterol and blood pressure (for women) occurred in the panel, while BMI was unchanged. The risk for CVD, using the Framingham equation, was estimated to be reduced overall by 19% (p = 0.0021) when comparing early cross sections (1985/86) with the later cross sections (1990/91).
CONCLUSIONS
It was concluded that a long term community based CVD prevention programme that combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. The individual attention and evaluation provided by the health provider survey seem to accelerate, but not increase the amount of, risk reduction.
研究目的
在预防心血管疾病（CVD）的社区干预计划的更大框架内，研究家庭医生和家庭护士进行的系统风险因素筛查与咨询的影响。
设计
比较干预地区与对照地区趋势的准实验研究。
地点
瑞典北部的一个市镇（5500名居民）为干预地区，瑞典北部地区（510,000名居民）为对照地区。
参与者
1985年至1992年期间，每年邀请所有30、40、50和60岁的居民。在2046名符合条件者中，1893人参与（92.5%），形成了8个独立的横断面。其中一个横断面（1986年）进行了重新调查，形成了一个面板。
主要结果
在横断面中，男性的平均总胆固醇从7.09 mmol/l降至6.27 mmol/l（p < 0.001），女性从7.13 mmol/l降至5.89 mmol/l（p < 0.001）；男性的平均收缩压从132.2 mmHg降至123.7 mmHg（p < 0.05），女性从129.2 mmHg降至122.0 mmHg（p < 0.001），在这八年期间。男性的体重指数（BMI）从25.6增加到26.2（p < 0.05），女性从25.0增加到25.5（无显著差异）。在面板中，胆固醇和血压（女性）相应降低，而BMI没有变化。使用弗雷明汉方程，将早期横断面（1985/86年）与后期横断面（1990/91年）进行比较时，估计CVD风险总体降低了19%（p = 0.0021）。
结论
得出的结论是，一项结合人群和个体策略的长期社区CVD预防计划可以在高危农村人群中显著促进CVD风险的健康转变。卫生服务提供者调查提供的个体关注和评估似乎加速了，但没有增加风险降低的幅度。
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