Eva Eurenius

Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study.

OBJECTIVE To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis. METHODS A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (> or =30 minutes, moderately intensive activity, most days of the week). RESULTS The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%; P > 0.05) and after (54% versus 44%; P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test; P = 0.000) (Grippit; P = 0.003), but not in any other variables assessed. CONCLUSION A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change.

Attitudes toward physical activity among people with rheumatoid arthritis

Physical activity confers health benefits in the general population, and this also seems to apply to people with rheumatoid arthritis (RA). Less explicit barriers than pain need to be explored and overcome to initiate and successfully maintain physical activity in individuals with RA. The present aim was to describe variations in attitudes to physical activity in a group of people with RA. Sixteen people with RA were chosen to represent various ages, genders, disease duration, functioning, and health habits. Semi-structured, in-depth interviews were carried out, transcribed, qualitatively analysed, and categorised on the basis of similarities and differences. The analysis indicated that attitudes toward physical activity could not be understood without inclusion of attitudes toward the disease and sometimes to life in general. Two dimensions of attitude, motivation and satisfaction, were identified. Four categories were revealed: motivated and satisfied, unmotivated and satisfied, motivated and dissatisfied, and unmotivated and dissatisfied, each representing different attitudes to physical activity. Our findings stress the importance of developing different educational interventions that address attitudes to physical activity in order to implement a healthy life style in individuals with RA.

Health-related quality of life in girls and boys with juvenile idiopathic arthritis: self- and parental reports in a cross-sectional study

BackgroundJuvenile Idiopathic Arthritis (JIA) affects children and adolescents with both short-term and long-term disability. These children also report lower health-related quality of life (HRQOL) compared to their healthy peers. However, there seems to be some discrepancies between self- and parent-reports, and gender differences need to be further studied. This study aims to describe HRQOL in girls and boys with JIA, and to explore gender differences in self-reports compared to parent-reports of HRQOL in children with JIA.MethodsFifty-three children and adolescents with JIA (70% girls and 30% boys) with a median age of 14 years (8–18 years), and their parents, participated in this cross-sectional study in Sweden. Data was systematically collected prior to ordinary visits at a Pediatric outpatient clinic, during a period of 16 months (2009–2010). Disability was assessed with the Childhood Health Assessment Questionnaire (CHAQ), and disease activity by physicians’ assessments and Erythrocyte Sedimentation Rate (ESR). The Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) was used to assess self- and parent-reports of HRQOL in the child.ResultsIn this sample of children with generally low disease activity and mild to moderate disability, more than half of the children experienced suboptimal HRQOL, equally in girls and boys. Significant differences between self- and parent-reports of child HRQOL were most evident among girls, with lower parent-reports regarding the girl’s physical- and psychosocial health as well as in the total HRQOL score. Except for the social functioning subscale, where parents’ reports were higher compared to their sons, there were no significant differences between boys- and parent-reports.ConclusionsMore than half of the girls and boys experienced suboptimal HRQOL in this sample, with no gender differences. However, there were differences between self- and parent-reports of child HRQOL, with most significant differences found among the girls. Thus, differences between self- and parent-reports of child HRQOL must be taken into account in clinical settings, especially among girls with JIA.

Improving child health promotion practices in multiple sectors : outcomes of the Swedish Salut Programme

BackgroundTo improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation.MethodsA before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points.ResultsSelf-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate ‘fathers visits’ in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff.ConclusionThis multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.

Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden.

Aim: To increase knowledge of self-rated health and lifestyle in relation to overweight/obesity among 13–15 year olds in northern Sweden. Methods: All 6768 13–15 year olds in nine out of 15 municipalities in Västerbotten County were asked to complete a cross-sectional school-based on-line survey in 2007. Eighty-two per cent participated in the study. Responses were considered reliable for 74% of the participants (2517 boys/2470 girls). The survey addressed demography, self-rated health, self-reported weight, height, and lifestyle characteristics. Simple and multiple logistic regression analyses were used. Results: Overweight/obesity (ISO body mass index ≥25 kg/m2) was more prevalent among boys (20%) than girls (11%), but more girls (19%) than boys (9%) reported fair or bad health. Overweight/obese boys and girls were more often physically inactive. For the boys, overweight/obesity was also associated with skipping breakfast, insufficient tooth brushing, and using snuff. For the girls, overweight/obesity was also associated with living with one parent and more television watching. Boys reported healthier habits concerning sleep duration, physical activity, eating breakfast, and smoking compared to the girls. On the other hand, girls reported better dietary and tooth brushing habits. Conclusions: This study uncovered two alarming findings: a fifth of the boys were overweight/obese and a fifth of the girls reported fair or bad health. Girls living with a single parent and boys and girls with unhealthy lifestyles were more likely to be overweight. Our findings emphasise the need for developing and implementing effective health promotion strategies for school-aged children to prevent an overweight and obesity epidemic that could continue into adulthood.

Maternal and paternal self-rated health and BMI in relation to lifestyle in early pregnancy: The Salut Programme in Sweden

Aim: This study’s aim was to increase knowledge about maternal and paternal self-rated health and body mass index in relation to lifestyle during early pregnancy. Methods: Study subjects were expectant parents visiting antenatal care (2006—07) as part of the Salut Programme in northern Sweden. During early pregnancy, 468 females and 413 male partners completed questionnaires. The questions addressed sociodemography, self-rated general health, weight and height, satisfaction with weight, and lifestyle, such as dietary habits, physical activity, sleeping pattern, and alcohol, tobacco, and drug use. Results: Most rated their general health as good, very good, or excellent, although women less often than men (88% and 93%). The sex difference was more prominent when restricting the comparison to self-rated health being very good or excellent - 49% of the women compared to 61% of the men. Being overweight or obese was common (53% of the men and 30% of the women). Few participants fulfilled the national recommendations with respect to a health-enhancing lifestyle; this was somewhat more common for women than men. Expectant parents with normal body mass index and vigorous physical activity were more likely to have very good or excellent self-rated health. Conclusions: Most expectant parents perceived their general health as good, although this perception was less for women than men. Being overweight and having a non-health-enhancing lifestyle were more common for men than women. Thus, there is need for more powerful health-promoting interventions for expectant parents.

A population-based study of overweight and obesity in expectant parents: socio-demographic patterns and within-couple associations

BackgroundOverweight and obesity in pregnancy increase the risk of several adverse pregnancy outcomes. However, both mothers’ and fathers’ health play an important role for long-term health outcomes in offspring. While aspects of health and lifestyle of pregnant women have been reported, the health of expectant fathers and correlations of health variables within couples have received less attention. This study aimed to explore the prevalence and socio-demographic patterns of overweight and obesity in Swedish expectant parents, and to assess within-couple associations.MethodsThis population-based, cross-sectional study investigated self-reported data from 4352 pregnant women and 3949 expectant fathers, comprising 3356 identified couples. Data were collected in antenatal care clinics between January 2008 and December 2011. Descriptive, correlation and logistic regression analyses were performed.ResultsThe self-reported prevalence of overweight (BMI 25.0-29.99) and obesity (BMI ≥30.0) was 29% among women (pre-pregnancy) and 53% among expectant fathers. In a majority of couples (62%), at least one partner was overweight or obese. The odds of being overweight or obese increased relative to partner’s overweight or obesity, and women’s odds of being obese were more than six times higher if their partners were also obese in comparison with women whose partners were of normal weight (OR 6.2, CI 4.2-9.3). A socio-demographic gradient was found in both genders in relation to education, occupation and area of residence, with higher odds of being obese further down the social ladder. The cumulative influence of these factors showed a substantial increase in the odds of obesity for the least compared to the most privileged (OR 6.5, CI 3.6-11.8).ConclusionsThe prevalence of overweight and obesity in expectant parents was high, with a clear social gradient, and a minority of couples reported both partners with a healthy weight at the onset of pregnancy. Partner influence on health and health behaviours, and the role both mothers and fathers play in health outcomes of their offspring, underpin the need for a more holistic and gender inclusive approach to the delivery of pregnancy care and postnatal and child health services, with active measures employed to involve fathers.

The Swedish version of the Multidimensional Health Locus of Control scales, form C. Aspects of reliability and validity in patients with rheumatoid arthritis

The objective was to investigate measurement properties of a Swedish version of the Multidimensional Health Locus of Control Scales, form C (MHLC-C). Four hundred and twenty-six people (115 males, 311 females) with rheumatoid arthritis (RA), age above 18 years completed the translated MHLC-C, the Arthritis Helplessness Index, the Hospital Anxiety and Depression Scales, and the Stanford Health Assessment Questionnaire. Pain and global disease activity were also assessed. Factor analysis confirmed the four-factor structure of the original MHLC-C with the proportion of explained variance ranging from a high 2.85 for “Internal” to a low 1.62 for “Other people”. Construct validity was supported by little, if any correlations with other measures (rp= < 0.01–0.33). Good test–retest stability was indicated for the four sub-scales (ICC 0.63–0.78) and internal consistency was satisfactory (Cronbachs alpha 0.61–0.82). In conclusion, we suggest that the measurement properties of the Swedish MHLC-C are consistent with those of the American original and that it is valid and reliable for use in Swedish patients with RA.

Clinical applicability of two tests of aerobic fitness in patients with rheumatoid arthritis

The aim of this study was to describe the clinical applicability of two different methods of aerobic fitness testing in patients with rheumatoid arthritis (RA). Five hundred and fifty-six patients with RA (median age 56 years, range 19–90, disease duration ≤6.5 years, 75% women) were included from 17 rheumatology units. Each patient was scheduled to perform a submaximal test of aerobic fitness, either on a bicycle or on a treadmill; the assignment to method was mainly determined by access to equipment at each participating unit. Eighty-eight patients (16%) were never tested, mainly because of use of beta-blockers or impairments, 45 patients (8%) terminated their tests prematurely and 423 patients (76%) completed their assigned test. Their estimated aerobic fitness was mainly classified as “low” (30%), “fair” (40%) or “average” (23%). The determinants of completing either of the tests were female gender (OR=2.06, 95% CI 1.22–3.47), age <65 years (OR=6.50, 95% CI 4.00–10.55) and no (OR=4.67, 95% CI 2.10–10.40) or mild disability (OR=6.24, 95% CI 2.43–16.06). It thus appears as if a majority of patients with RA are able to perform aerobic fitness testing despite the expected limitations related to impairments.

Leisure time physical activity among pregnant women and its associations with maternal characteristics and pregnancy outcomes

BACKGROUND Physical activity during pregnancy is generally considered safe and beneficial for both the pregnant woman and her fetus. The overall aim was to investigate pregnant womens pre-pregnancy and early pregnancy physical activity and its associations with maternal characteristics and pregnancy outcomes. METHODS This cross-sectional study combined data from the Maternal Health Care Register in Västerbotten (MHCR-VB) and the Salut Programme Register (Salut-R). Data were collected from 3,868 pregnant women living in northern Sweden between 2011 and 2012. RESULTS Almost half of the participants (47.1%) achieved the recommended level of physical activity. Compared to the women who did not achieve the recommended level of exercise, these women had lower BMI, very good or good self-rated health, and a higher educational level. No significant associations could be established between physical activity levels and GDM, birth weight, or mode of delivery. CONCLUSIONS Positively, a considerably high proportion of Swedish pregnant women achieved the recommended level of physical activity. Factors associated with recommended physical activity level were BMI ≤30 kg/m(2), very good or good self-rated health, and higher educational level. Our findings emphasize the need for health care professionals to early detect and promote fertile and pregnant women towards health-enhancing physical activity, especially those with low levels of physical activity and overweight/obesity, to improve overall health in this population.