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P Puska

Publications and source records attributed to P Puska.

At least 19 recordsLinked to original sources
PubMed2003

The Finnish evidence-based guideline for open-angle glaucoma.

In most patients, chronic open-angle glaucoma is a slowly progressive disease. Eyes with very high intraocular pressure (IOP > 30 mmHg) represent an exception to this and should be treated and followed extremely intensively. As lowering IOP is, so far, the only means of treating glaucoma, the majority of research reports deal with the IOP-lowering effect of the treatment. The primary goal of treatment, however, is to prevent glaucomatous damage to the structures and function of the eye. The effectiveness of treatment is monitored with optic disc and retinal nerve fibre layer imaging and with visual field examinations. If the glaucomatous changes are progressing, more effective treatment should be given. In the course of follow-up, it should be noted that the changes in the optic nerve structure and function appear and progress at different time-points with delays of up to several years. The assessment of abnormalities is dependent on the examination method and requires a great deal of experience on the part of the examiner. The important risk factors in glaucoma are elevated IOP (even if IOP is within normal range in half of patients ), age, positive family history, exfoliation, race and myopia.

Antihypertensive Agents↗
PubMed2002

Soy in hypercholesterolaemia: a double-blind, placebo-controlled trial.

OBJECTIVE: To study whether Abacor, a product based on isolated soy protein with high and standardised levels of isoflavones and cotyledon soy fibres, was more effective in lowering total and LDL cholesterol than placebo. DESIGN: Randomised, placebo-controlled, double-blind, parallel group, single centre study. SETTING: Primary care in Joensuu, North Karelia, Finland. SUBJECTS: Subjects were screened from the patient database of the health centre; 30 were randomised to the Abacor group and 30 subjects to placebo. Eight subjects were withdrawn, six from the active group, two from the placebo group. INTERVENTION: The preparations were given as two daily liquid supplements in addition to the subjects' regular diets for 6 weeks. RESULTS: Abacor showed a statistically significant lipid-lowering effect as compared to placebo, although an unexpected reduction was seen in the placebo group. The estimated difference between active treatment and placebo was 0.25 mmol/l (95% CI 0.01, 0.50; P=0.049) for total cholesterol, corresponding to reductions of 8.3 and 5.1%, respectively. The difference in reduction of LDL-cholesterol was 0.27 mmol/l (95% CI 0.06, 0.49; P=0.014) and corresponded to a reduction of 13.2% in the active treatment group, and 8.0% in the placebo group. Abacor showed a rapid onset of effect, as compared with placebo. During a wash-out period of 4 weeks after treatment, the subjects returned to pre-treatment cholesterol levels. CONCLUSION: Added to a regular diet, Abacor significantly reduced LDL-cholesterol and total cholesterol. These beneficial effects occurred within 6 weeks of treatment.

Adolescent↗
PubMed2002

Smoking trends in hypertensive and normotensive Finns during 1982-1997.

Despite the evidence that smoking is one of the main predictors of the cardiovascular disease risk among hypertensive subjects, there are very few data available of the smoking trends of these subjects at public health level. This study assesses the trends in smoking and in smoking cessation advice given by physicians in the hypertensive and normotensive population in Finland during 1982-1997. The data were derived from four independent cross-sectional standardised population surveys conducted in 1982, 1987, 1992 and 1997 in the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland. Men and women aged 25-64 years, selected randomly from the national population register, were classified to four groups according to their blood pressure level and antihypertensive treatment status: normotensive, unaware hypertensive, aware but not treated hypertensive and treated hypertensive. The total number of participants was 24 083. In men, the prevalence of smoking decreased significantly in both treated hypertensive patients and normotensive subjects during 1982-1997, whereas it increased significantly in treated hypertensive women. The proportion of current smokers who had been advised to stop smoking by their physician was significantly higher in treated hypertensive men compared to the other subgroups of men (P < 0.001). The observed decreasing trend in smoking in men is encouraging, but the increase in smoking among hypertensive women taking antihypertensive medication warrants concern. In the future, the methods used for smoking cessation advice given by health care personnel should be intensified to make this effort more effective.

Adult↗
PubMed2002

Validation of self reported smoking by serum cotinine measurement in a community-based study.

STUDY OBJECTIVE: The validity of self reported smoking in population surveys remains an important question. An associated question is what would be the value of measuring serum cotinine concentrations in such surveys to obtain validated smoking data. DESIGN: Cross sectional analysis of data on self reported smoking and serum cotinine among a random population sample of 5846 persons aged 25 to 64 years, who participated in the FINRISK-92 survey. MAIN RESULTS: Among self reported regular smokers, 97.2% of men and 94.9% of women had a cotinine concentration of 10 ng/ml or higher in serum. Of those participants who reported to have smoked at any time during their life but not during the previous month, 6.3% of men and 5.2% of women had a serum cotinine concentration of at least 10 ng/ml. Among never smokers 2.5% of men and 2.7% of women had detectable level of cotinine in their serum. The validity of self reporting was similar among subjects from different areas, ages, and socioeconomic groups. CONCLUSIONS: In a sample of the general population in Finland the validity of self reported smoking is high, and most of the few self reported non-smokers who had cotinine in their serum had only low or moderate levels.

Adult↗
PubMed2001

Nightmares as predictors of suicide.

STUDY OBJECTIVES: To examine the relationship between the frequency of nightmares and the risk of suicide. DESIGN AND SETTING: A prospective follow-up study in a general population of Finland starting in 1972. PARTICIPANTS: A total of 36,211 subjects (17,700 men and 18,511 women) aged 25-64 years at baseline. INTERVENTIONS: N/A. MEASUREMENTS: The study included self-administered questionnaires (mainly questions on socio-economic factors, medical history, health behavior, and psychosocial factors) and health examination at the local primary healthcare center. The frequency of nightmares was estimated. The subjects were followed until Dec. 31, 1995, or death. Information on deaths caused by suicide (n=159) or other self-inflicted injury was obtained from the National Death Register by computerized record linkage using the national personal identification code assigned to every Finnish resident. Using the Cox proportional hazards regression model we controlled for several potential confounding factors. RESULTS: The frequency of nightmares was directly related to the risk of suicide. Among subjects having nightmares occasionally the adjusted relative risk of suicide was 57% higher, and among those reporting frequent nightmares 105% higher compared with subjects reporting no nightmares at all. CONCLUSIONS: This is the first study to report a direct and graded association between the frequency of nightmares and death from suicide in a general population.

Adult↗
PubMed2001

Community-based noncommunicable disease interventions: lessons from developed countries for developing ones.

Community-based programmes for prevention and control of cardiovascular diseases (CVD) started in Europe and the USA in the early 1970s. High mortality from CVD in Finland led to the start of the North Karelia Project. Since then, a vast amount of scientific literature has accumulated to present results and discuss experience. The results indicate that heart health programmes have a high degree of generalizability, are cost-effective and can influence health policy. In the 1980s the focus of programmes expanded from CVD to noncommunicable diseases (NCD), mainly because of the common risk factors. Attention has now turned to promoting this approach in developing countries, where the prevalence of NCD is growing. Theory and experience show that community-based NCD programmes should be planned, run and evaluated according to clear principles and rules, collaborate with all sectors of the community, and maintain close contact with the national authorities. In view of the burden of disease they represent and of globalization, there is a great need for international collaboration. Practical networks with common guidelines but adaptable to local cultures in a flexible way have proved to be very useful.

Cardiovascular Diseases↗
PubMed2001

Exfoliation syndrome as a risk factor for cataract development: five-year follow-up of lens opacities in exfoliation syndrome.

PURPOSE: To ascertain whether the exfoliation syndrome (EXS) is a risk factor for cataract development. SETTING: Helsinki University Eye Hospital, Helsinki, Finland. METHODS: This prospective study examined the development of lens opacities using the Lens Opacity Meter. Visual acuity and refraction were measured in both eyes of 63 nonglaucomatous patients with clinically unilateral EXS. After 5 years, 46 patients were available for follow-up. Case histories of 14 patients were recorded. RESULTS: During the 5 year study, the rate of conversion to bilateral disease was 22% and to exfoliative glaucoma, 30%. At the beginning of the study, the mean lens opacity was 23.5 opacity units (OU) +/- 6.7 (SD) in EXS eyes and 22.9 +/- 7.2 OU in fellow, initially nonexfoliative (NE) eyes; the difference was not significant. After 5 years, the mean opacity was 30.0 +/- 8.8 OU in EXS eyes and 26.9 +/- 8.3 OU in NE eyes (P <.001). In patients who remained unilaterally affected, the EXS eye had a higher opacity value than the NE eyes at the start of the study (23.6 +/- 7.3 OU and 22.7 +/- 7.2 OU, respectively) (P <.05) and after 5 years (29.9 +/- 9.0 OU and 27.0 +/- 8.5 OU) (P <.01). There was a significant myopic change in refraction over time in both groups. The mean refraction in EXS eyes was +1.02 +/- 2.48 diopters (D) at the start and + 0.11 +/- 3.06 D after 5 years (P =.0001) and in NE eyes, +0.99 +/- 2.25 D and +0.43 +/- 2.55 D, respectively (P <.01). At the start of the study, the mean difference in refraction between fellow eyes (refraction in NE eye - refraction in EXS eye) was -0.27 +/- 1.00 D. After 5 years, it was +0.32 +/- 1.44 D (P =.016), showing a greater myopic change in EXS eyes. CONCLUSION: The results show that EXS is a risk factor for lens opacification.

Aged↗
PubMed2001

Gender differences in recurrent coronary events; the FINMONICA MI register.

BACKGROUND: Male gender is an established risk factor for first myocardial infarction, but some studies have suggested that among myocardial infarction survivors, women fare worse than men. Therefore, we examined the long-term prognosis of incident myocardial infarction survivors in a large, population-based MI register, addressing gender differences in mortality as well as the number of events and time intervals between recurrent events. METHODS AND RESULTS: Study subjects included 4900 men and women, aged 25-64 years, with definite or probable first myocardial infarctions who were alive 28 days after the onset of symptoms. At first myocardial infarction, women were older and more likely to be hypertensive or diabetic than men, and had a greater proportion of probable vs definite events. After adjustment for age and geographic region, men had 1.74 times the risk of fatal coronary heart disease relative to women (hazard ratio=1.63 and 1.55 for cardiovascular disease and all-cause mortality, respectively) over an average of 5.9 years of follow-up. Number and time intervals between any recurrent event--fatal and non-fatal--did not differ by gender. CONCLUSION: These data suggest that men are far more likely to have a fatal recurrent event than women despite comparable numbers of events.

Adult↗
PubMed2001

Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?

BACKGROUND: Mortality rates are much more favourable in Western European countries than in those of Eastern Europe. Health behaviour and psychosocial factors have been suggested to be important contributors to East-West differences in mortality and health status. METHODS: To compare reported health status as well as health behaviours and psychosocial factors which may be related to unequal health status in different parts of Europe, standardised postal surveys of representative populations samples were conducted in six Eastern and Western European areas. RESULTS: Higher mortality in the eastern populations was associated with more reported morbidity and generally more negative health ratings. Health behaviours and psychosocial factors were also more negative in the East. Multivariate analyses suggested that the East-West difference in health status may be partly explained by differences in health behaviours and psychosocial factors. CONCLUSION: Efforts to promote health in Eastern Europe should concentrate both on the promotion of healthier lifestyles and on improvement of social and economic conditions.

Adult↗
PubMed2001

Self-reported health in the Republic of Karelia, Russia and in north Karelia, Finland in 1992.

BACKGROUND: Major differences in mortality, cardiovascular disease risk factors and health behaviour are known to exist between the populations of eastern Finland and the Republic of Karelia, Russia. Little is known, however, whether similar differences exist in subjective health. METHODS: In spring 1992 a population survey was conducted in North Karelia, Finland and in the area of Pitkäranta, Republic of Karelia, Russia. Random population samples (n = 2,000 in North Karelia and n = 1,000 in Pitkäranta) stratified for age and sex were taken from the population registers. The subjects completed questionnaires and were examined at local health centres. RESULTS: In North Karelia 50% of men reported their health as being quite good or very good, compared to 34% in Pitkäranta (p < 0.0001 for area difference). Among women the corresponding percentages were 58% in North Karelia and 22% in Pitkäranta (p < 0.0001). High household income and education were associated with good self-rated health among both sexes in North Karelia and among women but not men in Pitkäranta. Self-reported physical condition was better in North Karelia than in Pitkäranta (p < 0.0001). Psychosomatic symptoms (p = 0.0002 among men and p < 0.0001 among women) and many somatic symptoms were more prevalent in Pitkäranta than in North Karelia. CONCLUSION: In general, people in North Karelia, Finland feel healthier than people in the neighbouring Republic of Karelia, Russia. Socioeconomic differences in subjective health are less prominent in the Republic of Karelia.

Adult↗
PubMed2001

Smoking and passive smoking in Estonia, Lithuania and Finland. Identifying target groups of tobacco policy.

BACKGROUND: The aim of this study was to identify population groups which are the most crucial as targets for anti-tobacco action. METHODS: A comparison was made of the prevalence and patterns of smoking and passive smoking in Estonia, Finland and Lithuania. RESULTS: Total exposure to smoking, both one's own and passive smoking, was more common in two Baltic countries than in Finland. In these Baltic countries passive smoking was notably common among women. In all countries the exposure was more prevalent among the younger and less educated, but no difference emerged between urban and rural areas. CONCLUSIONS: The following target groups were identified as priorities for anti-tobacco actions: i) men of all ages in Estonia and Lithuania to stop their already established tobacco use, ii) young women in all three countries to prevent their starting a career of tobacco use and iii) young and less educated women in Estonia and Lithuania to prevent passive smoking, i.e. their exposure to environmental tobacco smoke.

Adult↗
PubMed2001

East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme.

BACKGROUND: Differences have been reported in life expectancy and mortality between Eastern and Western European countries. Also, disparities have been found among different European countries or populations concerning the implementation of preventive practices by health professionals. This study analysed the patterns of reported preventive practices in three Eastern European areas and three Western ones. METHODS: Health surveys were carried out in particular geographical area of six countries participating in the project (three Eastern European countries; Russia, Poland and Hungary and three Western European countries; Finland, Germany and Spain). All of them are partners in the WHO-CINDI (Countrywide Integration Non-communicable Diseases Intervention) Programme. Three preventive practices are analysed: reported blood pressure and blood cholesterol measurements and reported antismoking counseling during the last year. Data are presented separately for the general population and for people reporting specific chronic conditions (cardiovascular disease, respiratory disease and/or diabetes mellitus). RESULTS: Blood pressure measurement and antismoking counseling are more frequently reported to be carried out by primary health care physicians in the Eastern European areas while blood cholesterol measurement is more frequently reported in Western European countries. All these preventive activities are more frequently reported to be done among people with chronic conditions than in the population as a whole. CONCLUSIONS: Major differences have been found in reported preventive practices between Eastern and Western European countries. Great potential exists for chronic disease prevention among them.

Blood Pressure↗
PubMed2001

Smoking cessation between teenage years and adulthood.

Most smokers begin smoking in adolescence. It is less well known how young people quit smoking and the factors that are associated with this process. A 15-year follow-up study on the North Karelia Youth Project has made it possible to assess these factors using a longitudinal study design. The project began in 1978 with students in Grade 7 of junior high school (age 13 years) and concluded in 1980 when the students reached Grade 9 (age 15 years). The follow-up study included four additional surveys. The present analyses are based on the data collected at ages 15, 21 and 28. The original sample comprised 903 students and the response rate of the last survey was 71%. A quarter (26%) of daily smokers and about half (46%) of occasional smokers at age of 15 had quit by the age of 28. The cessation rate was higher among females than males (P = 0.006). The cessation rate was higher among married (P = 0.015), employed (P = 0.01) and white-collar workers (P = 0.006). Cessation was less prevalent among those who had friends (P < 0.001) and family (P = 0.012) members who smoked. The cessation rate was lower among those who consumed fatty milk (P = 0.050), had less leisure-time physical activity (P = 0.032) and consumed more alcohol (P < 0.001). One-third of all teenage smokers stop smoking before the age of 28, averaging a 2.3% annual decline. Cessation is greater among occasional than daily smokers and greater overall among females.

Adolescent↗
PubMed2001

Self rated health and mortality: a long term prospective study in eastern Finland.

STUDY OBJECTIVE: To assess the relation between self rated health and mortality over a period of 23 years, taking into account medical history, cardiovascular risk factors, and education at the beginning of the follow up. DESIGN: A cohort of random population samples. The baseline studies included a self administered questionnaire and a health examination. Mortality data were collected from the national mortality register using personal identification numbers. SETTING: The provinces of North Karelia and Kuopio in eastern Finland. PARTICIPANTS: Random samples of working age people (n=21 302) from the population register. MAIN RESULTS: For self rated health, the age adjusted poor to good relative risk for all cause mortality was 2.36 (95% confidence intervals 2.10, 2.64) for men and 1.90 (1.63, 2.22) for women, and for cardiovascular mortality 2.29 (1.96, 2.68) for men and 2.34 (1.84, 2.96) for women. Adjusted for selected potentially fatal diseases from the subjects' medical histories, cardiovascular disease risk factors, and education, the corresponding relative risks for all cause mortality were 1.66 (1.47, 1.88) for men and 1.50 (1.26, 1.78) for women, and for cardiovascular mortality 1.54 (1.29, 1.82) for men and 1.63 (1.26, 2.10) for women. The association between self rated health and mortality attributable to external causes was fairly strong. CONCLUSIONS: Poor self rated health is a strong predictor of mortality, and the association is only partly explained by medical history, cardiovascular disease risk factors, and education.

Adult↗