Search PubMed⌕ Search

Biomedical subjects

P Puska

Publications and source records attributed to P Puska.

At least 217 records · Page 12Linked to original sources
PubMed1985

Ten years of the North Karelia project.

Medical and epidemiological research into the aetiology of CHD has drawn attention to the likely causal role of certain risk factors, especially elevated serum (LDL) cholesterol and blood pressure levels, and smoking. Conventional trials to establish the causality have come up against problems of feasibility and study design. Community-based studies have considerable potential in introducing changes to the general lifestyle and risk factors in large numbers of people (since the risk factors are closely related to the way of life and other features of the community). Thus a well evaluated community-based study can augment our knowledge on the role of the risk factors. Furthermore, a community study examines how the existing service structure and community resources can be used and assesses the overall feasibility and consequences of such an intervention. The North Karelia project, started in eastern Finland in 1972, has been a major community-based study on the prevention of CHD. The results of the 10-year evaluation of the project illustrate the feasibility and consequences of the approach. During the 10-year period 1972-82 the following net changes (i.e. adjusted for changes in the reference area) occurred in the risk factor means of the population aged 30-59 in North-Karelia: -28% for smoking (p less than .001), -3% for serum cholesterol (p less than .001) and -3% for systolic BP (p less than .001). During the period 1974-79 the age-standardized CHD mortality of men aged 30-64 was reduced by 22% in North Karelia, 12% in the reference area and 11% in the rest of Finland (p less than .05 compared with NK).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Dietary factors and hypertension.

There is increasing evidence that nutritional factors are critical in the pathogenesis of essential hypertension typical for acculturated societies. These factors include sodium, potassium, calcium, alcohol, and type and level of fat in the diet. More research is needed, however, before the role of various nutrients in the prevention and treatment of hypertension will be ascertained.

Caffeine↗
PubMed1985

Possibilities of a preventive approach to coronary heart disease starting in childhood.

Promotion in youth of lifestyles that are likely to result in optimum levels of cardiovascular risk factors is the basis for early prevention of cardiovascular diseases and promotion of health. Health behaviour is closely linked to the general lifestyle of an community. Thus for any long-term major change, a community-based approach is essential. Experience from the North Karelia project indicates that through a comprehensive community-based programme, health behaviour and risk factor levels of a whole country could be changed, and that resulted in reduction of coronary heart disease (CHD) in the area. Studies among children carried out as part of the North Karelia project have shown that children's smoking rates and nutrition habits can be influenced and their serum cholesterol levels can be modified. At least in Finland, family-based practical counselling and provision of social support seems to be an effective strategy in changing the nutrition habits of both adults and children. No evidence has been observed to indicate that this type of intervention would have any harmful emotional consequences among children. A study to show the impact of risk factor modification on coronary heart disease risk in adulthood is hardly feasible and, instead, studies to test the feasibility and effects of different intervention approaches for influencing health related behaviour and risk factors in children and adolescents should be emphasized.

Child↗
PubMed1985

Role of dietary fat in blood pressure control.

Three controlled intervention studies were carried out in North Karelia to study the possible role of dietary fat in the control of human blood pressure. All studies included middle-aged free-living couples (families) and a baseline (BS, 2 weeks), an intervention (IN, 6-12 weeks) and a switch-back (SB, 4-6 weeks) period. During IN the families were instructed to eat low fat (less than 25 en% instead of 39 en%), high P/S ratio diet (0.4-1.1 instead of 0.2). Salt and energy intake and other lifestyles were kept constant. In the first study the P/S ratio of the IN diet was 1.1. Both systolic and diastolic blood pressures decreased significantly during IN and increased back again during SB. The same results were obtained in the second study at P/S level 0.9 when a randomized group with 60% salt reduction and a control had little change in their blood pressure levels. In the third study the blood pressure reduction was again repeated during a 12 week IN period. The reduction was similar in two randomized groups with P/S 0.4 and 0.9, when both group had less than 25 en% of total fat. The results strongly support the hypothesis that dietary fat is related to human blood pressure, and that modification of dietary fat should be considered in the non-pharmacological prevention and management of hypertension.

Adult↗
PubMed1985

Concentration and composition of serum lipoproteins during a low-fat diet at two levels of polyunsaturated fat.

A 12-week dietary intervention was carried out among 40 families from North Karelia, a county in Finland with an exceptionally high rate of coronary heart disease and high serum cholesterol values. The proportion of dietary energy derived from fat was reduced during the 12-week intervention period from about 39% to 23% in all families. The families were randomly allocated into two groups. Twenty families consumed a diet with a polyunsaturated to saturated fat (P/S) ratio of 0.9 (group I), while the other 20 families had a diet with a P/S ratio of 0.4 (group II). Total serum cholesterol decreased by 16% and 9% in men of groups I and II, respectively, and by 16% in women of both groups. These changes were due to a decrease in both low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol. LDL cholesterol and phospholipid reached minimum values after 6 weeks on both intervention diets, but LDL protein responded more slowly. Thus, after 6 weeks LDL had an altered composition containing less cholesterol and phospholipids and more protein and triglycerides than during the baseline diet. During the intervention, the linoleic acid content in the serum cholesteryl ester fraction increased, and the magnitude of this change correlated negatively with the changes in total and LDL cholesterol. The decrease in HDL cholesterol during the two intervention diets was due to a fall in the HDL2 cholesterol (29% and 24% in men, and 26% and 25% in women in groups I and II, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Diet and serum sex hormones in healthy men.

The possible effect of dietary fat content and the ratio of polyunsaturated to saturated fatty acids (P/S-ratio) on serum sex hormones was studied in 30 healthy male volunteers. The customary diet of the subjects, which supplied 40% of energy as fat (mainly from animal sources, P/S-ratio 0.15) was replaced for a 6 weeks period by a practically isocaloric experimental diet containing significantly less fat (25% of energy) with a higher P/S-ratio (1.22) and other environmental factors were stabilized. Serum testosterone and 4-androstenedione decreased from 22.7 +/- 1.1 nmol/l to 19.3 +/- 1.2 nmol/l, (SEM, P less than 0.001) and from 4.6 +/- 0.2 nmol/l to 4.3 +/- 0.2 nmol/l (SEM, P less than 0.01), respectively. These changes were paralleled by a reduction in serum free (non-protein bound) testosterone (P less than 0.01) suggesting a possible change in biological activity. During the low fat period a significant negative correlation between serum prolactin and androgens was observed. All the changes in androgen levels were reversible. With the exception of a small but non-significant decrease in serum estradiol-17 beta, the other hormone parameters were practically unaffected by the dietary manipulation. Our results indicate that in men a decrease in dietary fat content and an increase in the degree of unsaturation of fatty acids reduces the serum concentrations of androstenedione, testosterone and free testosterone. The mechanism and importance of this phenomenon is discussed in the light of epidemiological and experimental data.

Adult↗
PubMed1984

Acute effects of marathon running on levels of serum lipoproteins and androgenic hormones in healthy males.

The acute effects of marathon (42.2 km) running on serum lipid and lipoprotein levels, particularly high-density lipoprotein (HDL) subfractions HDL2 and HDL3, and on levels of serum androgenic hormones, luteinizing hormone (LH), and testosterone were studied in 20 healthy non- champion -class joggers participating in the First North Karelian Heart Marathon. Serum triglyceride and cholesterol levels were unchanged after the marathon, whereas the lipoprotein distribution of both lipids was significantly altered. Very-low-density lipoprotein triglyceride (VLDL-TG) and cholesterol (VLDL-C) levels decreased significantly, whereas low-density lipoprotein triglyceride (LDL-TG) but not cholesterol (LDL-C) levels were increased, suggesting an accumulation of VLDL remnants in the LDL density range. HDL cholesterol (HDL-C) level rose significantly owing to an increase in HDL2-C. HDL3-C level remained the same. Serum levels of apolipoproteins A-I and A-II, the main apolipoprotein constituents of HDL, did not change during the marathon but their distribution between the HDL subfractions differed, indicating a conversion of HDL3 to HDL2. Serum levels of LH, testosterone, and sex-hormone-binding globulin (SHBG) all decreased during the marathon. The changes in levels of serum lipoproteins and androgenic hormones were not interrelated. We concluded that the short-term regulation of HDL levels during acute exhaustive exercise is controlled not by changes in serum androgenic hormones but by enhanced degradation of triglyceride-rich lipoproteins.

Adult↗
PubMed1984

Association between serum selenium and the risk of cancer.

A matched-pair analysis was conducted with data based on a prospective six-year follow-up of a random population sample to study the association between serum selenium and the risk of cancer. Case-control pairs were from a population, after exclusions, of 8,113 persons examined in 1972 from two counties in eastern Finland. Cases were 31- to 59-year-old men and women initially free of cancer. One control was matched to each case according to age, gender, daily tobacco consumption, and serum cholesterol concentration. The mean serum selenium of the 128 cases was 50.5 micrograms/liter and that of the controls was 54.3 micrograms/liter (p = 0.012 for difference). When the residual variation in tobacco consumption and serum cholesterol as well as that in four other possible confounders was allowed for in a multiple logistic model, serum selenium of less than 45 micrograms/liter was associated with a relative risk of cancer of 3.1 (95% confidence interval, 1.5-6.7, p less than 0.01). These data support the hypothesis that selenium deficiency increases the risk of certain cancers in middle-aged persons.

Adult↗
PubMed1984

Safety and effects of potassium- and magnesium-containing low sodium salt mixtures.

The main purpose of the present studies was to examine the safety of salt mixtures in which 35 or 55% of the NaCl in common table salt was replaced by potassium and magnesium salts. For 41 elderly hospitalized patients common salt from the hospital kitchen was replaced by Na+-K+-Mg2+ salt for 3-5 weeks; for in 85 drug-treated outpatients home use of NaCl was replaced by the use of Na+-K+-Mg2+ salt for 6 months. The patients' acceptance of the Na+-K+-Mg2+ salt was good. No metabolic or other side effects could be detected while the salt was being used. Na+-K+-Mg2+ salt was associated with a fall in blood pressure in drug-treated hypertensive patients, a rise in serum magnesium and in previously low serum potassium concentrations, a fall in raised fasting blood glucose levels, and an improvement in oral glucose tolerance. The results demonstrate that a considerable part of the NaCl in common table salt could be replaced by potassium and magnesium salts without causing potassium or magnesium toxicity. The results also lend support to the concept that an increase in potassium and magnesium intake and a decrease in sodium intake may have beneficial effects in a substantial number of people.

Aged↗
PubMed1984

Fish tapeworm, a disappearing health problem in Finland.

The occurrence of the tapeworm (Diphyllobothrium latum) in eastern Finland in 1975-81 was studied and findings were compared with previous results. The fish tapeworm has previously been shown to be a common health problem, especially in these parts of Finland. The prevalence rates of fish tapeworm eggs in large consecutive routine series of hospital laboratories have decreased to a level of 1-4% among the population. The results also indicate some possible differences in the rates and trends between different provinces in eastern Finland. The reasons for the occurrence and changing trends of the fish tapeworm in eastern Finland are discussed.

Diphyllobothriasis↗
PubMed1984

Changes in perceived heart disease risk and health during a community-based heart disease prevention program: the North Karelia project.

To test whether the cardiovascular disease declines in North Karelia were accompanied by subjective improvements in health, we analyzed responses to two questions about perceived risk of heart disease and health status on independent random population samples surveyed 10 years apart. Age stratified perceived risk of heart disease declined significantly more (p less than .01) and age stratified perceived health status improved significantly more in North Karelia than in the reference area (p less than .005).

Attitude to Health↗
PubMed1984

Message dissemination for a community-based cardiovascular disease prevention programme (the North Karelia Project).

The North Karelia Project was a community-based pilot programme in an Eastern Finnish community of 180,000 adults. During the intervention period from 1972 to 1977, the project successfully demonstrated that changing risk factors at the community level was feasible and could result in a significant reduction in disease rates. The North Karelia Project used mass media for dissemination of the message, but relied on face-to-face contact to persuade people to adopt the new lifestyles. Training seminars for professionals were a key programme component. On average, one seminar was conducted every two and a half weeks. Total project costs were only one per cent of the total health services costs for the county during the project. These findings suggest that community programmes can improve both subjective and objective cardiovascular health, and that the strategy of integrating funding into the project recruitment and commitment process is appropriate and may even be necessary for a successful community based heart disease prevention programme.

Adult↗
PubMed1984

Studies on the effect of dietary fat on blood pressure.

The role of dietary fat in the origin of human hypertension has aroused interest recently. Results from five intervention studies and from a cross-sectional international study are presented. Three of the intervention studies were carried out in Beltsville, Maryland, USA, and two were carried out in North Karelia, Finland. All the studies involved healthy people and diets typical of the areas concerned. During the experimental periods the diets were modified in such a way that the energy percentage from fats was lowered and the P/S ratio raised. Energy and salt intake were kept constant. The results showed that the blood pressure levels were consistently changed using various dietary fat modifications. The results give strong support to the hypothesis that dietary fat is associated with blood pressure.

Blood Pressure↗
PubMed1984

Changes in dietary habits and knowledge concerning salt during a community-based prevention programme for hypertension.

As part of the North Karelia Project a community-based intervention programme to reduce salt consumption was initiated in 1979. The aim of this three-year Salt Project was to evaluate the feasibility and effects of salt reduction in the population. Cross-sectional random population samples, aged 14 to 65 years, were examined both in North Karelia and the reference community in 1979 and 1982. The surveys included among other measurements 24-hour urine collection for Na and K excretion, a salt use index based on reported salt use and a knowledge index concerning salt and health. Changes in the salt intake level were very small. In men Na excretion increased slightly in North Karelia and stayed the same in the reference area. The Na/K ratio in North Karelian men increased significantly. The mean Na excretion level decreased slightly in women in both areas. The reduction in the Na/K ratio in North Karelian women and the decrease in the salt use index in women in both areas were significant. Further analyses showed that in both areas a significant reduction in Na excretion was found but only among normotensive women. There were no changes in the knowledge concerning salt. The feasibility of salt intake reduction was low partly due to insufficient environmental changes.

Adolescent↗
PubMed1984

Community-based prevention of hypertension in North Karelia, Finland.

A model programme for hypertension control in the community has been implemented in North Karelia, Finland, since 1972. The treatment status of the patients was improved and blood pressure levels were reduced during 1972 to 1977. This improvement started to level off during 1977 to 1982, although more than 10% of the population aged 35-64 years were treated with antihypertensive drugs. Several analyses were done to find out which dietary factors contributed to the blood pressure level and to its change in the community. The study material consisted of random samples of the population aged 30-59 years in two counties in Eastern Finland, who participated in the surveys in 1972, 1977 and 1982. The analyses confirmed that high BMI, high fat intake, alcohol drinking and high Na intake were associated significantly with blood pressure and also with its change both in the general population and in hypertensive persons. The high levels of these nutritional factors were also associated with unsatisfactory outcome of drug treatment in the hypertensive patients. Thus, it is likely that nutritional changes that can reduce the levels of BMI, the intake of fat, alcohol, and Na would contribute significantly both to primary prevention and to the effective treatment of elevated blood pressure in the community. In Eastern Finland the levels of alcohol intake have increased both in men and women, BMI increased in men and decreased in women and serum cholesterol levels dropped both in men and women between 1972 to 1982. The results of a community-based programme to reduce salt intake in North Karelia from 1979 to 1982 confirmed that Na intake level is high in Finland. The North Karelia Salt Project showed that it is difficult to reduce salt intake at the community level during a three-year period. A slight reduction in Na intake was seen only in women both in North Karelia and in the reference area. In men Na intake did not decrease. In conclusion our results suggest that primary prevention of hypertension at the community level is not easy and that a well conceived programme for a relatively long time period is needed.

Adolescent↗