BACKGROUND: Coronary heart disease mortality has declined in Finland by 55% among men and 68% among women between 1972 and 1992. About three-quarters of this decline has been explained by changes in the main coronary risk factors, the decrease in serum cholesterol being the most important one. The aim of this study was to analyze to what extent dietary changes could explain the change in serum cholesterol. METHODS: Cardiovascular risk factor surveys have been carried out in Finland from 1972 to 1992 at 5-year intervals. Dietary surveys were carried out in connection with these surveys in 1982 and 1992. An earlier, representative dietary survey carried out in 1969-1972 was used as the baseline measure for diet. RESULTS: The total fat content of the Finnish diet changed from 38% of energy to 34%, saturated fat from 21 to 16%, and polyunsaturated fat from 3 to 5% and the intake of cholesterol decreased by 16%. Based on Keys equation these changes could have decreased serum cholesterol level by 0.6 mmol/liter (23 mg/dl) in both genders. A shift from boiled to filtered coffee could have further decreased serum cholesterol by 0.3 mmol/liter (11 mg/dl). Thus, these changes together could explain the total change in serum cholesterol, which has been on average 1.0 mmol/liter (38 mg/dl). Several other changes in the diet have also been favorable. Fruit and vegetable consumption has increased two- to three-fold during this time period. Supplementation of fertilizers with selenium since 1985 has tripled the intake of selenium. CONCLUSIONS: Dietary changes seem to explain the decrease in serum cholesterol. Together with a decline in smoking among males as well as better blood pressure control they have contributed to the dramatic decline in coronary heart disease mortality in Finland.

Adult↗

PubMedDate not supplied

Trends in self-rated health in Finland 1972-1992.

BACKGROUND: Self-rated health is a useful indicator of the population's health. Yet follow-up studies on perceived health trends are scarce. The aim of this paper is to assess perceived health trends in Finland between 1972 and 1992. METHODS: Five cross-sectional studies were done in two areas in eastern Finland every 5th year since 1972 and in a third area in southwestern Finland since 1982. The total number of respondents was 33,962. The respondents filled in a questionnaire, followed by a health examination. The subjects were categorized by age, education, and household income. RESULTS: In 1972, one-third of the population reported good health, whereas in 1992 the rates were 50 and 60% for men and women, respectively. Younger persons reported better general health than older persons. High education and high household income were undisputed indicators of good health. Among men, their importance as predictors of good health diminished during the 20 years. CONCLUSIONS: Finnish people today not only live longer but also feel healthier. In order to achieve good health for all population groups we need continual efforts to diminish the socioeconomic disparities.

Adult↗

PubMedDate not supplied

Does prevention of cardiovascular diseases lead to decreased cost of illness? Twenty years of experience from Finland.

BACKGROUND: During the past 20 years the age-standardized cardiovascular disease mortality rate has declined in Finland by 50%. The aim of this study was to examine the social cost consequences of this decline. METHODS: The prevalence-based cost-of-illness analysis was applied to estimate both direct and indirect costs of cardiovascular disease in 5-year intervals from 1972 to 1992 (in 1992 prices). Summary data from the national registers covered all persons with cardiovascular disease who were treated, received sickness insurance benefits, or died from the disease. RESULTS: Direct health care costs increased, but the decline in indirect costs overcompensated that increase. The total cost among all persons age 35 and over, including the retired, was $2.7 billion in 1972 and $2.6 billion in 1992, which is a 4% decrease. In the age group of 35-64 years the total costs fell from $2.5 billion to $1.9 billion (25%). In terms of cost per capita the decline was 26 and 40% in the respective age groups. CONCLUSIONS: The costs of cardiovascular disease decreased since 1972. However, total costs declined clearly less than the cardiovascular disease mortality rate. This implies that considerable savings in total costs, especially in direct health care costs, may not be expected as a result of even very successful prevention programs.

Adult↗

PubMedDate not supplied

Evaluation of a national Quit and Win contest: determinants for successful quitting.

BACKGROUND: Within the CINDI framework, a European "Quit and Win" contest was organized in 1994. In Finland the number of participants was 5,879 (0.6% of smokers). In the CINDI demonstration area, North Karelia (NK), the participants numbered 618 (2.0% of smokers). This study compared abstinence maintenance among the participants in NK with the rates found elsewhere in Finland and analyzed determinants for successful quitting. METHODS: A follow-up study was conducted 12 months after the quit date with a sample of 2,114 participants. Response rates of 67-68% were achieved (n = 1,419). The abstinence was assessed at 1, 6, and 12 months. Two estimates are presented: (1) the proportion of abstainers among the respondents and (2) the proportion of abstainers among the sample, considering all nonrespondents smokers. The determinants for maintenance of smoking cessation were analyzed with logistic regression. RESULTS: Using the first estimate, the rates at 1/6/12 months were 75/36/28% in NK and 70/28/21% elsewhere (P < 0.01). Using the second estimate, the corresponding rates were 50/24/19% in NK and 46/19/14% elsewhere. The most significant determinants for successful quitting were sex, age, marital status, level of withdrawal symptoms, previous quitting attempts, and support received. CONCLUSIONS: The recruitment of smokers and the maintained cessation were more successful in the demonstration area. The difference between areas was explained by differences in the combined professional and lay support and by the sex and age distributions.

Adult↗

PubMedDate not supplied

Impact of unhealthy behaviors on cardiovascular mortality in Finland, 1978-1993.

BACKGROUND: Our aim was to study how combinations of three unhealthy behaviors (smoking, physical inactivity, and use of dairy fat) and an index describing their number were associated with the risk of cardiovascular mortality in a society showing remarkable improvement in health behaviors. METHODS: The material consisted of random samples of annual adult health behavior surveys from 1978 to 1991; included were 8,869 men and 10,105 women ages 45 to 64 years. The mortality follow-up covered Years 1978 to 1993. The study period was divided into four phases on the basis of number of deaths and timing of health behavior changes. Poisson multivariate models were used to determine the risk of cardiovascular mortality by all combinations of unhealthy behaviors and the index. In the models age, education, chronic morbidity, and body mass index were adjusted for. RESULTS: Each unhealthy behavior was found to be a risk factor for cardiovascular mortality when the whole study period was examined. Among men, daily smoking was a significant predictor of cardiovascular mortality in the first three phases, among women in the first and third phase. Among men physical inactivity became significant only in the last phase, among women in all except the last phase. The combinations of physical inactivity with use of dairy fat or with smoking were more significant for women than for men. The combination of smoking and use of dairy fat was significant only for men. The association of the index with cardiovascular mortality was slightly stronger among women than among men. CONCLUSIONS: The predictive values of unhealthy behaviors on cardiovascular mortality changed by period depending on their frequency. The combinations of unhealthy behaviors are to be preferred over the index in description of lifestyle determinants of cardiovascular mortality.

Cardiovascular Diseases↗

PubMedDate not supplied

Retrobulbar/peribulbar block with 0.2% ropivacaine or 1% lidocaine for transscleral cyclophotocoagulation or retinal panphotocoagulation.

BACKGROUND AND OBJECTIVES: Brief analgesia is needed to complete krypton laser cyclophotocoagulation for glaucoma patients and is advantageous in argon laser panphotocoagulation for diabetic retinopathy. We studied whether 0.2% ropivacaine, known for analgesia with minimal motor block or 1% lidocaine, with rapid onset and short duration of action, both supplemented with hyaluronidase, are suitable local anesthetics for retrobulbar/peribulbar block for these procedures. METHODS: Seventy-four treatment sessions of 65 patients were included in this prospective, randomized, double-blind study. Data were collected on adequacy of analgesia, need for supplementary blocks and eye movements at 10 minutes after injecting the block and at the end of the treatment, and need for patching the eye at discharge. RESULTS: Frequency of inadequate analgesia (24% in ropivacaine group and 32% in lidocaine group), and of supplementary blocks (11% and 14%, respectively) did not differ between the groups and exceeded our clinically acceptable level. Ropivacaine produced less motor block than lidocaine at 10 minutes (P < .001) and at the end of the treatment (P = .002). However, at discharge, the eye was significantly more often patched in the ropivacaine (70%) group than in the lidocaine group (41 %) (P = .035). In the ropivacaine group, a mobile eye did not predict inadequate intraoperative analgesia, whereas in the lidocaine group it did (P = .001). CONCLUSION: According to our preliminary data, neither 0.2% ropivacaine nor 1% lidocaine reached acceptable frequencies of adequate analgesia during transscleral cyclophotocoagulation, while all retinal panphotocoagulations could be completed under the initial block.

Adult↗

PubMedDate not supplied

Impact of mass media and interpersonal health communication on smoking cessation attempts: a study in North Karelia, 1989-1996.

This article summarizes an impact evaluation of the North Karelia Project (Finnish CINDI program) on smoking cessation attempts. During the period 1989-1996, data were collected by annual surveys, with response rates varying from 66% to 76%. This study included 1,694 adult current smokers or persons who had quit smoking during the past year, out of a total of 6,011 respondents. Smoking cessation attempts during the past 12 months were examined as a dependent variable. Reported exposures to mass media and interpersonal health communication were examined as possible determinants of smoking cessation. Weekly exposure to mass media health messages was significantly associated with cessation attempts among men only. In contrast, interpersonal health communication, or social influence, was a significant determinant of cessation attempts among both sexes. Exposure to both mass media and interpersonal health communication had an even stronger impact on cessation attempts. Thus, interpersonal communication appears to be an important catalyst of community programs, and its inclusion should be emphasized to obtain a higher impact with community programs.

Adolescent↗

PubMedDate not supplied

Effect of a diet low in saturated fatty acids on plasma lipids, lipoproteins, and HDL subfractions.

The effect on serum high density lipoprotein subfractions of a low fat diet with a high ratio of polyunsaturated-to-saturated fatty acids was studied in 38 middle-aged volunteers (19 men and 19 women) in North Karelia, Finland. The mean serum HDL2 cholesterol decreased from 32 +/- 2 mg/dl (mean +/- SE) to 28 +/- 2 mg/dl (p less than 0.001) during the experimental diet and returned to 33 +/- 2 mg/dl (p less than 0.001) after a return to the original diet. No changes were observed in the concentration of HDL3 cholesterol. A highly significant decrease was observed in serum apoprotein A-I concentration, but not in apoprotein A-II concentration during the experimental diet. It is concluded that a low-fat, high-P/S ratio diet lowers LDL and HDL2 cholesterol in healthy volunteers, but does not influence the level of HDL3 subfraction.

Apoproteins↗

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Reduction of blood pressure associated with dietary polyunsaturated fat.

Evidence linking the beneficial effect of dietary polyunsaturated fat on systolic and distolic blood pressure is reported. Under controlled dietary conditions, i.e., when the polyunsaturated fat to saturate fat ratio (P/S) is maintained at about 1.0, with fat providing 25% of total energy intake, blood pressure is significantly lowered in healthy males and females in the 40- to 60-year age group. The subjects selected for these studies were either normotensive or mildly hypertensive. When the subjects resumed their usual diets, their blood pressures reverted to baseline values. Body weights of the subjects remained relatively constant in these studies, and sodium chloride intakes averaged 8 to 12 g per day. It is suggested that the lowering of blood pressure by dietary linoleic acid is mediated through prostaglandins.

Adult↗

PubMedDate not supplied

North Karelia (Finland) hypertension detection project. Five-year follow-up of hypertensive cohort.

A 5-year follow-up study of a random sample of middle-aged hypertensives indicated that the North Karelia (Finland) Hypertension Detection Project was effective in reducing blood pressure levels. This analysis indicated that the intensification of drug treatment caused marked blood pressure reduction in the community, especially among individuals with previously undetected cases of hypertension. Reduction of blood pressure levels among nontreated persons was observed in this study and may reflect in part the importance of both active case finding and follow-up including health education and preventive services. The community approach used in this study reached and brought under control most of those people who were undetected at the beginning of the study and most of the hypertensives. On the basis of the results, it is concluded that a well-organized hypertension control program can meet the challenge of hypertension care and benefit millions of people throughout the world.

Adult↗

PubMedDate not supplied

Relation of blood pressure, serum lipids, and smoking to the risk of cerebral stroke. A longitudinal study in Eastern Finland.

The impact of blood pressure, serum cholesterol and triglycerides, and smoking on the risk of cerebral infarction and other stroke was studied by a longitudinal design. A random sample of the population aged 35-59 years in two counties of Eastern Finland was examined in 1972, with a participation rate of 92 per cent. In subjects (both sexes) standardized epidemiological measurements on blood pressure, height, weight, and serum lipids were made and questionnaire data were obtained on smoking. The cohort was followed for seven years by means of national hospital discharge and death certificate registers. During the follow-up 77 men and 65 women had a cerebral stroke. Based on multiple logistic risk function analysis, age, smoking, blood pressure, and history of previous stroke and diabetes turned out to be independent predictors of both cerebral infarction and other strokes in men. Diastolic blood pressure of 100 mm Hg or more was associated with a 1.9-fold (90% CI = 1.1-3.6) risk of cerebral infarction in men and 2.5-fold (90% CI = 1.1-5.6) risk in women with no previous stroke. In men 37% (90% CI = 21-53%) of all cerebral strokes were attributable to systolic blood pressure of 150 mm Hg or more and 27% (90% CI = 11-42%) to diastolic blood pressure of 95 mm Hg or more.

Adult↗