Coronary heart disease and stroke in developing countries: time to act.
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Coronary Disease↗
Biomedical subjects
P Puska
Publications and source records attributed to P Puska.
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↗
Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study.
OBJECTIVE: To examine socioeconomic differences in case fatality and prognosis of myocardial infarction (MI) events, and to estimate the contributions of incidence and case fatality to socioeconomic differences in coronary heart disease (CHD) mortality. DESIGN: A population-based MI register study. METHODS: The FINMONICA MI Register recorded all MI events among persons aged 35-64 years in three areas of Finland during 1983-1992. A record linkage of the MI Register data with the files of Statistics Finland was performed to obtain information on socioeconomic indicators for each individual registered. First MI events (n=8427) were included in the analyses. MAIN RESULTS: The adjusted risk ratio of prehospital coronary death was 2.11 (95% CI 1.82, 2.46) among men and 1.68 (1.14, 2.48) among women with low income compared with those with high income. Even among persons hospitalised alive the risk of death during the next 12 months was markedly higher in the low income group than in the high income group. Case fatality explained 51% of the CHD mortality difference between the low and the high income groups among men and 38% among women. Incidence contributed 49% and 62%, respectively. CONCLUSIONS: Considerable socioeconomic differences were observed in the case fatality of first coronary events both before hospitalisation and among patients hospitalised alive. Case fatality explained a half of the CHD mortality difference between the low and the high income groups among men and more than a third among women.
Adult↗
Socioeconomic inequalities in the incidence, mortality and prognosis of subarachnoid hemorrhage: the FINMONICA Stroke Register.
Low socioeconomic status (SES) is associated with increased mortality from stroke, but usually no distinction is made between stroke subtypes. We analyzed the relationship of SES with mortality and morbidity of subarachnoid hemorrhage (SAH). In the FINMONICA Stroke Register, 956 consecutive SAH events were recorded during 1983-1992 in patients aged 25-74 years. We used taxable income stratified into three categories, low, middle, and high, as an indicator of SES. The age-standardized incidence of SAH among men and women aged 25-44 years was approximately three times higher in the low-income group than in the high-income group. In older individuals, differences between the income groups were less pronounced. Among survivors of the acute stage, a poorer prognosis was observed in patients with low income than in those with high income. In conclusion, there is a clear excess mortality and morbidity of SAH in young individuals with low income, particularly among men.
Adult↗
Socioeconomic differences in the incidence, mortality and prognosis of intracerebral hemorrhage in Finnish Adult Population. The FINMONICA Stroke Register.
We examined the association of socioeconomic status (SES) with the incidence, mortality and case fatality of intracerebral hemorrhage (ICH). During 1982-1992, 909 ICH events were registered among persons aged 25-74 years. Taxable income was used as an indicator of SES. It was stratified into three categories: low, middle and high. The age-standardized incidence and mortality of ICH were significantly higher in the low- than in the high-income group in both genders. Among men aged 25-59 years, the adjusted odds ratio (OR) of ICH death within 1 year after the onset of the event was twice as high in the low-income group as in the high-income group (OR = 2.12, 95% confidence interval 1.02-4.40). In conclusion, marked socioeconomic differences were found in the incidence and mortality of ICH, in particular among working aged men.
Adult↗
Socioeconomic status and ischemic stroke: The FINMONICA Stroke Register.
BACKGROUND AND PURPOSE: It has been shown that low socioeconomic status is associated with death from stroke. More-detailed data have, however, remained scanty. The purpose of the present study was to examine the association of socioeconomic status with ischemic stroke. Besides mortality, we analyzed the incidence, case-fatality ratio, and prognosis of ischemic stroke events. METHODS: Our population-based study included 6903 first stroke events registered by the FINMONICA Stroke Register in 3 areas of Finland during 1983 to 1992. Indicators of socioeconomic status, such as taxable income and education, were obtained by record linkage of the stroke register data with files of Statistics Finland. RESULTS: Incidence, case-fatality ratio, and mortality rates for ischemic stroke were all inversely related to income. Furthermore, 28 days after the onset of symptoms, a greater proportion of patients with low income than of those with high income was still in institutionalized care and/or in need of help for their activities of daily living. Population-attributable risk of the incidence of first ischemic stroke due to low socioeconomic status was 36% for both sexes. For the death from first ischemic stroke, it was 56% for both sexes. CONCLUSIONS: Persons with low socioeconomic status have considerable excess rates of morbidity and mortality from ischemic stroke in Finland. A reduction in this excess could markedly decrease the burden of ischemic stroke to the society and thus constitute an important public health improvement.
Adult↗
Trends in cigarette smoking in 36 populations from the early 1980s to the mid-1990s: findings from the WHO MONICA Project.
OBJECTIVES: This report analyzes cigarette smoking over 10 years in populations in the World Health Organization (WHO) MONICA Project (to monitor trends and determinants of cardiovascular disease). METHODS: Over 300,000 randomly selected subjects aged 25 to 64 years participated in surveys conducted in geographically defined populations. RESULTS: For men, smoking prevalence decreased by more than 5% in 16 of the 36 study populations, remained static in most others, but increased in Beijing. Where prevalence decreased, this was largely due to higher proportions of never smokers in the younger age groups rather than to smokers quitting. Among women, smoking prevalence increased by more than 5% in 6 populations and decreased by more than 5% in 9 populations. For women, smoking tended to increase in populations with low prevalence and decrease in populations with higher prevalence; for men, the reverse pattern was observed. CONCLUSIONS: These data illustrate the evolution of the smoking epidemic in populations and provide the basis for targeted public health interventions to support the WHO priority for tobacco control.
Adult↗
Attitudes towards war, killing, and punishment of children among young people in Estonia, Finland, Romania, the Russian Federation, and the USA.
OBJECTIVE: To study the cultural differences in moral disengagement, which lends support to attitudes used to justify violence. METHODS: We carried out classroom surveys of a total of 3122 students in the USA (Houston, TX, and Washington, DC) and in four European countries--Estonia (Tartu), Finland (Helsinki), Romania (Satu Mare) and the Russian Federation (St Petersburg). Data were also taken from a random sample telephone survey of 341 young adults (aged 18-35 years) in Texas, USA. Ten distinct groups were studied. Seven questions were common to all the surveys, using identical statements about the participants' agreement with attitudes relating to war, diplomacy, killing, and the punishment of children. FINDINGS: The US students were more likely than those in Europe to agree with the following statements: "War is necessary" (20% vs 9%), "A person has the right to kill to defend property" (54% vs 17%), and "Physical punishment is necessary for children" (27% vs 10%). Justification of war and killing was less common among females than males in all groups; other differences within the US groups and the European groups were smaller than the differences between the US and European groups. CONCLUSION: The results confirm the gap between the US and European groups in moral disengagement attitudes and tendencies that could lead to deadly violence.
Adolescent↗
Nutrition and cardiovascular disease in Finland since the early 1970s: a success story.
This paper describes the Finnish experience on the population strategy to prevent cardiovascular disease with special reference to diet. Systematic work to lower the risk factors of cardiovascular disease started in the early 1970s with the North Karelia project and rapidly expanded to cover the whole country. The main aims were to change the type of fats used, to lower sodium intake and to increase vegetable and fruit consumption. Concurrently, a comprehensive monitoring system was developed including regular population surveys every five years. During the period 1972-1997 major changes took place in the diet as well as in blood pressure and serum cholesterol levels. At the same time, cardiovascular mortality decreased dramatically. The Finnish experience shows that dietary changes are possible but require a persistent and comprehensive intervention.
Animals↗
Relation of adult height to cause-specific and total mortality: a prospective follow-up study of 31,199 middle-aged men and women in Finland.
The purpose of this study was to analyze the association of adult height with cause-specific and total mortality. The study included 31,199 men and women aged 25-64 years who participated in a risk factor survey in 1972, 1977, 1982, or 1987 in eastern Finland. The cohorts were followed until the end of 1994. The relation between height and mortality was assessed by using Cox proportional hazard models. The authors found that height was associated inversely with most of the measured risk factors and directly with socioeconomic status. For both genders, height was inversely associated with cardiovascular and total mortality; the age- and birth-cohort-adjusted risk ratios per 5 cm increase in height were 0.89 and 0.91 for men and 0.86 and 0.90 for women, respectively. The inverse association also remained after adjustment for the other known risk factors. For men, an independent inverse association also was found between height and mortality from chronic obstructive pulmonary disease and from violence and accidents. Cancer mortality was not associated with height. Thus, genetic factors, and environmental factors during the fetal period, childhood, and adolescence, which determine adult height, appear to be related to a person's health later in life.
Accidents↗
Relationship of socioeconomic status to the incidence and prehospital, 28-day, and 1-year mortality rates of acute coronary events in the FINMONICA myocardial infarction register study.
BACKGROUND: Low socioeconomic status (SES) is associated with increased coronary heart disease mortality rates. There are, however, very little data on the relation of SES to the incidence, recurrence, and prognosis of myocardial infarction (MI) events. METHODS AND RESULTS: The FINMONICA MI Register recorded detailed information on all MI events among men and women aged 35 to 64 years in 3 areas of Finland during the period of 1983 to 1992. We carried out a record linkage of the MI register data with files of Statistics Finland to obtain information on indicators of SES, such as taxable income and education, for each individual who is registered. In the analyses, income was grouped into 3 categories (low, middle, and high), and education was grouped into 2 categories (basic and secondary or higher). Among men with their first MI event (n=6485), the adjusted incidence rate ratios were 1.67 (95% CI 1.57 to 1.78) and 1.84 (95% CI 1.73 to 1.95) in the low- and middle-income categories compared with the high-income category. For 28-day mortality rates, the corresponding rate ratios were 3.18 (95% CI 2.82 to 3.58) and 2.33 (95% CI 2.03 to 2.68). Significant differentials were observed for prehospital mortality rates, and they remained similar up to 1 year after the MI. Findings among the women were consistent with those among the men. CONCLUSIONS: The excess coronary heart disease mortality and morbidity rates among persons with low SES are considerable in Finland. To bring the mortality rates of low- and middle-SES groups down to the level of that of the high-SES group constitutes a major public health challenge.
Adult↗
International quit and win 1996: standardized evaluation in selected campaign countries.
BACKGROUND: Quit and Win '96 recruited 70,000 smokers in 25 countries. The participants tried to abstain from smoking for at least 4 weeks. All participating countries followed the jointly agreed rules. Half of the countries implemented the campaign nationally and half, regionally. METHODS: A 1-year follow-up study was conducted in the participating countries. The aim of this study was to provide a standardized evaluation based on data from eight European campaign sites. Three measures were used to evaluate the effectiveness of the campaigns. The first measure was the participation rate, which is the proportion of participants among the smoking population targeted in each site. The second measure was a cautious estimate for the continuous 1-year abstinence rate, which is the proportion of abstainers among the follow-up sample regarding all non-respondents as relapsed. Third was the measure of the population impact, which is the efficacy of the intervention multiplied by its reach, where the efficacy equals the abstinence rate and the reach equals the participation rate. RESULTS: The participation rates varied from 0.1 to 2%, being highest in North Karelia, Finland, and Pitka;auranta, Russia. The abstinence rates varied from 12 to 35%, being highest in Hungary, Ukraine, and Russia, where the prevalence of smoking is also relatively high. The population impacts varied from 0.02 to 0.5%, being highest in Pitka;auranta, where both the reach and the efficacy of the Quit and Win were relatively high. CONCLUSIONS: There was great variation in effectiveness, with population impact being affected more by participation rate than abstinence rate. Quit and Win contests are feasible interventions in diverse European populations. To improve the effectiveness, future campaigns should increase the reach of the intervention.
Adult↗
Corneal thickness and corneal endothelium in normotensive subjects with unilateral exfoliation syndrome.
PURPOSE: To examine the central corneal thickness (CCT) and corneal endothelium in both eyes of patients with unilateral exfoliation syndrome (EXS). To determine the effect of CCT on the measurement of intraocular pressure (IOP). METHODS: In this cross-sectional clinical study, comparisons were made of CCT (Humphrey Ultrasonic Pachometer), corneal endothelial cells (Keeler-Konan contact specular microscope) and IOP (Goldmann applanation tonometer) between the exfoliative (E) and fellow nonexfoliative (NE) eyes in 40 normotensive patients with unilateral EXS. The CCT was used to obtain a corrected value for the IOP. RESULTS: The E eyes had significantly higher values for CCT (0.528+/-0.030 vs 0.523+/-0.032 mm, P<0.01) and IOP (15.7+/-3.6 vs 14.4+/-2.9 mmHg, P<0.001) than the fellow NE eyes. The paired E and NE eyes did not differ in endothelial cell density (2779+/-540 vs 2870+/-386 cells/mm2), in the coefficient of variation of cell size (0.25+/-0.03 vs 0.26+/-0.03) or in the frequency of hexagonal cells (80.5+/-6.5 vs 82.0+/-5.0%). After correcting IOP for CCT, the E eyes still had significantly higher IOP than the NE eyes (15.1+/-4.4 vs 14.2+/-3.7 mmHg, P<0.05). CONCLUSION: Normotensive eyes with early EXS did not have quantitative (cell density) or qualitative (variation in cell size, frequency of hexagonal cells) morphological changes in corneal endothelium, but had higher values for IOP and CCT. After correcting IOP for CCT, the E eyes still had significantly higher IOP than the fellow NE eyes.
Aged↗
Heavy coffee drinking and the risk of suicide.
Earlier research has implicated coffee drinking as a possible protective factor for suicide. We followed-up 43,166 subjects for the mean 14.6 years, and 213 suicides were committed. Daily coffee drinking had a J-shaped association with the risk of suicide. Using the Cox model we controlled for potential covariates, and found that among heavy coffee drinkers (> or = 8 cups/day) the risk of suicide was 58% higher compared with more moderate drinkers.
Adult↗
Image analysis to improve diagnosis of exfoliation.
PURPOSE: To improve visualization of exfoliation material in standard colour photographs by image analysis. METHODS: Standard anterior segment colour photographs taken from 17 patients with known exfoliation were subjected to film scanning with a maximum accuracy of 3175 dpi. RESULTS: Before image scanning, visualization of exfoliation was classified as barely visible in 10 (59%) patients and clearly visible in 7 (41%) patients. After the image scanning, exfoliation material became clearly visible in 13 (76%) patients and could easily be demonstrated. CONCLUSION: Diagnosis of exfoliation material can be improved by standard film scanning.
Anterior Eye Segment↗
Joint heavy use of alcohol, cigarettes and coffee and the risk of suicide.
AIMS: To estimate the relationship between joint heavy use of alcohol, cigarettes and coffee, and the risk of suicide in a general population with high rate of suicide. DESIGN: Prospective cohort analyses. SETTING: Finland. PARTICIPANTS: Data from 36,689 adult (age range 25-64 years) men and women who participated in the population surveys between 1972 and 1992. MEASUREMENTS: The mortality of the cohort was monitored for a mean of 14.4 years, which yielded 169 suicides. Criteria for heavy use of each psychoactive substance were defined as follows: alcohol (> 120 g/week), cigarettes (> or = 21/day) and coffee (> or = seven cups/day). FINDINGS: About half the men and 80% of the women did not use any of the psychoactive substances heavily. Every third man and every fifth woman used one substance heavily, and the prevalence for those who exceeded criteria for joint heavy use of two substances was 9% for men and 1% for women. Joint heavy use of all three substances was rare. The adjusted relative risk of suicide increased linearly with increasing level of joint heavy use of alcohol, cigarettes and coffee. Among subjects with heavy use of one substance the risk was 1.55 (95% CI = 1.10, 2.18), with joint heavy use of two substances 2.22 (95% CI = 1.37, 3.61), and with joint heavy use of all three substances 3.99 (95% CI = 1.80, 8.84) compared with no heavy use. CONCLUSIONS: Clustering of the heavy use of alcohol, cigarettes and coffee could serve as a new marker for increased risk of suicide.
Adult↗
Trends in lipid levels and hypercholesterolemia in hypertensive and normotensive finnish adults from 1982 to 1997.
OBJECTIVES: To assess the trends in lipid levels and awareness of hypercholesterolemia in hypertensive and normotensive population in Finland from 1982 to 97. DESIGN: Four independent cross-sectional population surveys conducted in 1982, 1987, 1992 and 1997. SETTING: The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland. SUBJECTS: Men and women aged 25-64 years, selected randomly from the national population register. The subjects were classified to four groups according to their blood pressure level and treatment status: normotensive, unaware hypertensive, aware but not treated hypertensive and treated hypertensive. The total number of participants was 24 083. MAIN OUTCOME MEASURES: We assessed the mean serum total cholesterol and HDL cholesterol concentrations, the prevalence of hypercholesterolemia (total cholesterol >/=6.5 mmol L-1 or the use of lipid-lowering drugs), the prevalence of a high ratio of total cholesterol to HDL cholesterol (ratio >/=5) and the awareness of hypercholesterolemia amongst the four study groups. RESULTS: Mean total cholesterol, the prevalence of hypercholesterolemia and the prevalence of a high ratio of total to HDL cholesterol decreased, whereas the awareness of hypercholesterolemia increased significantly in all study groups. The decline in mean total cholesterol was largest in treated hypertensive subjects of both sexes (13% in men, 14% in women). Mean HDL cholesterol increased significantly in all study groups except in the unaware hypertensive men, but it remained significantly lower in treated hypertensive patients in both sexes compared with the other groups (P < 0.001). CONCLUSIONS: The lipid profile of both the hypertensive and normotensive population has significantly improved in both the hypertensive and normotensive population in Finland from 1982-97. The introduction of newer antihypertensive drugs has not had any effect on the HDL cholesterol level amongst treated hypertensive patients at the population level.
Adult↗
Occasional smoking increases total and cardiovascular mortality among men.
The aim was to study whether occasional smoking increases mortality risk. The mortality of random samples of the Finnish Adult Health Behavior surveys from 1978 to 1991 were followed for 18 years from 1978 to 1995. Poisson models were used to determine the risk of total and cardiovascular mortality. It was found that occasional smokers were less often sedentary and had less often unhealthy diet than other smoking status groups. Occasional smoking among men was significantly related to the risk of both total (age-adjusted relative risk, RR, 1.6, 95% confidence interval, CI, 1.3-2.1) and cardiovascular mortality (age-adjusted RR 1.5, 95% CI 1.0-2.3). Controlling for education, period and chronic morbidity did not change results. Among women no significant associations could be established; when adjusted for age, period, education and morbidity the RR for cardiovascular mortality was 1.4 (95% CI 0.6-3.4) and total mortality 1.0 (95% CI 0.6-1.6). Occasional smoking is associated with increased risk of premature death, at least among men. Although occasional smoking is a less dangerous practice than regular smoking, it is not a safe alternative for daily smoking.
Adolescent↗