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Biomedical subjects

P Puska

Publications and source records attributed to P Puska.

At least 109 records · Page 6Linked to original sources
PubMed1995

Angiotensin-converting enzyme genotypes in the high- and low-risk area for coronary heart disease in Finland.

The deletion/deletion genotype of the insertion (I)/deletion (D) polymorphism of the angiotensin-converting enzyme (ACE) gene has been suggested to be a risk factor for myocardial infarction (MI). The objective of this study was to evaluate whether genotype distributions of the I/D polymorphism of the ACE gene are different between individuals from high-risk and low-risk areas for coronary heart disease in the genetically isolated population of Finland and to assess the impact of this genetic risk factor by comparing individuals with different parental histories of MI. Representative population-based samples of middle-aged men (n = 363) and women (n = 358) from two areas of Finland were used. The area had a borderline significant effect on the prevalence of the genotype DD (beta = 0.35, SE = 0.16, X2 = 470, df = 1, P = 0.03), the DD genotype being more prevalent in eastern Finland (the high-risk area). The II genotype was more prevalent in women with parental history of MI, so we could not replicate the previous findings of the risk-increasing effect of DD genotype in this sample. Although the observed difference in the ACE DD genotype between the high-risk and low-risk areas for coronary heart disease might represent one of the genetic factors contributing to the difference in risk of coronary heart disease between eastern and southwestern Finland, the data emphasize the fact that also other risk factors, including other genes, contribute to this difference and the high incidence of MI in Finland.

Adult↗
PubMed1995

The amount of lens exfoliation and chamber-angle pigmentation in exfoliation syndrome with or without glaucoma.

Correlations of the amount of chamber-angle pigmentation and exfoliation material with IOP and with image analysis of the optic discs are reported in the paired eyes of 63 persons with unilateral exfoliation syndrome, and 35 patients with unilateral capsular glaucoma. The effect on IOP of phenylephrine-induced pigmentary dispersion is examined. Chamber-angle pigmentation was more pronounced in capsular glaucoma than in the nonglaucomatous exfoliation eyes (p < 0.01), although the amount of lens exfoliation was the same. In nonglaucomatous exfoliative eyes IOP correlated significantly with the amount of chamber-angle pigmentation (p < 0.01) and exfoliation material (p < 0.05). The nonglaucomatous exfoliative eyes with grade > or = 2 trabecular pigmentation and those with reduction of IOP on phenylephrine provocation had smaller rim areas and rim/disc area ratios than the fellow eyes (p < 0.05). Rather than the amount of exfoliation, the main risk factor for glaucoma seems to be the degree of chamber-angle pigmentation.

Aged↗
PubMed1995

Coronary risk factor levels: differences between educational groups in 1972-87 in eastern Finland.

STUDY OBJECTIVE: To compare differences in coronary heart disease (CHD) risk factor levels between educational groups in the 1970s and 1980s in eastern Finland. DESIGN AND PARTICIPANTS: Independent, cross sectional population surveys were undertaken in 1972, 1977, 1982, and 1987 of randomly selected men and women aged 30-59 living in two provinces in eastern Finland. Altogether 20,096 subjects participated. The lowest observed level of participation in either sex or province in any year was 77%. Serum cholesterol values and blood pressure measurements, body mass index, smoking, and the level of education were determined in each survey using comparable methodology. MAIN RESULTS: More poorly educated men and women had higher levels of all risk factors at the end of the study period (1987). There was no change between 1972 and 1987 in differences between educational groups in mean serum cholesterol values and the diastolic blood pressure level in either sex, and in smoking in men. In women, the proportion of smokers was highest in the better educated in the 1970s but lowest in this group in the 1980s (interaction between year of examination and educational level p < 0.01). Differences between educational groups in mean body mass index increased with time in both men (p < 0.001) and women (p = 0.06). CONCLUSIONS: Relative differences between socioeconomic groups in CHD mortality have increased in Finland in the 1970s and 1980s. Present results from eastern Finland show no reduction in differences between educational groups in risk factor levels, and even some evidence of increasing differences. Although a comparison between mortality trends and risk factor trends is problematic, trends in the risk factors analysed do not seem to be a major cause for the increasing differences in CHD mortality in Finland, at least in men. On the other hand, the risk factor trends analysed show no progress towards reducing inequalities in health, a major goal of public health policy.

Adult↗
PubMed1995

Fatty acid composition of serum lipid fractions in relation to gender and quality of dietary fat.

UNLABELLED: The fatty acid compositions of serum lipid fractions are believed to reflect the quality of dietary fat, but only a few cross-sectional studies have examined these relationships in a representative free-living population. We related the composition of dietary fat obtained by 7-day food records from 84 free-living middle-aged married couples, on their habitual diets, to gas chromatographic analyses of the percentage compositions of fatty acids in three lipid fractions of fasting sera. Dietary polyunsaturated fat had Pearson's correlation coefficients of 0.63, 0.73 and 0.44 with n-6 polyunsaturated fatty acids in serum cholesteryl esters, triglycerides and phospholipids, respectively. Intake of fish showed correlations of 0.60, 0.36 and 0.52 with the percentage of eicosapentaenoate in the respective fractions. Dietary saturated fat had correlations of 0.57 and 0.54 with saturated fatty acids in serum cholesteryl esters and triglycerides, respectively. Dietary monounsaturated fat did not correlate positively with monounsaturated fatty acids in any serum lipid fraction. There were some small but significant gender differences in the serum fatty acid compositions. CONCLUSIONS: of the three serum lipid fractions, triglycerides appear to be the best reflectors of dietary polyunsaturated and saturated fat, but the intake of monounsaturated fat is poorly reflected in all serum lipid fractions. Intake of fish is mirrored in all serum lipid fractions, best in cholesteryl esters and phospholipids.

Adult↗
PubMed1995

Importance of risk factor clustering in coronary heart disease mortality and incidence in eastern Finland.

BACKGROUND: Smoking, a high serum cholesterol level and elevated blood pressure are the most important risk factors for coronary disease. Each of these major risk factors contributes independently to the risk of coronary disease, and clustering of the risk factors may increase the risk more than any of the factors alone. METHODS: This study is a 12-year prospective follow-up of 7928 men and 8530 women examined in eastern Finland. Risk factor categories were created by combining smoking status and dichotomized values of serum cholesterol level and blood pressure. Endpoints for the follow-up were either coronary death or a first coronary event (fatal or non-fatal). The effect of risk factor clustering was analyzed by assessing relative risks, mortality and incidence, and population-attributable risks in each of the risk-factor categories. RESULTS: The relative risks for coronary death and first coronary event in men with all three risk factors (smoking, serum cholesterol > or = 6.5 mmol/l and either systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg) were 11.8 and 7.3 respectively, compared with men with none of these factors. The corresponding risk ratios for women were 9.6 and 8.6. The 12-year coronary mortality varied between 10.0 deaths per 10000 person-years in men with none of the risk factors to 98.9 per 10000 person-years in men with all three risk factors. The 12-year incidences in men were 37.4 and 206.3 per 10000 person-years, respectively. The coronary mortality in women varied between 3.4 and 27.9 deaths per 10000 person-years and the incidence between 13.3 and 110.8 per 10000 person-years. Most of the population-attributable risk in men was associated with the combination of smoking with a high serum cholesterol level with elevated blood pressure. CONCLUSION: The results illustrate the public-health importance of these major risk of cardiovascular diseases.

Adult↗
PubMed1994

Serum cholesterol concentration and mortality from accidents, suicide, and other violent causes.

OBJECTIVE: To study the association of mortality from accidents, suicides, and other violent deaths with serum cholesterol concentration. DESIGN: Baseline measurements in two randomly chosen independent cohorts were carried out in 1972 and 1977. Mortality was monitored over 10-15 years through the national death registry. SETTING: Eastern Finland. SUBJECTS: The two cohorts comprised men (n = 10,898) and women (n = 11,534) born between 1913 and 1947. There were 193 deaths due to accidents, suicides, and violence among men and 43 among women. MAIN OUTCOME MEASURE: Mortality from accidents, suicides, and other violent deaths was used as the end point. Deaths from these causes were pooled together in the analyses. RESULTS: Serum cholesterol concentration was not associated with mortality from accidents, suicides, and other violent deaths in the univariate analyses or in the proportional hazards regression analyses including smoking, systolic blood pressure, alcohol drinking, and education. In both genders smoking was more prevalent among those who died from accidents, suicides, and other violent causes than from other causes. Frequent use of alcohol increased mortality from these causes. CONCLUSION: The risk of accidents, suicides, and other violent deaths was not related to serum cholesterol concentration, whereas such deaths were more prevalent in smokers and alcohol drinkers.

Accidents↗
PubMed1994

Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland.

OBJECTIVES: To estimate the extent to which changes in the main coronary risk factors (serum cholesterol concentration, blood pressure, and smoking) explain the decline in mortality from ischaemic heart disease and to evaluate the relative importance of change in each of these risk factors. DESIGN: Predicted changes in ischaemic heart disease mortality were calculated by a logistic regression model using the risk factor levels assessed by cross sectional population surveys, in 1972, 1977, 1982, 1987, and 1992. These predicted changes were compared with observed changes in mortality statistics. SETTING: North Karelia and Kuopio provinces, Finland. SUBJECTS: 14,257 men and 14,786 women aged 30-59 randomly selected from the national population register. MAIN OUTCOME MEASURES: Levels of the risk factors and predicted and observed changes in mortality from ischaemic heart disease. RESULTS: The observed changes in the risk factors in the population from 1972 to 1992 predicted a decline in mortality from ischaemic heart disease of 44% (95% confidence interval 37% to 50%) in men and 49% (37% to 59%) in women. The observed decline was 55% (51% to 58%) and 68% (61 to 74) respectively. CONCLUSION: An assessment of the data on the risk factors for ischaemic heart disease and mortality suggests that most of the decline in mortality from ischaemic heart disease can be explained by changes in the three main coronary risk factors.

Adult↗
PubMed1994

Trends in cardiovascular disease risk factor clustering in eastern Finland: results of 15-year follow-up of the North Karelia Project.

BACKGROUND: The study describes 15-year cardiovascular disease risk factor clustering trends in eastern Finland and assesses the degree to which high levels of the risk factors are clustering in the same individuals. METHODS: Four independent cross-sectional surveys in randomly selected population samples (in 1972, 1977, 1982, and 1987) have been carried out in two provinces in eastern Finland (North Karelia and Kuopio) to assess the level of cardiovascular disease risk factors and the impact of a community-based prevention program. Each survey included a self-administered questionnaire, blood pressure measurements, and determination of serum cholesterol. Blood pressure and serum cholesterol values were dichotomized. All subjects were classified as either current smokers or nonsmokers. The total sample size was 30,118 and the participation rate varied between 77 and 94%. The common age range in all four surveys was 30 to 59 years. RESULTS: The proportion of individuals with a combination of two or three risk factors decreased markedly during the survey period. However, smoking tended to cluster increasingly with the other risk factors in 1987 compared with that seen in 1972. Among men, the proportion of smokers having either high blood pressure or high serum cholesterol levels, or both, is still high. CONCLUSIONS: The observed clustering of cardiovascular disease risk factors, particularly among men, underlines the importance of assessing other risk factors in persons with a high level of one risk factor and the need for a multifactorial approach in primary prevention. It is possible that high-risk behaviors, like smoking and high consumption of saturated fat and salt, were normal in 1972, but in 1987 they were declining, though they remained clustered among a particular segment of the population.

Adult↗
PubMed1994

Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma.

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation. METHODS: Transscleral contact krypton laser cyclophotocoagulation was performed in 62 eyes of 57 patients with therapy-resistant glaucoma. A minimum follow-up for 6 months was obtained for 59 eyes. The krypton laser was delivered via a fiberoptic probe with compression of the sclera by the probe. The energy used was 4 to 5 J per application at the tip of the probe with an exposure time of 10 seconds. RESULTS: The intraocular pressure (IOP) decreased from the baseline mean of 34.8 +/- 11.0 mmHg to 20.4 +/- 8.3 mmHg within 10 days, to 22.6 +/- 12.5 mmHg at 1 month, to 21.3 +/- 11.3 mmHg at 3 months, and to 20.9 +/- 9.1 mmHg at 6 months postoperatively. Intraocular pressures of 8 to 24 mmHg were obtained in 62% of the eyes at 1 month, 60% at 3 months, and 73% at 6 months postoperatively with one or more cyclophotocoagulations but no other hypotensive procedures. The corresponding success rates after 6 months were 82% for eyes in which the procedure was performed to preserve vision and 50% for eyes in which the procedure was performed to relieve pain. No clinical signs of scleral injury or cyclodestruction-related loss of vision were detected. CONCLUSIONS: Krypton laser cyclophotocoagulation appears to be an effective and well-tolerated means of lowering IOP in therapy-resistant glaucoma. An advantage of the method is that standard retinal krypton photocoagulators can be used for the procedure.

Ciliary Body↗
PubMed1994

Twenty-year trends in coronary risk factors in north Karelia and in other areas of Finland.

BACKGROUND: The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, began in the eastern province of North Karelia in Finland in 1972. A number of other national CHD prevention activities have also been undertaken particularly since 1977. In the 1980s, a national strategy was developed for CHD prevention. This paper reports the 20-year changes in risk factors in North Karelia and in the original reference area of the project and the 10-year changes in a third area in southwestern Finland. METHODS: The results are based on comparable surveys of cross-sectional population samples, aged 30-59 years, every fifth year since 1972. RESULTS: During the first 5 years total cholesterol and blood pressure fell more in North Karelia than in the reference area, but subsequently changes have been about the same in both areas. The decline levelled off between the 1982 and 1987 surveys. This resulted in new nationwide preventive activities and during the last 5 years major declines in both serum total cholesterol and blood pressure have been observed. Smoking reduced more during the first 10 years in North Karelia than in Kuopio province. During the last 10 years a small decline has been observed in both areas. No change in smoking has occurred in southwestern Finland in the last 10 years. CONCLUSIONS: A major decline in cardiovascular disease risk factors has been observed in the last 20 years in Finland. This decline was associated with the launch of the national demonstration project in North Karelia in the 1970s and with subsequent major national activities thereafter.

Adult↗
PubMed1994

Lens opacity in unilateral exfoliation syndrome with or without glaucoma.

The exfoliation syndrome as a risk factor for lens opacification was investigated with pairwise comparisons of lens opacity, visual acuity, refraction, and anterior chamber depth in 126 eyes of 63 patients with unilateral exfoliation syndrome, and in 84 eyes of 42 patients with unilateral capsular glaucoma. As compared with fellow eyes, the exfoliative eyes showed poorer visual acuity (p < 0.05) and more frequent occurrence of subcapsular cataract (2% vs 8%). Compared with the fellow eyes the lenses in the capsular glaucomatous eyes were more opaque, whether without pilocarpine (p < 0.05), or with pilocarpine treatment (p < 0.0001). Visual acuity was poorer (p < 0.01), refraction more myopic (p < 0.05), and anterior chamber depth less (p < 0.05) in the capsular glaucomatous eyes with pilocarpine treatment. Thus, there are slight changes in the lenses of the exfoliative eyes, the cataractous lens changes being more advanced in the capsular glaucomatous eyes.

Aged↗
PubMed1994

Interocular differences in optic disc configuration in the unilateral exfoliation syndrome.

Thirty-seven patients with normal visual fields and open angles in both eyes, and lens exfoliation in only one eye, were examined for intraocular pressure, and optic disc topography was determined from stereophotographs of the fundi with the computerized three-dimensional image analyzer. The rim-to-disc radius ratios at intervals of 30 degrees were obtained with the instrument. The mean intraocular pressure of the exfoliative eyes (17.5 +/- 2.9 mmHg) was significantly higher than that of the nonexfoliative eyes (15.9 +/- 2.8 mmHg). In the exfoliative eyes, the mean rim-to-disc radius ratio at the inferior-temporal was significantly smaller, and the higher the intraocular pressure of the exfoliative eye in comparison with that of the nonexfoliative eye, the smaller were the rim-to-disc radius ratios at the inferior-temporal and inferior radii. In the exfoliative eyes, pressure-dependent changes are observable in the inferior and inferior-temporal areas of the optic disc prior to visual field loss.

Aged↗
PubMed1994

Health-related behaviors in the Republic of Karelia, Russia, and North Karelia, Finland.

Risk factors and health behaviors related to chronic diseases were studied in a population survey in Pitkäranta District in the Republic of Karelia, Russia, and in North Karelia, Finland, in Spring 1992 (Puska, Matilainen et al., 1993). The random sample of the population (25 to 64 years) was 1,000 in Pitkäranta and 2,000 in North Karelia. Among men there were more current smokers in Pitkäranta than in North Karelia (65% vs. 31%) whereas among women the respective rates were 11% and 16%. Self-reported alcohol consumption was higher in North Karelia. Leisure time physical activity was much less frequent in Pitkäranta both among men and women. Use of vegetables and berries was very infrequent in Pitkäranta. The differences in health behavior can at least partly explain the differences in risk factors and in mortality of chronic diseases.

Journal Article↗
PubMed1994

Is back pain increasing? Results from national surveys in Finland during 1978/9-1992.

The development in the prevalence of back pain, back diseases diagnosed by a physician, and joint pain were studied in Finland during the period 1978/9-1992. The data consisted of annual surveys of representative national samples (n = 5000) of 15-64 year old Finns. The effects of sex, age-group, and study year on the proportions of those with a disorder were studied by logistic regression analyses. All prevalences increased with age. Symptoms were more common among women. The prevalence rates of the symptoms remained stationary through the time period. There were further no systematic changes in the prevalence of diagnosed back diseases. The lower prevalence levels from the year 1985 onwards were probably because of a change in the questionnaire layout, and the two periods were modelled separately. Possible reasons for the discrepancy between the present results and those from previous surveys in Finland are discussed.

Adolescent↗
PubMed1994

Trends in cerebrovascular mortality and in its risk factors in Finland during the last 20 years.

At the beginning of the 1970s, the mortality rates from cerebrovascular disease in Finland were among the highest in the world. In addition, the levels of the main known risk factors for cardiovascular disease, such as high blood pressure, elevated serum cholesterol level and cigarette smoking, were by international comparisons very high. Within Finland, higher mortality from both stroke and ischemic heart disease was observed in the eastern part of the country, where the levels of the risk factors mentioned were higher than in the western regions. Official mortality statistics show that deaths from stroke in Finland declined steeply in the 1970s, and continued to decline, although at a slower pace, during the 1980s. Furthermore, the decline in stroke mortality was greater in eastern Finland than in the western part of the country, such that the gap observed between east and west Finland in stroke mortality has now almost disappeared. These findings are supported by the trends observed from the North Karelia stroke register and from the FINMONICA stroke register. A cohort study has demonstrated that high blood pressure, high blood cholesterol level and cigarette smoking are risk factors for fatal stroke in the male population of eastern Finland. In women, only high blood pressure was found to be a risk factor for fatal stroke, while for cigarette smoking and high blood cholesterol levels the risk, though increased, was not statistically significant. A national strategy has been developed to control and reduce the main cardiovascular risk factors in Finland. The North Karelia project, started in Finland in 1972, was the first program of its type aimed at the reduction of risk factors in a whole population. Arterial blood pressure and total blood cholesterol levels have decreased significantly during the last 20 years in both men and women. The prevalence of cigarette smoking has been reduced only in men. The changes in risk factors that have occurred parallel the changes in stroke mortality, suggesting that the selected strategy--to reduce risk factor levels on a population-wide basis--has been effective in reducing stroke mortality in Finland.

Adult↗
PubMed1994

A randomized, prospective study on the use of sodium hyaluronate (Healon) in trabeculectomy.

The effect of injecting sodium hyaluronate (Healon) before fistulization in trabeculectomy was investigated in a prospective, randomized study of 107 consecutive eyes. Fifty-two eyes were operated on with the viscoelastic and 55 without. An early postoperative intraocular pressure (IOP) peak of 21 mm Hg or more occurred in 27% of the study eyes versus 17% of the control eyes, an insignificant difference. The mean peak IOPs of the study and the control eyes did not differ significantly (29.8 +/- 9.0 mm Hg versus 32.7 +/- 10.2 mm Hg), nor did the mean IOPs and the need for glaucoma medications 1 month after surgery. Shallow/flat anterior chamber and choroidal detachment were equally frequent in both groups, but hyphema occurred significantly more often in the study group (40%) than in the control group (18%).

Aged↗