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Biomedical subjects

P Puska

Publications and source records attributed to P Puska.

At least 163 records · Page 9Linked to original sources
PubMed1989

Mental disability among elderly men in Finland: prevalence, predictors and correlates.

Mental disability, variables associated with it and predictors of mental disability in late life were studied in 716 men from eastern and southwestern Finland in connection with the 25-year follow-up of the east-west study, which formed the Finnish part of the seven-countries study. The examinations were carried out in autumn 1984, when the men were 65-84 years of age. According to a 10-item mental status questionnaire, 95% of the men had normal mental capacities. There were no differences between the 2 areas. Old age, low educational level, low functional capacity, low body mass index, low serum cholesterol, low diastolic blood pressure, low alcohol or coffee consumption, low hemoglobin, low serum calcium, low serum triiodothyronine, high scores on the Zung Self-rating Depression Scale, and presence of transient ischemia or stroke were associated with mental disability in 1984. In the prospective analysis, low forced vital capacity, low forced expiratory volume in 0.75 s and high blood pressure in middle age predicted mental disability in old age.

Aged↗
PubMed1989

Plasma vitamins E and A inversely correlated to mortality from ischemic heart disease in cross-cultural epidemiology.

In eight study populations in which the medians of total plasma cholesterol did not differ significantly (mean 5.8 mM, p greater than 0.05) and therefore did not correlate with the IHD mortality (r2 = 0.05), the median of absolute plasma level of vitamin E (alpha-tocopherol) was inversely related to the IHD mortality (r2 = 0.55; p = 0.003). Vitamin A behaved similarly (r2 = 0.51; p = 0.046). The absolute levels of vitamins E and A together with cholesterol predicted (by multiple regression analysis) the IHD mortality of these eight populations fairly well (r2 = 0.81; p = 0.06). Considering all 12 study populations analyzed thus far, total plasma cholesterol correlated with the IHD mortality directly as expected (r2 = 0.51; p less than 0.01), but the median of the plasma alpha-tocopherol individually standardized for cholesterol and triglycerides (220 mg/dL + 110 mg/dL, respectively) maintained a strong inverse association with the IHD mortality (r2 = 0.49; p = 0.01). In the partial regression analysis, lipid-standardized vitamin E exhibited an even stronger inverse correlation with IHD mortality (r2 = 0.69; p less than 0.001). Again, vitamin A behaved similarly to vitamin E, that is, after lipid-standardization of individuals (r2 = 0.33; p = 0.07), as well as in the cholesterol-independent partial regression analysis (r2 = 0.74; p less than 0.001). Both vitamins may act singularly, for after lipid-standardization they vary de facto independently (rs = 0.012) in individuals. The combination of vitamins E and A as obtained by multiple partial regression predicted the actual IHD mortality to a large extent (r2 = 0.89; p less than 0.001), whereas the three-variable prediction model, with the median of total cholesterol and of individually lipid-standardized vitamins E and A, fit the actual IHD mortality of these 12 populations almost completely (r2 = 0.94; p less than 0.001). In conclusion, the plasma status of vitamins E and A are important, hitherto underrated risk factors of IHD, which may act independently, but can, if combined, predict at least 53% of the cross-cultural differences of IHD mortality. After inclusion of total cholesterol into a multivariate model, up to 94% of the IHD mortality can be predicted. The present epidemiological data are in agreement with the hypothesis that these vitamins have physiological functions in the protection of lipoproteins against peroxidation and atherogenic apo-B modifications, respectively, but that does not exclude additional beneficial effects of vitamin E and A in the arterial wall.

Adult↗
PubMed1989

The North Karelia project: 15 years of community-based prevention of coronary heart disease.

The North Karelia Project - a community-wide health intervention programme - was launched in 1972 as response to the local petition to reduce the heavy toll of heart disease in North Karelia. The strategy of community-based prevention was based on the previous pioneering international work on epidemiology of cardiovascular diseases and prevention in which Finland had in many ways participated. Comprehensive scientific evaluation of the programme was carefully designed. The effects of the programme on risk factor reduction and on prevention of cardiovascular diseases are assessed by large population surveys every five years and by data on incidence of cardiovascular diseases and mortality rates. The authors present the 15 years' results and some of the most recent findings of the North Karelia Project, and discuss the overall experience and its national an international implications.

Adult↗
PubMed1989

Changes in alcohol consumption and mortality in aged Finnish men.

Drinking patterns and changes in alcohol consumption from 1974 to 1984 and associations between alcohol consumption in 1974 and ten-year mortality rates from cardiovascular, violent, cancer or all causes were studied among Finnish men born between 1900 and 1919. The overall absolute alcohol consumption was low in both 1974 and 1984. The average alcohol consumption and drinking pattern did not significantly change with increasing age, though some individual changes occured. Moderate or heavier alcohol consumption was a significant risk factor for cancer deaths among non-smoking men, but not in male smokers. Moderate or heavier alcohol consumption might also be a significant risk factor in violent death. Low, moderate or heavier alcohol consumption was not a significant risk factor for coronary deaths among the men in this rural Finnish population.

Aged↗
PubMed1989

Dietary polyunsaturated fat and hypertension.

A significant reduction in blood pressure has been observed during low-fat high poly unsaturated fattyacids/saturated fattyacid--ratio diets in a series of studies conducted in the U.S. and Finland. The results suggest the active role of linoleic acid but the effects of decreased intake of saturated fats and the concomitant changes in the intake of other dietary components cannot be ruled out.

Blood Pressure↗
PubMed1989

Postheparin plasma lipoprotein and hepatic lipase are determinants of hypo- and hyperalphalipoproteinemia.

To study the role of the two postheparin plasma lipolytic enzymes, lipoprotein lipase (LPL) and hepatic lipase (HL) in high density lipoprotein (HDL) metabolism at a population level, we determined serum lipoproteins, apoproteins A-I, A-II, B, and E, and postheparin plasma LPL and HL activities in 65 subjects with a mean HDL-cholesterol of 34 mg/dl and in 62 subjects with a mean HDL-cholesterol of 87 mg/dl. These two groups represented the highest and lowest 1.4 percentile of a random sample consisting 4,970 subjects. The variation in HDL level was due to a 4.1-fold difference in the HDL2 cholesterol (P less than 0.001) whereas the HDL3 cholesterol level was increased only by 32% (P less than 0.001) in the group with high HDL-cholesterol. Serum apoA-levels were 128 +/- 2.2 mg/dl and 210 +/- 2.8 mg/dl (mean +/- SEM) in hypo- and hyper-HDL cholesterolemia, respectively. Serum apoA-II concentration was elevated by 28% (P less than 0.001) in hyperalphalipoproteinemia. The apoA-I/A-II ratio was elevated only in women with high HDL-cholesterol but not in men, suggesting that elevation of apoA-I is involved in hyperalphalipoproteinemia in females, whereas both apoA proteins are elevated in men with high HDL cholesterol. Serum concentration of apoE and its phenotype distribution were similar in the two groups. The HL activity was reduced in the high HDL-cholesterol group (21.2 +/- 1.5 vs. 38.5 +/- 1.8 mumol/h/ml, P less than 0.001), whereas the LPL activity was elevated in the group with high HDL-cholesterol compared to subjects with low HDL-cholesterol (27.8 +/- 1.3 vs. 19.9 +/- 0.8 mumol/h/ml, P less than 0.001). The HL and LPL activities correlated in opposing ways with the HDL2 cholesterol (r = 0.57, P less than 0.001 and r = 0.51, P less than 0.001, respectively), and this appeared to be independent of the relative ponderosity by multiple correlation analysis. The results demonstrate major influence of both HL and LPL on serum HDL cholesterol concentration at a population level.

Adult↗
PubMed1989

Vitamin A, vitamin E and selenium status in an aged Finnish male population.

Vitamin A (retinol), vitamin E (alpha-tocopherol) and selenium concentrations in serum were studied during the autumn season (October and November) in two Finnish male populations aged 65-84 years and living either in eastern or southwestern Finland. The mean vitamin A concentration was higher in south-western, but the mean selenium concentration was higher in eastern Finland. Mean vitamin A concentrations did not differ between age groups, but in the south-west highest vitamin E and selenium concentrations were found among the youngest population. A severe vitamin A deficiency (below 300 micrograms/l) was found only in 3 (1%) men in the east and 4 (1%) men in the south-west, and a mild deficiency (300-399 micrograms/l) in 11 (4%) men in the east and 16 (4%) men in the south-west. Vitamin E deficiency after the correction by serum total cholesterol (below 2 mg/l/g/l) was found only in 3 (1%) men in the east and 1 (0%) man in the south-west, and low values (2.0-2.9 mg/l/g/l) were found in 13 (4%) men in the east and 34 (9%) men in the south-west. A severe deficiency of selenium (below 46 micrograms/l) was found in 10 (3%) men in the east and 15 (4%) men in the south-west, while a mild deficiency (46-69 micrograms/l) was found in 140 (45%) men in the east and 197 (52%) men in the south-west. The overall vitamin A and vitamin E status of elderly Finnish men was relatively adequate, while severe or mild deficiencies of selenium were common.

Aged↗
PubMed1989

Trends and determinants of ischaemic heart disease mortality in Finland: with special reference to a possible levelling off in the early 1980s.

There has been a general decline in mortality from ischaemic heart disease (IHD) in Finland since the beginning of the 1970s. An intensified preventive programme was started in the province of North Karelia in 1972. Between 1974 and 1979 the decline in IHD mortality in North Karelian men was steeper than that in the rest of Finland. This favourable trend was associated with a fall in the levels of major coronary disease risk factors. Case-fatality from acute coronary events did not change much during this period. A levelling off in the decline in IHD mortality has been observed in the 1980s first in North Karelia and later in the whole of Finland. These findings from the official mortality statistics were confirmed in North Karelia by the data from the population-based coronary register. This levelling off in the decline in IHD mortality was associated with levelling off in risk-factor reductions in eastern Finland and with little improvement in risk-related behaviours in Finland during the 1980s. The IHD rates are still high and associated with persistent high risk factor levels and particularly with high serum cholesterol and blood pressure levels. Together with IHD mortality, the decline in total mortality also levelled off both in North Karelia and in the rest of Finland during the early 1980s. Compared with other countries, the rates of coronary disease and total mortality in the middle-aged Finnish population, especially among men, are among the highest in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Plasma apolipoprotein B in middle-aged Finnish men. Evidence for a regional gradient of apo B and lack of negative correlation between apo B and dietary linoleate in hyperapobetalipoproteinemia.

Plasma apolipoprotein B (apo B) concentrations were determined in 178 randomly selected 40-49-year-old men from Eastern and Southwestern Finland and compared with the concentrations of plasma lipids and the fatty acid composition of plasma and adipose tissue determined previously from the same populations. The plasma apo B concentrations ranged from 50 to 209 mg/dl. Although men from the two regions had similar mean concentrations of plasma triglyceride, total cholesterol and high density lipoprotein (HDL)-cholesterol, men from Eastern Finland had significantly higher mean apo B levels (139 +/- 25 mg/dl) and a lower ratio of total cholesterol to apo B (1.85 +/- 0.25) than the Southwestern men (125 +/- 33 mg/dl and 2.05 +/- 0.40, respectively). In the whole population, apo B and total cholesterol had significant negative correlations with the percentages of linoleate in the fatty acids of plasma and adipose tissue, which are known to reflect the quality of dietary fat. As the percentages of linoleate have previously been shown to be lower in the Eastern population, part of the regional difference in apo B is obviously explained by differences in the quality of dietary fat. On the other hand, men (n = 59) who had high plasma apo B (greater than 130 mg/dl) but low density lipoprotein (LDL)-cholesterol within the reference values (less than 5.17 mmol/l) showed no correlation between linoleate and apo B. This suggests that other factors than dietary fat determine the concentration of apo B in this group of men.

Adipose Tissue↗
PubMed1988

Dietary changes in the North Karelia Project (1972-1982).

The North Karelia Project is a community-based program to reduce the high cardiovascular disease rates in the province of North Karelia in eastern Finland. Dietary changes aimed at reducing serum cholesterol levels were among the main objectives. The evaluation of the program was based on examinations of independent cross-sectional population samples in 1972, 1977, and 1982 in North Karelia and in a matched reference area. A questionnaire was used to measure changes in dietary habits during the program. A major shift from whole to low-fat milk took place in both areas as well as a reduction in the amount of butter used on bread. The net reduction in North Karelia (difference in change compared with the reference area) in the intake of saturated fatty acids from milk and fat spreads used on bread was 20% in men and 14% in women. This reduction was similar in different age, education, and occupational groups suggesting that the dietary intervention had reached the whole community. The validity of the reported dietary changes was confirmed by parallel changes in serum cholesterol levels.

Adult↗
PubMed1988

Ten-year results of hypertension care in the community. Follow-up of the North Karelia hypertension control program.

The development of hypertension care over the 10-year period 1972-1982 in North Karelia and a reference area was assessed using three separate random samples of the population aged 30-59 years. The results show a clear improvement in the blood pressure levels of the population and in the hypertension care in North Karelia between 1972 and 1977 when the activities of the hypertension program of the North Karelia Project were gradually implemented. Awareness of elevated blood pressure increased from 39% to 71% among men and from 60% to 87% among women. The proportion of men under antihypertensive drug treatment increased from 4% to 10% and that of women increased from 10% to 15%. After 1977, the hypertension care was maintained but no further improvements were observed in general blood pressure levels. An improvement in hypertension care started in the reference area later than in North Karelia. In spite of favorable changes, the blood pressure level of the population was still high in 1982, the mean casual value among men being 145/87 mmHg and that among women being 141/84 mmHg. It is obvious that further progress in hypertension care is needed.

Adult↗
PubMed1988

Social connections and mortality from all causes and from cardiovascular disease: prospective evidence from eastern Finland.

The association between an a priori measure of social connections and five-year mortality from all causes, cardiovascular diseases (International Classification of Diseases, Eighth Revision (ICD-8) codes 390-458), and ischemic heart disease (ICD-8 codes 410-414) was studied in 13,301 men and women from eastern Finland who were first interviewed in 1972 or 1977. For men, there was a graded association between extent of social connections and mortality. In multivariate models with adjustment for age, smoking, serum cholesterol, mean weighted blood pressure, measures of prevalent illness, and other possible confounders, men who were in the two lowest quintiles of the social connections scale were at increased risk compared with those in the highest quintile (odds ratio (OR)all cause = 1.54, 95% confidence interval (CI) = 1.21-1.95; ORcardiovascular disease = 1.54, 95% CI = 1.11-2.13; ORischemic heart disease = 1.34, 95% CI = 0.94-1.90). No strong or consistent association was found for women. The association for men was modified by levels of blood pressure with the effect of low social connections greater at higher levels of blood pressure. In three separate analyses, there was no evidence for confounding or effect modification due to prevalent illness at baseline.

Adult↗
PubMed1988

10-year trends in physical activity in the eastern Finnish adult population: relationship to socioeconomic and lifestyle characteristics.

In a large, community-based cardiovascular disease prevention study in Eastern Finland, independent random population samples were surveyed in 1972, 1977 and 1982. The leisure-time physical activity (LTPA), occupational physical activity (OPA), and socioeconomic and lifestyle characteristics were assessed. In men and women aged 30-59, the proportion with high LTPA increased from 1972 to 1982 by approximately one half (p less than 0.001), whereas that of high OPA decreased during the same period (p less than 0.001). In both sexes, high overall physical activity fell from 1972 to 1977 (p less than 0.001), but no more from 1977 to 1982. The proportion of entirely sedentary remained stable. Education, income and younger age showed a positive, body mass index, smoking and OPA a graded, negative association with high LTPA in 1972 and 1982. Significant (p less than 0.001) differences in 10-year trends of changes in LTPA were observed: men and women with low education or income increased LTPA more than those with high education and income. Socioeconomic factors, such as income and education, appear to have lost importance as determinants of population-wide exercise, whereas the clustering of low physical activity with overweight and smoking has increased.

Adult↗
PubMed1988

Results of a one-year worksite and mass media based intervention on health behaviour and chronic disease risk factors.

The North Karelia Worksite Intervention Study was carried out to assess the effectiveness of worksite-based innovative intervention on chronic disease risk factors. The one-year intervention combined use of mass media, worksite opinion leaders, risk assessment and counselling and other health education measures. The study used eight medium sized intervention worksites (IW) and eight matched reference worksites (RW). Of the 715 workers 91% participated in the initial survey, and out of these 89% in the one-year follow-up survey. The proportion of current smokers changed from 39% to 30% (p less than 0.05) at the IWs while no change took place at the RWs (33%). The effect on smoking was confirmed by serum thiocyanate analyses. An additive score of the three main CHD risk factors changed from 3.1 to 2.7 at the IWs and from 3.2 to 3.0 at the RWs (p less than 0.05 for the net change). The results and experiences showed the feasibility of the intervention and significant, although modest, effects on risk factors and health behaviour, notably smoking.

Chronic Disease↗
PubMed1988

From pilot project to national implementation: experiences from the North Karelia Project.

The North Karelia Project started in 1972 as a response to the request of the local people. It was aimed at reducing the exceptionally high mortality and morbidity from cardiovascular diseases in the area. The Project's activities have been directed towards inducing behavioural changes amongst the entire population. Equally, the care of those already sick (such as hypertensives) has also simultaneously been reorganized. The Project has involved the whole of that society, in addition to the health care system, and has collaborated with the food industry, schools and various voluntary organizations. The most recent new activity is a programme to promote marketing of local vegetables and berries to have a substitution for dairy farming, as consumption of dairy products reduce with new dietary habits. The results are encouraging. The individually reported health behavioural changes are reflected by a clear net reduction in biological risk factors (serum cholesterol, blood pressure) compared to the reference community. Also statistics show that mortality from ischaemic heart disease has been reduced more significantly in North Karelia (-22%) than in the rest of Finland (-11%) during the period 1974-1979. The activities tested in North Karelia, and found to be feasible, have been recommended for implementation nationwide in Finland. For instance, anti-smoking activities were first tested in North Karelia before the introduction of national legislation, and experiences obtained in health education have been conveyed to other sectors of the Finnish population through national television in several programmes. The county of North Karelia continues to be a demonstration area in Finland, at present for the Integrated Programme for the Prevention of Noncommunicable Diseases.

Cardiovascular Diseases↗
PubMed1988

Determinants and predictors of heavy alcohol consumption among aging Finnish men.

The aim was to identify socioeconomic, health behaviour, and health factors associated with or predicting heavy alcohol consumption in late middle age (55-74 years) or in old age (65-84 years). The material included a follow-up study of two cohorts of Finnish males resident either in eastern or south-western Finland. The main variables associated with heavy alcohol consumption in late middle age were: relatively young age and heavy smoking. The main associated variables in old age were good mental and physical capacity, occurrence of chronic bronchitis, the absence of certain cardiac diseases, and heavy smoking. Heavy smoking was the main predictor of heavy alcohol consumption 5-25 years later; alcohol consumption 10 years earlier was also an important predictor. Some regional differences were found in associated or predictive variables. The results suggest that, with the exception of alcohol consumption itself and heavy smoking, socioeconomic, health and other health behaviour factors are not very important in explaining or predicting heavy alcohol consumption among aging Finnish men. Drinking and smoking habits were closely related in these aging or aged men.

Age Factors↗