Regional and age differences in the reliability and factor structure of the SDS among elderly (65-84 years) men who were living either in eastern or in southwestern Finland were investigated. The Cronbach alpha coefficient was .803 for the eastern and .809 for the southwestern cohort; these figures were reasonably high. The tendency found was for the coefficient to be somewhat higher for the old (75-84 years) than for the young-old (65-74 years) population. In investigating the factor structure, a principal components factor analysis was performed, and the remaining factors were rotated using the orthogonal Varimax rotation algorithm. Three factors emerged for young-old men in the East, for young-old men in the Southwest and for old men in the Southwest, and four factors for old men in the East. The factor patterns of the first two factors showed similarities in both regions, but their order was different. "Loss of self-esteem" accounted for more of the common variance in the East and "agitated mood" in the Southwest. The differences in the third factor between the two regions were evident.
A discharge register maintained by the National Research and Development Center for Welfare and Health was employed to study the use of hospital services, attributable to chronic obstructive pulmonary disease (COPD), in Finland. From a total population of 5 million COPD caused 113,016 hospital treatment periods during 1983-92 of persons aged 35 years or over. In men the need of hospital treatment for COPD started to rise sharply after the age of 50. Men aged 73 had the highest amount of admissions (3962 admissions per 10-year period). Women aged 68 had the highest amount of admissions (802 admissions per 10-year period). The highest admission rate per 1000 inhabitants was found for men at the age of 82 (37.0 admissions per 1000 population/ year) and for women at the age of 77 (3.8 admissions per 1000 population/year). During the 10-year period a total of 27,008 new COPD patients aged 35 or over received hospital care. The highest number of new admissions occurred among both sexes at the age of 71 (750 admissions per 10-year period in men and 233 admissions per 10-year period in women). This means that most of admissions are due to elderly COPD patients seeking treatment repeatedly. As the populations in the developed countries are ageing, the significance of COPD for the health care system is growing.
The association between alcohol consumption and 10-year mortality by death cause was studied in 1112 men aged 55-74 years and living either in eastern or south-western Finland. After adjustment for age, blood pressure, smoking, serum cholesterol, and other variables, the relative odds ratio of 10-year total mortality associated with consuming 1-273 g of absolute alcohol per month was 0.9 (95% confidence interval of 0.6-1.2) and with consuming more than 273 g per month due to violence was small, 15, but relative odds of violent death associated with consuming 1-273 and 274 or more grams of alcohol per month were 3.4 and 16.2, respectively (95% confidence intervals of 0.4-31.9 and 1.9-141.2).
Frequent use of health services has been associated with such concepts as alexithymia, hypochondriasis, and psychological distress. The aim of this case-control study was firstly to assess whether alexithymia, hypochondriasis, and psychological distress are associated with frequent attendance and secondly to assess the gender differences of these associations in a primary health care setting. A sample of 304 frequent attenders (eight or more visits during 1 year), including all of the frequent attenders during 1994, and 304 randomly selected age- and sex-matched controls were selected. Half of the sample (every second individual selected in date-of-birth order) was invited for an interview, 113 frequent attenders and 107 controls completed a questionnaire during the interview. Alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20), hypochondriasis was screened with the Whiteley Index (WI), and Symptom Checklist-36 (SCL-36) was used to determine psychological distress. We found a distinct gender difference in the associations of these characteristics with frequent attending. Significant associations of alexithymia, hypochondriasis, and psychological distress with frequent attending were found among men, but not among women. Alexithymia, hypochondriasis, and psychological distress should be considered when treating frequent attenders, especially males.
The purpose of this study was to analyse the association of ambulatory blood pressure (ABP) to left ventricular mass (LVM) in a population aged over 64 years and to describe the level of ABP in subjects with and without left ventricular hypertrophy (LVH) in older age.
ABP measurement and echocardiography for calculation of LVM were assessed in 490 inhabitants (mean age 70.7 years, range 64-87 years) of a small town in southwestern Finland who were able to visit an outpatient clinic. Explanatory factors associated with LVM were assessed with linear regression analysis. LVH was defined as calculated LVM-index values exceeding 150 g/m2 in men and 120 g/m2 in women adopted from the Framingham Study.
Systolic ABP was significantly associated with LVM. No correlation between diastolic ABP and LVM was found. Other factors independently related to LVM were gender, body mass index and age. The prevalence of echocardiographic LVH was 22%. Subjects with LVH had markedly higher systolic ABP levels than those without LVH (mean (SD) 24-h ABP: 132(16)/75(8) mmHg vs. 123(13)/75(8) mmHg).
Systolic ABP is associated with LVM in older people. In addition, systolic ABP is superior to diastolic ABP in relation to LVM in the aged.
The association of physical activity with coronary risk factors and self-reported physical ability was studied in a cohort of 331 healthy Finnish men aged 45-64 years at entry, representing the survivors of a 20-year longitudinal study from 1964 to 1984. Baseline physical activity was not significantly related to levels of coronary risk factors at subsequent 5-year, 10-year or 20-year follow-up examinations. The 72 who increased their physical activity during the study period smoked less at 20-year follow-up than those who remained sedentary (p = 0.03). No other significant associations between 20-year changes of physical activity and coronary risk factors were seen. Although baseline physical activity was not, physical activity and exercise at 20-year follow-up were positively related to indices of functional capacity assessed at the end of the study period, when the subjects had reached a mean age of 73 years. It is concluded from this long-term study that a relative increase of physical activity between middle and old age is associated with both less smoking and a maintained high level of physical ability.
The purpose was to examine changes in the numbers of asthma-related hospitalizations among conscripts and possible seasonal fluctuations. Data on treatment periods for asthma among men aged 18-22 years at military hospitals in 1982-1992 were collected from the national hospital discharge register. Monthly numbers of hospitalizations were calculated for each year separately, together with the frequency of such periods per 1000 conscripts. Results. A total of 4894 asthma-related hospitalizations were recorded in 1982-1992, the frequency per 1000 conscripts increasing from 8.5 in 1982 to 27.7 in 1992. Evident seasonal fluctuations were observed in 1982-1989, the peaks being recorded for February (14% above the annual average), July (26%) and November (51%). A change in these seasonal fluctuations was observed in 1990-1992, however. The frequency of asthma-induced hospitalizations among conscripts tripled between 1982 and 1992, evidently indicating a real increase in the number of occurrences. The hospitalization peaks are located at the beginning of military service, a point at which factors tending to aggravate asthma exercise a major impact.
The number of asthma related treatment periods in hospital has increased in many countries, particularly among children. The aim of the present investigation was to describe the use made of hospital services by asthmatic patients over a wide range in Finland.
A total of 255,387 treatment periods for asthma that had occurred between 1972 and 1986 was collected from the discharge register maintained by the National Board of Health (diagnosis 493, International Classification of Diseases). The numbers of admissions, days in hospital, and new occurrences of asthma were calculated by sex and age in relation to the total population at the end of each year.
Asthma induced treatment periods in hospital in Finland were 12,860 (277 treatment periods per 100,000 inhabitants) in 1972 and 20,000 (406 per 100,000 inhabitants) in 1986. The annual increase in the number of such periods was 4.7% for men (95% confidence interval (95% CI) 3.5 to 5.9%) and 3.4% for women (2.1 to 4.7%) in relation to population. The most pronounced change was found in those aged 65 years and over, in which the number of treatment periods was found to increase annually by 7.5% (6.0 to 9.0%) for men and 4.9% (3.4 to 6.5%) for women, whereas the smallest increase was found among persons under 15 years with an annual change of 1.3% (0.2 to 2.3%) for boys and 1.1% (-0.1 to 2.4%) for girls. Although the number of asthma related treatment periods increased, that of new patients with asthma did not. An average of 114 new male asthmatic patients per 100,000 men were treated in hospitals annually between 1977 and 1986, whereas the figure for women was 115; the annual change during this 10 year period was 0.2% (-0.8 to 1.2%) for men and -0.8% (-1.8 to 0.2%) for women.
The increase in the number of asthma related hospital treatment periods seemed attributable to the frequent treatment of the same patients. Treatment periods for persons aged 40 years or over were found to increase most, suggesting that the treatment of these asthmatic patients should be optimised and its organisation improved.
Serum concentrations of vitamins A, D and E, osteocalcin, calcium, selenium, cholesterol and HDL-cholesterol were measured in 270 elderly Finnish men aged from 65 to 84 years. alpha-Tocopherol and selenium decreased with aging as did 25-hydroxyvitamin D. Low serum levels were found especially for 25-hydroxyvitamin D (19% less than 8 micrograms/l), selenium (45% less than 70 micrograms/l) and osteocalcin (52% less than 1.8 micrograms/l). Men living in institutions for the aged had lower serum 25-hydroxyvitamin D levels than those living at home. Smoking was associated with decreased and alcohol consumption with increased serum levels of 25-hydroxyvitamin D. Those men who reported having most weekly working hours had highest serum levels of 25-hydroxyvitamin D. Serum osteocalcin correlated with 25-hydroxyvitamin D at normal or high serum vitamin levels but not at low vitamin levels; neither did it correlate with age or consumption of tobacco, alcohol or multivitamin pills.