The present article describes the background and principles of a programme for community control of hypertension, which is part of the North Karelia project--a comprehensive community programme for the control of cardiovascular diseases. The hypertension programme also forms part of an international co-operative study by WHO. The programme consists of a community intervention integrated with the service structure. The methods used include health education of the public, education of health service personnel, organization of a service for the spreading of information and also for screening, treatment and follow-up. Every hypertensive person in the community is registered in the hypertension register and checked on annually. The evaluation is made mainly on baseline and terminal survey data from the intervention area and a reference area, the hypertension register, a myocardial infarction register and a stroke register in the intervention area.
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.
A hypertension control program was established as part of the more comprehensive North Karelia Project. This project was started in 1972 in response to a petition from the population of North Karelia, a county in Finland, asking for national assistance to reduce the exceptionally high cardiovascular disease mortality and morbidity in the area. The North Karelia Project was carried out from 1972 to 1977.The hypertension control program was implemented mainly in local health centers by physicians and public health nurses, who followed guidelines issued by the project staff and worked under its supervision.Although the target population for the North Karelia Project was the entire population of North Karelia, the project focused on middle-aged men. The hypertension subprogram was introduced in steps. Its objectives included the training of health personnel, establishment of an information system in the county to educate people about hypertension, and organization of the detection, treatment, and followup of hypertensives. A hypertension dispensary was established in each of the 12 health centers in the county. Continuous training of the local public health nurses and physicians faciliated integration of the hypertension program into the operations of the health centers.A central hypertension register and the hypertension control clinics at the health centers were the essential tools in the systematic followup of hypertensives. Some 17,000 hypertensives were on the register by the end of the 5-year project.The main aim in providing health education about hypertension, as well as in treating hypertension itself, was to prevent severe cardiovascular diseases as a whole. Therefore the hypertension control program was integrated into the comprehensive cardiovascular disease control program, and hypertensives received advice concerning smoking and dietary changes as well as about high blood pressure.A survey of health care personnel in North Karelia and in a reference area showed that the care of hypertensives was more systematic in North Karelia and that its health care personnel were more satisfied with the cardiovascular disease care that was provided.
Correlations between individual health habits, dimensions of health behaviour and differences in health habits between nonsmokers, ex-smokers and smokers were studied in a 65-74-year-old population in eastern Finland. The results showed the cumulative character of many positive health habits. High health knowledge was associated with positive health habits. The health habits of smokers were less positive than those of nonsmokers or ex-smokers. Factor analysis showed the health behaviour to be multidimensional in character. There were differences in the dimensions of health behaviour between men and women.
The aim of the study was to study the fat consumption of first grade pupils in elementary school, especially the quality and quantity of the fats used both at home and at school. The data were collected in the year 1990 by questionnaires sent to the parents and by interviewing the children. The study population consisted of all the first grade pupils (N = 54) in an elementary school in the town of Varkaus. According to our findings there is a need for individual nutrition education. The families ought to pay attention to decreasing saturated fats and to increasing oils and vegetables, fruits and berries in their diet.
A widely based epidemiologic research on hypertension has led to successful action programs abroad: e.g. the incidence of hypertension fell by about 50% in North Karelia, Finland, and in the USA the life expectancy rose by 1.5 years. Against the background of international scientific agreement both the Conference for Security and Cooperation in Europe and the World Health Organization have awarded hypertension the highest priority for European cooperation. In the Federal Republic there is a great backlog; the responsible politicians are called upon to set a new course.
The Finnish population has a high risk of coronary heart disease, which is associated to a high population level of serum total cholesterol (CHOL) already evident at early ages. The study investigated the familial aggregation of CHOL in a sample of families with young offspring from eastern Finland.
Fifteen-year-old offspring were examined during 1996-1997 and their biological parents were examined during 1993-1994. A total of 224 children were invited and 184 families participated, of which 123 were included in the analysis with complete data. The main outcome measure was the CHOL (millimoles per liter).
Significant positive familial correlations of CHOL were found for the pairs of mother/offspring (r = 0.35, P or =5 mmol/L (OR = 3.26, 95% CI = 1.2-8.9, n = 111).
The study confirmed the familial aggregation of CHOL. The consistent CHOL association between the mother and the offspring may indicate the key role of the mother for the primary prevention of hypercholesterolemia.