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.
A community programme for rehabilitation and secondary prevention for patients with acute myocardial infarction as part of a comprehensive community programme for control of cardiovascular diseases (North Karelia Project).
The comprehensive community programme for the control of cardiovascular diseases in North Karelia includes a special subprogramme for the rehabilitation and secondary prevention among patients with an acute myocardial infarction (AMI). The target group of the programme were persons under the age of 65 who had an AMI according to the community-based AMI register and had survived the acute phase of the disease. The programme consisted of systematic long-term medical follow-up at an outpatient MI clinic and of decentralized local group-rehabilitation with special emphasis on secondary prevention. The main component of the programme were health education and submaximal physical exercise, aiming at the reduction of the known secondary risk factors and the improvement of the general well-being of the patients. The feasibility of this programme was good. During the five-year period from 1973 to 1977 a total of 1308 persons under the age of 65 survived an AMI. Out of these patients 515 visited the outpatient MI clinic and 575 took part in the rehabilitation groups. The participation rate in the rehabilitation groups in the whole community increased during the period from 24% to 63%. During the programme period there was a reduction in incidence of recurrent infarctions and new vocational invalidity pensions among the patients with AMI.
Socioeconomic status (SES) is importantly associated with cardiovascular morbidity and mortality, but no information exists on the relationship between SES and progression of atherosclerotic vascular disease. We investigated the association between education and income and the 4-year progression of carotid atherosclerosis in a population-based sample of Finnish men. Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to estimate changes in maximum and mean intima-media thickness (IMT) and maximum plaque height across levels of SES in 1022 men. Associations between SES and atherosclerotic progression were examined in relation to risk factors and stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease (IHD). There were significant, inverse, graded relationships between levels of education and income for all three progression measures, which were largely unaffected by risk factor adjustment. For education, the age- and baseline IMT-adjusted maximum progression for those with primary schooling or less was 0.28 mm and for those who graduated from high school, 0.24 mm (P = .05). Compared with the lowest SES group, men with the highest SES had 14% to 29% less atherosclerotic progression, depending on the measure used. Associations of the same magnitude were evident in subgroups without advanced baseline IMT and in men who were free of IHD. These results show that men with poor education and low income have significantly greater progression of carotid atherosclerosis than men with more advantages. The findings strengthen the contention that SES plays a significant role early in the atherosclerotic disease process and that reducing the burden of atherosclerotic vascular disease associated with lower SES will require approaches that focus on all stages of the life course.
The association of socioeconomic status with the risk of death from ischaemic heart disease and any disease as well as the risk of cerebral stroke and any cancer was studied in 3644 men aged 30-59, based on a random sample from the population of eastern Finland. Age, smoking, blood pressure, and serum cholesterol concentration were allowed for in multiple logistic models. On the basis of these data, not being married, short education, and low income are associated with an excessive risk of death from ischaemic heart disease and any disease. The data also indicated that men who were not married and who lived in urban areas might have an increased risk of cerebral stroke and those with a short education an increased risk of cancer.
Cites: Am J Epidemiol. 1981 Jul;114(1):81-946972694
Cites: Am J Epidemiol. 1982 Apr;115(4):526-377072702
To test whether the cardiovascular disease declines in North Karelia were accompanied by subjective improvements in health, we analyzed responses to two questions about perceived risk of heart disease and health status on independent random population samples surveyed 10 years apart. Age stratified perceived risk of heart disease declined significantly more (p less than .01) and age stratified perceived health status improved significantly more in North Karelia than in the reference area (p less than .005).
Cites: N Engl J Med. 1978 Oct 5;299(14):741-4692548
Cites: Br Med J (Clin Res Ed). 1983 Dec 17;287(6408):1840-46423038
Risk of dementia and Alzheimer's disease is higher among adults with limited education, and the less educated perform poorer on cognitive function tests. This study determines whether the socioeconomic environment experienced during childhood has an impact on cognitive functioning in middle age.
A population-based study of eastern Finnish men (n = 496) aged 58 and 64 for whom there were data on parent's socioeconomic position (SEP), their own education level, and performance on neuropsychological tests. Cognitive function was measured using the Trail Making Test, the Selective Reminding Test, the Verbal Fluency Test, the Visual Reproduction Test, and the Mini Mental State Exam.
We found a significant and graded association between parental SEP (combined as an index) and cognitive function both prior to and after adjustment for respondent's education. Those from more disadvantaged backgrounds exhibited the poorest performance. When the separate components of the parental SEP measure were used, father's occupation and mother's education were independently associated with the respondent's score for three and five of the tests, respectively (there was no association with father's education and mother's occupation). After adjustment for the respondent's education, father's occupation was no longer associated with respondent's test score, however, the results were essentially unchanged for mother's education.
Higher SEP during childhood and greater educational attainment are both associated with cognitive function in adulthood, with mothers and fathers each contributing to their offspring's formative cognitive development and later life cognitive ability (albeit in different ways). Improvements in both parental socioeconomic circumstances and the educational attainment of their offspring could possibly enhance cognitive function and decrease risk of dementia later in life.
A community-based programme to improve awareness and control of hypertension was launched in 1972 in North Karelia. It was incorporated in the existing health-services system. An assessment five years later showed that, compared with a reference area not included in the programme, awareness of hypertension had improved, the prevalence of hypertension had dropped, levels of blood-pressure were lower by age-group, and the number of people on antihypertensive treatment had increased.