Heikki Heinonen

Type 2 Diabetes Prevention in the Real World: Three-year results of the GOAL Lifestyle Implementation Trial

OBJECTIVE We study the effectiveness of the GOAL Lifestyle Implementation Trial at the 36-month follow-up. RESEARCH DESIGN AND METHODS Participants (n = 352, type 2 diabetes risk score FINDRISC = 16.2 ± 3.3, BMI 32.6 ± 5.0 kg/m2) received six lifestyle counseling sessions over 8 months. Measurements were at baseline, 12 months (88.6%), and 36 months (77.0%). RESULTS Statistically significant risk reduction at 12 months was maintained at 36 months in weight (−1.0 ± 5.6 kg), BMI (−0.5 ± 2.1 kg/m2), and serum total cholesterol (−0.4 ± 1.1 mmol/l). CONCLUSIONS Maintenance of risk reduction in this “real world” trial proves the interventions potential for significant public health impact.

RURAL URBAN DIFFERENCES IN HEALTH AND HEALTH BEHAVIOUR: A BASELINE DESCRIPTION OF A COMMUNITY HEALTH-PROMOTION PROGRAMME FOR THE ELDERLY

Study objective: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. Design: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. Setting: Fourteen municipalities in the Lahti region (Päijät-Häme County) in Finland. Participants: A regionally and locally stratified random sample of men and women born in 1946—50, 1936—40, and 1926—30. A total of 4,272 were invited and 2,815 (66%) participated. Main results: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). Conclusions: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Päijät-Häme County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.

Type 2 Diabetes Prevention in the Real World Three-year results of the GOAL Lifestyle Implementation Trial

OBJECTIVE We study the effectiveness of the GOAL Lifestyle Implementation Trial at the 36-month follow-up. RESEARCH DESIGN AND METHODS Participants (n = 352, type 2 diabetes risk score FINDRISC = 16.2 ± 3.3, BMI 32.6 ± 5.0 kg/m2) received six lifestyle counseling sessions over 8 months. Measurements were at baseline, 12 months (88.6%), and 36 months (77.0%). RESULTS Statistically significant risk reduction at 12 months was maintained at 36 months in weight (−1.0 ± 5.6 kg), BMI (−0.5 ± 2.1 kg/m2), and serum total cholesterol (−0.4 ± 1.1 mmol/l). CONCLUSIONS Maintenance of risk reduction in this “real world” trial proves the interventions potential for significant public health impact.

Self-rated health and indicators of SES among the ageing in three types of communities

Aims: This paper examines associations between self-rated health, three indicators of SES (self-reported education, disposable household income, adequacy of income) and three types of communities (urban, densely or sparsely populated rural areas) among ageing men and women in the Province of Päijät-Häme, Southern Finland. There is a lack of knowledge regarding the magnitude of community type when examining the relation between subjective health and SES. Methods: Cross-sectional questionnaire data gathered in the spring of 2002 for a prospective follow-up of community interventions were used. These data, together with a number of clinical and laboratory measurements, yielded the baseline for a 10-year community intervention study. A representative stratified (age, gender, area) sample of men and women living in the province and belonging to the birth cohorts 1926—1930, 1936—1940, and 1946—1950 was obtained from the National Population Registry. The target sample was 4,272, with 2,815 persons responding (66% response rate). Results: Positive associations between indicators of SES and self-rated health were observed in all three community types. After adjusting for other factors, adequacy of income showed the strongest (positive) association with self-rated health in urban areas in all age groups. A similar pattern of associations, with varying statistical significance, though, was found in the two rural areas. Conclusions: This study supports the view that while actual income is positively correlated to health, adequacy of income is an even stronger predictor of it. Thus, there was a significant link between better financial standing and good health among ageing people, especially in urban areas.

Is the Evaluation of the Global Quality of Life Determined by Emotional Status

The present study investigated relationships between global QOL perceptions and well-being dimensions. Especially our goal was to evaluate the impact of generally recognised four broad dimensions of QOL (physical, functional, social and emotional well-being) on global QOL perceptions, additionally persons satisfaction with life achievements and economical situation were measured as well as social demographic variables. The subjects were a representative sample of Finns (n = 4613, from 25 to 65 years) of the FINRISK-97 study. Correlation coefficients and models of hierarchical regression indicated that physical, functional and social well-being as well as sociodemographic factors and satisfaction with life achievements are important factors of global QOL perceptions both among males and females. However percentages of variances explained with these measures were only moderately high, ranging from 1 to 10%. After measures of emotional well-being were entered into the models of hierarchical analyses of regression, variances explained grew dramatically over 20%. The results of the study indicated that global QOL judgements are likely to be based on current emotional state.

Register-based data indicated nonparticipation bias in a health study among aging people

OBJECTIVES To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people. STUDY DESIGN AND SETTING Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements. RESULTS Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups. CONCLUSION Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people.

Perceived health-related self-efficacy associated with BMI in adults in a population-based survey

Background: The concept of ability to control personal behaviour in various environmental temptations is called self-efficacy. The high prevalence of obesity and overweight in Finland is the reason for studying the determinants of weight. The aim of the present study was to clarify the associations between body mass index and health-related self-efficacy (HSE), including food patterns, health behaviour and education. Methods: A random sample of adults was invited to the cross-sectional FINRISK 2002 Study in six regions in Finland. Participants (n=7784) gave information on education, health behaviour, HSE and food consumption. Height and weight were measured in a health examination. The response rate was 60% for men and 71% for women. Six food patterns were identified by principal component analysis on the basis of food consumption. The scores from seven-item HSE was calculated and categorized into tertiles for the analysis. The associations of BMI with self-efficacy and exploratory variables were tested using general linear modelling in total population and by gender. Results: A weak HSE was associated with a higher BMI after adjusting for age, education, food patterns and health behaviour. In addition, low education, infrequent PA and non-smoking were associated with the higher BMI, but the association of HSE and BMI remained in multivariate model. The associations of food patterns and BMI were small. The adverse association with BMI was observed for patterns with sweet and butter. Conclusion: The study supports the importance of self-control in weight management, which needs to be considered as an empowerment tool in health education.

Longitudinal changes in functional capacity: effects of socio-economic position among ageing adults

IntroductionHealth and functional capacity have improved especially in Western countries over the past few decades. Nevertheless, the positive secular trend has not been able to decrease an uneven distribution of health. The main aim of this study was to follow-up changes in functional capacity among the same people in six years time and to detect whether the possible changes vary according to socio-economic position (SEP). In addition, it is of interest whether health behaviours have an effect on these possible changes.MethodsThis longitudinal follow-up study consisted of 1,898 individuals from three birth cohorts (1926–1930, 1936–40, 1946–50) who took part in clinical check-ups and answered to a survey questionnaire in 2002 and 2008. A sub-scale of physical functioning from the RAND-36 was used to measure functional capacity. Education and adequacy of income were used as indicators of socio-economic position. Repeated-measures ANOVA was used as a main method of analysis.ResultsPhysical functioning in 2002 and 2008 was poorest among those men and women belonging to the oldest cohort. Functional capacity deteriorated in six years among men in the oldest cohort and among women in all three cohorts. Socio-economic disparities in functional capacity among ageing people existed. Especially lower adequacy of income was most consistently associated with poorer functional capacity. However, changes in functional capacity by socio-economic position remained the same or even narrowed independent of health behaviours.ConclusionSocio-economic disparities in physical functioning are mainly incorporated in the level of functioning at the baseline. No widening socioeconomic disparities in functional capacity exist. Partly these disparities even seem to narrow with ageing.

Relationship Between Self-Reported Functional Limitations and Physical Performance Status Among Aged Home Care Clients

ABSTRACT Objective: This study investigated relationship between self-reported functional limitations and measured physical performance among aged homecare clients. Design: Baseline measurement of a physical performance intervention. Setting: Health centers in six semi-urban and rural municipalities in Finland. Participants: One hundred and seventy-one aged (mean age 82 years.) home care clients. Measurements: Self-reported limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), functional balance by the Berg Balance Scale (BBS), physical performance by the Short Physical Performance Battery (SPPB), the 10-meter walking time test, and the hand grip strength test. Results: Significant interdependencies between the number of functional limitations and the measured performance status were found. In the hierarchical regression model, measures of performance status explained 40% of the variance of the functional limitations. Conclusions: A threshold of physical performance status on which people seem to report no or minimal limitation was found. Physical performance measures are independent predictors of functional limitations, and therefore, interventions should directly address factors associated with physical performance in order to enhance autonomy of aged persons.

Weight and Health Behaviour Changes among Ageing People with Medication for Hypertension and High Cholesterol Level

Purpose. It is hypothesized that people with medication for hypertension and/or high cholesterol level do not lose weight or change their health behaviour. Methods. This is a six-year follow-up study consisting of 1,428 individuals from two birth cohorts (1936–40, 1946–50) who took part in clinical check-ups and answered to the survey questionnaires in 2002 and 2008. Results. Those participants, born in 1946–50, who had medication at the baseline had higher increase of body mass index (𝑃<0.01) and waist circumference (𝑃<0.01) at the follow-up. No major disparities in health behaviour changes between medicated and nonmedicated were found. Conclusions. Findings of this study support partly the hypothesis that aging individuals with medication for hypertension and/or high cholesterol level do not lose weight or change their health behaviour.