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Biomedical subjects

S Miilunpalo

Publications and source records attributed to S Miilunpalo.

At least 19 recordsLinked to original sources
PubMed2001

Evidence and theory based promotion of health-enhancing physical activity.

Physical activity appears to improve health-related quality of life by enhancing psychological well being and by improving physical functioning, particularly in persons compromised by poor health. Health enhancing physical activity (HEPA) can in addition to, and instead of, structured and planned exercise and sports comprise other forms of physical activity, such as occupational activities, lifestyle activities and recreational activities. However, wide-range and long-term population strategies are needed for the promotion of physical activity in each of the categories of HEPA. It is necessary to create realistic opportunities for different population groups and individuals. The theoretical knowledge of the determinants of the target behaviour has to be translated to a practical form. On the basis of available empirical studies, the Predisposing, Enabling and Reinforcing factors in the PRECEDE-PROCEED model for health promotion, are all relevant and important for the adoption and maintenance of physical activity. In the end, promotional activities are needed where people live and work, i.e. at local level.

Adaptation, Psychological↗
PubMed2001

Implementation of guidelines in primary health care. A challenge for the municipal health centres in Finland.

OBJECTIVE: To assess the implementation of guidelines in Finnish primary health care units. DESIGN: A semi-quantitative analysis of a cross-sectional interview survey. SETTING: All municipal health centres in a selected region in Finland. SUBJECTS: Head physicians and head nurses of the 31 participating units. MAIN OUTCOME MEASURES: Number of guidelines adopted; methods used in the implementation; and the unit's estimated purposefulness in the implementation of guidelines. RESULTS: All health centres had adopted at least one guideline in the defined task areas, but only one-third of the units had implemented several guidelines. The implementation methods utilised were usually directive and passive rather than co-operative and problem-solving. Half of the units used training and methods involving active participation of the personnel, and in one-third a multiprofessional approach was applied. Clients' representatives were hardly ever involved in the adaptation of guidelines. A quarter of the health centres were assessed as purposeful in their policy to implement guidelines, the large units being more goal-oriented than the smaller ones. CONCLUSIONS: A minority of health centres are goal-oriented in the adoption of guidelines and use versatile methods to support the implementation; this presents an important managerial challenge for national health care development in Finland.

Cross-Sectional Studies↗
PubMed2000

Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality--16 y follow-up of middle-aged and elderly men and women.

OBJECTIVE: To investigate the independent associations and the possible interaction of body mass index (BMI), leisure time physical activity (LTPA) and perceived physical fitness and functional capability with the risk of mortality. DESIGN: Prospective 16y follow-up study. SUBJECTS: A regionally representative cohort of 35-63-y-old Finnish men (n= 1,090) and women (n= 1,122). MEASUREMENTS: All-cause, cardiovascular disease (CVD) and coronary heart disease (CHD) mortality were derived from the national census data until the end of September 1996 while the initial levels of BMI, LTPA, physical fitness and function were determined from self-administered questionnaires. RESULTS: After adjustment for age, marital and employment status, perceived health status, smoking and alcohol consumption, the Cox proportional hazards model showed that BMI was not associated with the risk of death among the men or the women. Compared with the most active subjects the men and women with no weekly vigorous activity had relative risks of 1.61 (95% confidence interval, CI, 0.98-2.64) and 4.68 (95% CI, 1.41-15.57), respectively, for CVD mortality, and for the men there was a relative risk of 1.66 (95% CI, 0.92-2.99) for CHD mortality. When compared with the men who perceived their fitness as better than their age-mates, the men with the 'worse' assessment had a relative risk of 3.29 (95% CI, 1.80-6.02) for all-cause mortality and 4.37 (95% CI, 1.80-10.6) for CVD mortality. Men with at least some difficulty in walking a distance of 2 km had a relative risk of 1.62 (95% CI, 1.05-2.50) for all-cause mortality when compared with those who had no functional difficulties. In addition, in the comparison with subjects with no functional difficulties, the men and women who had some difficulty climbing several flights of stairs had relative risks of 1.47 (95% CI, 0.97-2.23) and 2.39 (95% CI, 1.25-4.60) for all-cause mortality, respectively. For CVD mortality the relative risks were 1.85 (95% CI, 1.04-3.30) and 3.38 (1.22-9.41), respectively. CONCLUSIONS: Although BMI did not prove to be an independent risk factor for mortality from CVD, CHD or from all causes combined, perceived physical fitness and functional capability did. An increase in LTPA seems to have a similar beneficial effect on the mortality risk of obese and nonobese men and women, and the effect also seems to be similar for fit and unfit subjects.

Adult↗
PubMed2000

Stages of change in two modes of health-enhancing physical activity: methodological aspects and promotional implications.

Measurement scales for stages of change were developed and the stages were assessed in two specific modes of Health-Enhancing Physical Activity (HEPA) in a cross-sectional survey (N = 1516); representative samples were selected from three age groups, i.e. from three phases of adult life. Outdoor Aerobic Exercise (OAE) was used as an example of fitness activity; Everyday Commuting Activity (ECA) was selected to represent lifestyle physical activity. Scales used by the Prochaska team were modified for this study, and the stages of Precontemplation and Preparation were each divided into two new stages. Consistency of the stage measurement was moderate for OAE and good for ECA. As regards content validity, consistent associations were found between stage scores and contextual variables for both behaviors. The results show that, at a given time, a person can be in different stages in different modes of HEPA. Therefore, the behavior of interest must be specified before accurate information on the stages of change in a population can be obtained. The results also indicate the importance of contextual factors in HEPA promotion.

Adult↗
PubMed1999

The impact of smoking, alcohol consumption, and physical activity on use of hospital services.

OBJECTIVES: This study investigated the associations of smoking, excess alcohol consumption, and physical inactivity with the use of hospital care. METHODS: A cohort of 19- to 63-year-old Finnish men (n = 2534) and women (n = 2668) were followed prospectively for 16 years. Number of hospital days was extracted from the national hospital discharge registry, while data concerning exposure variables were derived from the baseline questionnaire. RESULTS: After adjustment for confounders, male smokers had 70% (95% confidence interval [CI] = 49%, 95%) and female smokers had 49% (95% CI = 29%, 71%) more hospital days due to my cause than did those who had never smoked. Men consuming a moderate amount of alcohol had 21% (95% CI = 10%, 31%) fewer hospital days due to any cause than did nondrinkers. Men who had the lowest energy expenditure during leisure-time physical activity had 36% (95% CI = 15%, 63%) more hospital days than the most active men. The figure for women was 23% (95% CI = 4%, 44%). CONCLUSIONS: Smoking was strongly associated with an increased use of hospital services. The associations of alcohol consumption and leisure-time physical activity with use of hospital care depended on the diagnosis under study.

Adult↗
PubMed1998

The versatile nature of physical activity--on the psychological, behavioural and contextual characteristics of health-related physical activity.

This paper presents a comprehensive characterisation of physical activity based on psychological, behavioural and contextual aspects. Based on the characterisation it suggests a promotional classification of physical activity into five categories. The categories are: 1, Occupational activity; 2, Lifestyle activity; 3, Recreation activity; 4, Fitness activity; and 5, Sport activity. Examples are given of activities in each category and of the related emotional aspects, outcome expectations, degree of personal choice and health benefits. The importance of the emotional component and the relevance of the outcome expectations are discussed and contextual considerations are presented on the basis of the promotional classification. The implications of the classification for the practice of health-enhancing physical activity promotion are discussed.

Adult↗
PubMed1998

How can physical activity be changed--basic concepts and general principles in the promotion of health-related physical activity.

Basic concepts and general principles in the promotion of health-related physical activity are presented based on selected behavioral science theories, research findings and conceptual analysis. The concepts and principles selected include (1) a realistic and flexible concept of physical activity, (2) a pragmatic use of the determinants of physical activity, (3) targeting promotion to specific stages of adoption at a time, (4) a systematic facilitation of the change process by health communications and environmental changes, and (5) a stepwise organization of the promotional activities while respecting the target people's freedom of choice.

Adaptation, Psychological↗
PubMed1997

Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women.

The agreement between self-reported diseases in a questionnaire survey and data from medical records was assessed in a representative sample of Finnish men and women (n = 596) aged 45-73 years. The accumulated medical record information was abstracted from the records in the health centers and the central hospital in the study region. The agreement between the two information sources was substantial (kappa 0.73-0.80) for cardiovascular diseases as a group, hypertension, angina pectoris, myocardial infarction, and diabetes. The lowest agreement (kappa < 0.55) was found for lower back disorder, hip and knee arthrosis, and claudication. These results showed that the agreement between questionnaire data and medical records was good for well-known chronic diseases that have clear diagnostic criteria and are easily communicated to the patient. Conversely, the agreement was poor for diseases with nonestablished diagnostic criteria and a fluctuating course.

Adult↗
PubMed1997

The process and methods of health counseling by primary health care personnel in Finland: a national survey.

A stratified random sample of 53 Finnish health centers was selected, and representative samples of their physicians, nurses and physiotherapists were surveyed by questionnaire on the frequency of their use of health education methods in health counseling and their perception of the ease vs. difficulty of implementing the stages of the process of lifestyle counseling. Overall, the assessment of the enabling and reinforcing factors in client health behavior (social relationships and physical environment), the translation of these factors into a behavior change program and the evaluation of such programs were seen as difficult by all three categories of health care professionals. The implementation stage of lifestyle counseling was, however, generally rated as easy, although quite a limited selection of education methods and self-evident motivational prompts were used. The physiotherapists regarded the process of lifestyle counseling in their specialty, exercise counseling, as easier to conduct and they used a more varied selection of methods than the other health care personnel groups. The findings indicate a need for further in-service education for Finnish health center professionals on health education methods as well as a need for the restructuring of the care system to allow better opportunities for the full realization of the process of health counseling.

Counseling↗
PubMed1997

Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population.

The validity of various self-reported health assessments in predicting physician contracts and all-cause mortality was investigated in a prospective study in Finland. The follow-up periods were one year for the use of physician services and ten years ten months for the mortality. The study cohort comprised 1340 men and 1500 women, 35-63 years of age at the beginning of the study. The initial health assessments were derived from postal questionnaires in 1980 (response rate 77.5%). The survey was repeated one year later to verify the stability of the respondents' perceived health status. The data on the physician contacts and mortality were registered independently. The stability of perceived health status was relatively good and the perceived health was inversely associated with the number of physician contacts per year. A consistent inverse association, standardized by age, sex and social status, was observed between perceived health status and perceived physical fitness and mortality, while the predictive value of self-reported chronic diseases was low. The results suggest that the subjective health assessments are valid health status indicator in middle-aged populations, and they can be used in cohort studies and population health monitoring.

Adult↗
PubMed1997

Association between leisure time physical activity and 10-year body mass change among working-aged men and women.

OBJECTIVE: To determine whether habitual leisure time physical activity and body mass change of working-aged men and women are associated. DESIGN: Prospective 10 y follow-up study. SUBJECTS: A regionally representative cohort of 19-63 y old men (n = 2564) and women (n = 2695) in three municipalities in Finland. MEASUREMENTS: The main outcome measures were average body mass change during the 10 y of follow-up and the clinically significant body mass gain defined as a body mass gain of 5 kg or more during the follow-up and a body mass index of 26 or higher at the end of the follow-up. Leisure time physical activity was determined from self-administered questionnaires. RESULTS: After adjustment for the potential confounders, the logistic regression analysis showed that the men and women with no regular weekly activity at the end of the follow-up had an odds ratio of 2.59 (95% confidence interval, 1.69-3.97) and 2.67 (1.65-4.31), respectively for clinically significant body mass gain in comparison with the most active groups. The men who had decreased their activity during the 10 y follow-up had an odds ratio of 1.96 (1.39-2.75), and the men who were physically inactive all the time had an odds ratio of 1.62 (1.18-2.20) for clinically significant body mass gain when compared with the subjects who were active all the time. Among the women the odds ratios for clinically significant body mass gain after adjustment for potential confounders were 2.49 (1.72-3.60) and 1.61 (1.17-2.21), respectively. CONCLUSION: These findings are consistent with the hypothesis that regular physical activity prevents body mass gain and physical inactivity is a risk factor for body mass gain and obesity among adults.

Adult↗
PubMed1997

Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women.

BACKGROUND: The association of physical activity and the risk of coronary heart disease (CHD), hypertension and diabetes has previously been studied mostly in separate follow-up studies. The present analysis focuses on the association between physical activity and these three metabolic diseases in a representative adult cohort. METHODS: The effect of the total amount and intensity of leisure time physical activity on the risk of the three diseases was studied in a cohort of 1340 men and 1500 women aged 35-63 years. RESULTS: During the 10 years of follow-up the incidence rates per 1000 person-years for CHD, hypertension and diabetes were 108, 142 and 64 for men and 75, 117 and 54 for women, respectively. In the Cox proportional hazards model the men's total amount of activity was inversely associated with the risk of CHD and hypertension. An age- and smoking-adjusted relative risk of 1.98 (95% confidence interval [CI]: 1.22-3.23) for CHD and age-adjusted risk of 1.73 (95% CI: 1.13-2.65) for hypertension were found for the lowest third total activity group compared with the highest third of total activity. Vigorous activity once or more often a week was inversely associated with the risk of hypertension. For the women both a higher total amount of activity and weekly vigorous activity had an inverse association with the risk of diabetes. An age-adjusted relative risk of 2.64 (95% CI: 1.28-5.44) for diabetes was found for the lowest third activity group compared with the highest third. CONCLUSIONS: The results suggest a preventive effect of leisure time physical activity on CHD, hypertension and diabetes. This effect may differ among middle-aged men and women and the relative importance of the total amount and the intensity may vary depending on the outcome measure.

Adult↗
PubMed1996

Characteristics of leisure time physical activity associated with decreased risk of premature all-cause and cardiovascular disease mortality in middle-aged men.

The association between leisure time physical activity and the risk of all-cause and cardiovascular disease mortality was analyzed in a Finnish cohort of 1,072 men age 35-63 years who were followed up for 10 years and 10 months. During the period, 168 deaths were recorded, 93 of which were the result of cardiovascular diseases. Leisure time physical activity was assessed by several measures: 1) a single question combining an estimate of the frequency and intensity of the total amount of leisure time physical activity, 2) a compiled measure of leisure time physical activity derived from three separate questions concerning the intensity and frequency of activity, 3) a physical energy expenditure index computed as an estimate of weekly energy expenditure for leisure time activity and commuting to work, 4) 16 separate specified activities of daily living and domestic chores included in the leisure time physical activity index. The association between baseline leisure time physical activity and the risk of death was assessed using the Cox proportional hazards model. After adjustment for potential confounders, the leisure time physical activity energy expenditure index and participation in several specific activities of daily living and domestic chores showed that the mortality risk for all causes and cardiovascular diseases was highest in the most sedentary men. With respect to the leisure time physical activity energy expenditure index, sedentary men ( those with an estimated weekly energy expenditure in leisure time physical activity of < 800 kcal) had an increased risk of 2.74 (95% confidence interval 1.46-5.14) for all-cause mortality and a risk of 3.58 (95% confidence interval 1.45-8.85) for cardiovascular disease mortality compared with the most active persons (those with an estimated weekly energy expenditure in leisure time physical activity of at least 2,100 kcal) when age, initial health status, marital status, employment status, and smoking were controlled.

Adult↗
PubMed1995

Strengths and weaknesses in health counseling in Finnish primary health care.

Representative samples of Finnish health centres and of their physicians, nurses and physiotherapists were selected for a comprehensive survey on the professionals' work characteristics, health education attitudes and counseling practices. The main objectives of the study were to study the degree of implementation of patient counseling, with special reference to the national goals in health policy and to analyze the determinants of counseling practices in terms of predisposing, enabling and reinforcing factors. Broadly defined patient counseling was frequent in the contacts with all 3 professional groups and no differences in counseling frequency were found between different sizes of health centres. However, the objective of implementing counseling in every patient contact, with the incorporation of guidance regarding healthy living habits in it, recommended in the national health policy goals, was only partially realized. There were distinct differences between the 3 professional groups in counseling attitudes, topics, methods and purposes. These differences reflect, to a great extent, the differences in the professional tasks and the basic training between the 3 groups and also differences in the characteristics of patient contacts. These findings indicate a need for further in-service training in the methods of patients counseling, as well as restructuring the health care delivery system to allow more time for counseling, better continuity between contacts and more co-work between the members of primary care teams.

Finland↗
PubMed1993

Measurement of problem-oriented need for the primary health care services: need for exercise counseling as an example.

Based on several previous approaches, a new model for the measurement of needs for primary health care services is constructed and demonstrated. This fourfold model includes the concepts of diagnostic need, perceived need, client dependent demand and provider dependent demand. The empirical results concerning the need for exercise counseling in the primary health care indicated that the present approach is feasible and comprehensive enough to obtain valuable information about the health needs and how they are supplied. The model makes it possible to identify discrepancies, for example, between the experts' and clients' priority ratings and between the criterion-based prevalence of a problem and the practice of the care providers. It may also reveal barriers and inequalities in the use of services. For health administrators and decisionmakers the present problem-oriented model provides a systematic approach to assess needs for health care services and to develop the services provided.

Adult↗
PubMed1989

Erythrocyte cation transport in obesity, hypertension, and during antihypertensive drug therapy.

The number and activity of erythrocyte ATPase-dependent sodium-potassium pump units were increased in obese subjects (p = 0.02). No link was observed between the number or activity of the pump units and hypertension. The ouabain-insensitive rubidium (i.e. potassium) transport was not associated with relative body weight or blood pressure status. Sodium-lithium countertransport correlated significantly with obesity but not with blood pressure status. In the hypertensive patients, before or after therapy with verapamil, hydrochlorothiazide, pindolol or atenolol there were no significant differences in cation transport. We propose that the correlation between obesity and essential hypertension cannot be explained by these two cation transport systems.

Adolescent↗
PubMed1986

Unusual association of hyperkalemia and hypertension.

We report an unusual association of hyperkalemia, mild hyperchloremic acidosis, and hypertension in a young woman. Pseudohyperkalemia, Addison's disease, renal insufficiency, classical hyporeninemic hypoaldosteronism, isolated hypoaldosteronism, and iatrogenic causes were excluded. The patient's findings were compatible with a rare syndrome designated as type II pseudohypoaldosteronism, Gordon's syndrome.

Adult↗