Lieto, Finland
Lieto, Finland

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Salminen M.,University of Turku | Salminen M.,Harkatie Health Center | Kuoppamaki M.,University of Turku | Kuoppamaki M.,Naantali Health Center | And 6 more authors.
Diabetes and Metabolism | Year: 2010

Aim: The aim of this study was to investigate the relationship between the metabolic syndrome (MetS) and mortality in the aged population. Methods: In this prospective population-based study with a 9-year follow-up, the participants were all residents of the municipality of Lieto, Finland, aged 64 and over in 1998-99 (n= 1529). Altogether, 1260 (82%) were included in the study. Cox proportional-hazard models were used to estimate hazard ratios (HRs) for all-cause, cardiovascular (CVD), coronary heart disease (CHD) and cerebrovascular (CV) mortality as predicted by MetS (defined by modified International Diabetes Federation criteria). Results: At baseline, 17% of the men and 21% of the women had MetS. During the 9-year follow-up, 422 deaths occurred. After multivariable adjustment, no significant differences were found between subjects with and without MetS for all-cause, CVD, CHD or CV mortality in all study participants or by gender. On evaluating MetS components separately, elevated blood pressure was found to predict lower all-cause mortality in all participants [HR: 0.65; 95% confidence interval (CI): 0.47-0.89], and lower CHD mortality in men (HR: 0.42; 95% CI: 0.18-0.97). In women, high triglyceride levels predicted lower all-cause mortality (HR: 0.67; 95% CI: 0.47-0.95), whereas low HDL cholesterol predicted higher all-cause (HR: 1.61; 95% CI: 1.15-2.24) and CV (HR: 2.44; 95% CI: 1.05-5.67) mortality. Conclusion: These findings suggest that MetS does not predict mortality later in life and, of the separate components of MetS, only low HDL cholesterol is predictive of mortality in women. Also, even markedly higher blood pressure values than those included in the criteria for MetS fail to predict mortality in this age group. Objectif: L'objectif de cette étude était d'examiner les relations éventuelles entre syndrome métabolique (SMET) et mortalité chez les sujets âgés. Méthodes: Étude prospective en population avec suivi de neuf ans. Tous les sujets étaient résidents de la commune de Lieto en Finlande et âgés de 64 ans ou plus en 1998-1999 (n= 1529). Au total, 1260 sujets (82 %) ont participé à l'étude. Le risque relatif (RR) de mortalité toutes causes confondues et de mortalité cardiovasculaire, coronaire et vasculaire cérébrale a été calculé grâce au modèle proportionnel de Cox en fonction de l'existence ou non d'un SMET (défini selon les critères révisés de la Fédération internationale du diabète). Résultats: À l'inclusion, 17 % des hommes et 21 % des femmes étaient atteints de SMET. Pendant le suivi de neuf ans, 422 sujets sont décédés. L'ajustement multivarié n'a révélé aucune différence importante liée au SMET entre les sujets des deux sexes quant à la mortalité cardiovasculaire, coronaire et vasculaire cérébrale et la mortalité toutes causes confondues. L'évaluation de chacun des composants du SMET a montré que l'hypertension artérielle était associée à une mortalité toutes causes confondues plus basse pour l'ensemble de la population étudiée (RR 0,65; intervalle de confiance à 95 % 0,47-0,89) et à une mortalité coronaire plus basse chez les hommes (RR 0,42; IC 95 % 0,18-0,97). Chez les femmes, l'hyperglycémie était associée à une mortalité toutes causes confondues plus basse (RR 0,67; IC à 95 % 0,47-0,95), tandis que des concentrations basses de HDLc étaient associées à une mortalité toutes causes confondues et à une mortalité vasculaire cérébrale plus élevées (respectivement RR 1,61; IC à 95 % 1,15-2,24) et (RR 2,44; IC à 95 % 1,05-5,67). Conclusion: Ces résultats suggèrent que le SMET est dépourvu de valeur pronostique de mortalité dans les phases ultérieures de la vie. Parmi les composants individuels du SMET, seules des concentrations basses de HDLc sont associées à la mortalité chez les femmes. Même des valeurs de pression artérielle plus élevées que les critères du SMET sont dépourvues de valeur pronostique de la mortalité dans cette tranche d'âge. © 2010 Elsevier Masson SAS.


Salminen M.,University of Turku | Salminen M.,Harkatie Health Center | Kuoppamaki M.,University of Turku | Kuoppamaki M.,Naantali Health Center | And 6 more authors.
Acta Diabetologica | Year: 2011

The aim was to analyze the relationship between metabolic syndrome (MetS) and vascular risk among the aged. A prospective population-based study, with a 9-year follow-up. All subjects of the municipality of Lieto in Finland aged ≥64 in 1998-99 participated (n = 1183). Hazard ratios (HRs) for fatal or non-fatal coronary (CHD), cerebrovascular (CV), or all vascular events predicted by MetS (defined by International Diabetes Federation) were estimated. During the 9-year follow-up, a total of 348 vascular events occurred, including 208 CHD and 150 CV events. After multivariable adjustment, CHD events (1.70, 1.07-2.71, P = .026) and vascular events (1.57, 1.07-2.30, P = .021) were more common in men with MetS compared to men without it. Evaluating MetS components individually, low HDL-cholesterol among women predicted a higher occurrence of CV (2.44, 1.46-4.09, P < .001) and all vascular (1.78, 1.26-2.53, P = .001) events. Elevated blood pressure among men was related to fewer CHD events (0.46, 0.25-0.83, P = .010). Our findings suggest that MetS does predict vascular events in late life among men. In older women, only low HDL-cholesterol was associated with vascular risk. Slightly or moderately elevated blood pressure values do not predict vascular events in this age group. © 2011 Springer-Verlag.


Nurminen J.,University of Turku | Puustinen J.,University of Turku | Puustinen J.,Harkatie Health Center | Puustinen J.,Satakunta Hospital District | And 8 more authors.
Age and Ageing | Year: 2013

Background: in men, the concomitant use of two or more benzodiazepines or two or more antipsychotics is associated with an increased risk of fracture(s). Potential associations between the concomitant use of drugs with central nervous system effects and fracture risk have not been studied. Objective: the purpose was to describe the gender-specific risk of fractures in a population aged 65 years or over associated with the use of an opioid, antiepileptic or anticholinergic drug individually; or, their concomitant use with each other; or the concomitant use of one of these with a psychotropic drug. Methods: this study was part of a prospective, population-based study performed in Lieto, Finland. Information about fractures in 1,177 subjects (482 men and 695 women) was confirmed with radiology reports. Results: at 3 years of follow-up, the concomitant use of an opioid with an antipsychotic was associated with an increased risk of fractures in men. During the 6-year follow-up, the concomitant use of an opioid with a benzodiazepine was also related to the risk of fractures for males. No significant associations were found for females. Conclusion: the concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older. © The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.


Hohtari-Kivimaki U.,University of Turku | Hohtari-Kivimaki U.,Satakunta Central Hospital | Salminen M.,University of Turku | Salminen M.,Harkatie Health Center | And 4 more authors.
Aging Clinical and Experimental Research | Year: 2013

Background and aims: The aim of this study was to assess the adequacy of the short, 9-item Berg Balance Scale (BBS-9) to predict fall risk among the community-dwelling aged. Methods: The subjects (n = 519) were derived from the participants in a multifactorial fall prevention intervention conducted in Pori, Finland. Receiver operating characteristic (ROC) analysis was used to determine the cut-off score for BBS-9 (range 0-36) to classify aged people with a fall risk during a 12-month follow-up. Logistic regression was used to analyse the relationship of potential con-founders with fall risk. The association between the cut-off score for BBS-9 and fall risk was tested using the Chisquare test. Results: In determining the cut-off score of BBS-9 to classify fall risk, the highest sensitivity (0.51) and specificity (0.57) (when both presumed to be above 0.50) sum score was within the limit range 32 scores or below. The area under curve (AUC) was significantly better in the model adjusted for significant confounders (vision and the number of regularly used drugs) (AUC = 0.64) than in the unadjusted model (AUC = 0.57) (p = 0.045). Among patients who scored 32 or below in BBS-9 the incidence of multiple falls was 20.0 %, whereas among those who scored 33-36 it was 15.7 %. Conclusions: BBS-9 with the cut-off score of 32/33 together with data on vision and the number of regularly used drugs predicted moderately the risk of falling among the community-dwelling aged. © Springer International Publishing Switzerland 2013.


Nurminen J.,University of Turku | Nurminen J.,Harkatie Health Center | Nurminen J.,Turku Health Center | Puustinen J.,University of Turku | And 5 more authors.
BMC Public Health | Year: 2010

Background. There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over. Methods. This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD), antipsychotic (AP) or antidepressant (AD)] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women) during the follow-up was collected from medical records. Two follow-up periods (three and six years) were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses. Results. The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women. Conclusions. The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures. © 2010 Nurminen et al; licensee BioMed Central Ltd.


Virtanen R.,University of Turku | Kryssi V.,University of Turku | Vasankari T.,University of Turku | Salminen M.,University of Turku | And 4 more authors.
European Journal of Preventive Cardiology | Year: 2014

Background: Early detection of atrial fibrillation (AF) in older people is important because AF is often asymptomatic and its first manifestation may be a disabling stroke. The objective of the LietoAF Study is to assess the motivation and capability of older people to learn pulse palpation and continue regular pulse measurements, and whether this selfassessment is helpful in the detection of new AF.Design and method: The LietoAF Study is an intervention study. A total of 205 people aged ≥75 years were randomly selected to participate in the programme where a trained nurse gave individual education on pulse palpation. At 1 month, the eligible participants came to the first follow-up visit to assess the success of pulse self-monitoring.Results: A total of 139 participants (68%) learned pulse palpation and performed regular measurements during the early follow-up period. The significant independent predictors for learning and motivation were high Mini-Mental State Examination score (>24) (OR 7.5, 95% CI 1.537.3, p=0.014), computer use at home (OR 4.7, 95% CI 1.911.5, p=0.001), independence at daily activities (OR 4.2, 95% CI 1.413.6, p=0.013) and low heart rate (OR 1.04, 95% CI 1.01.08, p=0.037). Education did not cause extra visits to local healthcare centres and did not affect quality of life. Four participants observed a new asymptomatic AF during the 1-month follow-up. Conclusion: Active older people are motivated and seem to learn pulse palpation. Our early experience suggests that simple nurse-based education is effective and useful in the early detection of asymptomatic AF. © 2013 The European Society of Cardiology.


Hohtari-Kivimaki U.,University of Turku | Hohtari-Kivimaki U.,Satakunta Central Hospital | Salminen M.,University of Turku | Salminen M.,Harkatie Health Center | And 3 more authors.
Aging Clinical and Experimental Research | Year: 2012

Background and aims: To create a shorter version of the Berg Balance Scale (BBS) and to assess correlations between short BBS and static and dynamic aspects of balance among community-dwelling aged with a self-reported history of falling. Methods: 519 (88%) subjects were included in the study, for whom BBS, and static and dynamic balance measurements were performed. Explanatory factor analysis was used to create a shorter version of the BBS. Static and dynamic balance was measured on a force platform. Correlations between the short BBS and static and dynamic balance were analysed by Spearman's correlation analysis. Cronbach's alpha was used to assess the internal consistency of the short BBS. Results: Explanatory factory analysis produced two factors. Factor 1 consisted of nine items and factor 2 of four items of the BBS. One item of the original BBS was not loaded in these factors. The short BBS (BBS-9) was formed of factor 1. It correlated significantly with the original BBS, and had moderate correlations with static and dynamic aspects of balance (p<0.001). The high scores of BBS-9 were associated with better static and dynamic balance. BBS-9 demonstrated as good internal consistency reliability (Cronbach's alpha [α]=0.69) as the original BBS (α=0.74). Conclusions: Results support the applicability of BBS-9 in assessing functional balance among the aged with quite good physical function. However, more studies are needed to verify applicability to other samples and to assess cut-off scores for BBS-9, to predict the likelihood of falling. ©2012, Editrice Kurtis.


Salminen M.,University of Turku | Salminen M.,Harkatie Health Center | Raiha I.,University of Turku | Raiha I.,Turku City Hospital | And 3 more authors.
Archives of Gerontology and Geriatrics | Year: 2012

Aim: The aim was to carry out a systematic review of original studies about morbidity in the aged in Finland. Methods: Publications with data on morbidity in the aged (≥65 years) in peer-reviewed scientific journals in Finnish and English were systematically searched for in literature databases, websites of National Institute of Health and Welfare (NIHW), National Public Health Institute (NPHI), and Stakes and reference lists of retrieved articles. Publications from 1990 onwards were included. Results: The search produced 39 publications about morbidity in the aged in Finland fulfilling the inclusion criteria. The most common disease categories in the aged were cardiovascular diseases (CVDs), musculoskeletal disorders (MSDs), hypertension, orthostatic hypotension (OH), insomnia, diabetes, articular diseases, diseases causing cognitive decline, and depression. The prevalence of many of these diseases increased with age. Conclusions: The morbidity increases with aging, and even the oldest-old are not exceptionally healthy. Because of the increasing number of aged people, the absolute use of health and social services by this population sector will most probably increase in Finland and other developed countries. © 2011 Elsevier Ireland Ltd.


Salminen M.,University of Turku | Salminen M.,Harkatie Health Center | Kuoppamaki M.,University of Turku | Kuoppamaki M.,Naantali Health Center | And 6 more authors.
Diabetes and Vascular Disease Research | Year: 2013

The aim was to analyse the relationship between metabolic syndrome and type 2 diabetes mellitus risk among the aged. This was a prospective population-based study, with a 9-year follow-up. All subjects of the municipality of Lieto in Finland aged ≥64 in 1998-1999 with no type 2 diabetes mellitus at baseline (n=1117) were included. Hazard ratios for incident type 2 diabetes mellitus predicted by metabolic syndrome (defined by modified International Diabetes Federation criteria) were estimated. During the 9-year follow-up, a total of 69 participants (6.2%) developed type 2 diabetes mellitus. After multivariable adjustment (age, gender, smoking, frequency of exercise, cardiovascular disease and low-density lipoprotein-cholesterol), type 2 diabetes mellitus (hazard ratio, 95% confidence interval) (3.15, 1.89-5.25, p < 0.001) was more common in subjects with metabolic syndrome compared to subjects without it. Evaluating metabolic syndrome components individually, impaired fasting glucose (5.09, 2.64-9.82, p < 0.001) and obesity (1.71, 1.05-2.97, p = 0.034) predicted a higher incidence of type 2 diabetes mellitus. Our findings suggest that metabolic syndrome predicts onset of type 2 diabetes mellitus even in late life. Impaired fasting glucose and obesity should be targets for primary prevention of diabetes among the aged with metabolic syndrome. © 2012 The Author(s).


Lahteenmaki R.,University of Turku | Puustinen J.,University of Turku | Puustinen J.,Pori City Health Center | Vahlberg T.,University of Turku | And 11 more authors.
British Journal of Clinical Pharmacology | Year: 2014

Aim We compared the efficacy of melatonin and placebo as adjuvants in the withdrawal of patients from long term temazepam, zopiclone or zolpidem (here 'BZD') use. Methods A double-blind, placebo-controlled, randomized trial was conducted in a primary health care outpatient clinic. Ninety-two men or women (≥55 years) with primary insomnia and chronic BZD use received controlled release melatonin 2 mg (CRM) (n = 46) or placebo (n = 46) during the 1 month withdrawal from BZDs. Psychosocial support was provided. Follow-up continued for up to 6 months. Successful BZD withdrawal by the end of 1 month was confirmed by BZD plasma determinations, while reduction in BZD use and abstinence continuing for 6 months were noted. Results There were two drop-outs on CRM and one on placebo. After a 1 month withdrawal, 31 participants (67%; 95% CI 54, 81) on CRM and 39 (85%; 74, 95) on placebo had withdrawn completely (intention-to-treat analysis between groups, P = 0.051; per protocol P = 0.043). Reduction in BZD use was similar or even more rare in the CRM than in the placebo group (P = 0.052 per protocol). After 6 months, 14 participants in the CRM group and 20 in the placebo group remained non-users of BZD (NS between groups). BZD doses were higher in the CRM than in the placebo group at the end of the 6 month follow-up (P = 0.025). Withdrawal symptoms did not differ between the groups. Conclusions Gradual dose reduction of BZDs combined with CRM or placebo, and psychosocial support produced high short term and moderate long term BZD abstinence. CRM showed no withdrawal benefit compared with placebo. © 2013 The British Pharmacological Society.

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