Background Calcific aortic valve disease (CAVD) is the most common valvular heart disease in Western world. CAVD is ranging from mild aortic valve sclerosis to severe obstructive aortic stenosis (AS). The development of AS has been... more
Background Calcific aortic valve disease (CAVD) is the most common valvular heart disease in Western world. CAVD is ranging from mild aortic valve sclerosis to severe obstructive aortic stenosis (AS). The development of AS has been associated with several risk factors including age, sex and hypertension. However, there is limited knowledge about factors that predict the development of aortic stenosis. Purpose We investigated if the circulating metabolite profile can predict the development of aortic stenosis in Finnish males. Methods We did a non-targeted LC-MS metabolomics analysis to baseline (1984–1989) serum samples from a prospective population-based Kuopio Ischemic Heart Disease risk factor study (KIHD) cohort of 2682 random Finnish males aged from 42 to 60 years. During the follow-up (until year 2020), 53 subjects developed either moderate (peak flow gradient 36–64mmHg or mean flow gradient 20–40mmHg) or severe aortic valvular stenosis (peak flow gradient over 64mmHg or mean ...
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Background Lower urinary sodium concentrations (UNa) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether UNa... more
Background Lower urinary sodium concentrations (UNa) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether UNa predicted major adverse coronary events (MACE) and all-cause mortality over 28–33 years. Methods One hundred and eighty men with chronic HF from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) were included. Baseline data was collected between 1984 and 1989. MACE and all-cause outcomes were obtained using hospital linkage data (1984–2017) with a follow-up of 28–33 years. Cox proportional hazards models were generated using 24-h UNa tertiles at baseline (1 ≤ 173 mmol/day; 2 = 173-229 mmol/day; 3 = 230-491 mmol/day) as a predictor of time-to-MACE outcomes, adjusted for relevant covariates. Results Overall, 63% and 83% of participants (n = 114 and n = 150) had a MACE event (median 10 years) and all-cause mortality event (median 19 years), respec...
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The American Heart Association (AHA) recently developed the Cardiovascular Health Index (CVHI), a health metric consisting of 7 modifiable risk factors. The relationship of the CVHI with preclinical markers, such as carotid intima-media... more
The American Heart Association (AHA) recently developed the Cardiovascular Health Index (CVHI), a health metric consisting of 7 modifiable risk factors. The relationship of the CVHI with preclinical markers, such as carotid intima-media thickness (CIMT) has not been assessed. We examined 490 male monozygotic and dizygotic twins without overt cardiovascular disease. CIMT was measured using B-mode ultrasonography. Each of the 7 CVHI components (blood pressure, fasting glucose, total cholesterol, body mass index, physical activity, healthy diet, and smoking) was given a point score of 0, 1, or 2 to represent poor, intermediate, or ideal health, respectively. A CVHI summation score was computed (range 0 to 14) and categorized as inadequate (0 to 4), average (5 to 9), or optimum (10 to 14) cardiovascular health. Mixed-model regression was used to examine the association of the CVHI with CIMT. The mean age of the twins was 55.4 years, and 61% were monozygotic. The mean CIMT was 0.75 (± 0....
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Serum copper (Cu) and zinc (Zn), essential micronutrients that have important immunomodulatory and antimicrobial properties, are biomarkers of ageing. Serum Cu/Zn-ratio may be a more reliable marker for age-related degenerative conditions... more
Serum copper (Cu) and zinc (Zn), essential micronutrients that have important immunomodulatory and antimicrobial properties, are biomarkers of ageing. Serum Cu/Zn-ratio may be a more reliable marker for age-related degenerative conditions compared with serum Cu or Zn alone. We aimed to assess the association between Cu/Zn-ratio and the risk of incident pneumonia in a prospective cohort study. Serum levels of Cu and Zn were measured at baseline using atomic absorption spectrometry in 2503 men aged 42–61 years in the Kuopio Ischemic Heart Disease prospective cohort study. Hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident pneumonia using Cox regression models. A total of 599 cases of pneumonia occurred during a median follow-up of 26.1 years. Serum Cu/Zn-ratio and Cu were each linearly associated with incident pneumonia. A unit increase in Cu/Zn-ratio was associated with an increased risk of pneumonia in analysis adjusted for potential confounders includi...
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Previous reports of an association between handgrip strength (HGS) and the risk of hypertension have utilized cross-sectional designs. We aimed to assess the prospective association between HGS and hypertension risk in a general... more
Previous reports of an association between handgrip strength (HGS) and the risk of hypertension have utilized cross-sectional designs. We aimed to assess the prospective association between HGS and hypertension risk in a general population. Handgrip strength was assessed at baseline in 463 Finnish men and women aged 61-73 years. Handgrip strength was normalized (HGS/body weight2/3). After 16 years median follow-up, 110 hypertension cases occurred. Comparing the extreme tertiles of normalized HGS, the multivariable adjusted hazard ratio (95% CI) for hypertension was 0.63 (0.38-1.04). Previous evidence of associations may have been driven by study design limitations such as lack of temporality.
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Handgrip strength (HGS), a measure of muscular strength, might be a risk indicator for cognitive functioning, but the evidence is not consistent. Using a new prospective study and meta-analysis of published observational cohort studies,... more
Handgrip strength (HGS), a measure of muscular strength, might be a risk indicator for cognitive functioning, but the evidence is not consistent. Using a new prospective study and meta-analysis of published observational cohort studies, we aimed to evaluate the prospective associations of HGS with poor cognitive outcomes including cognitive impairment, dementia and Alzheimer’s disease (AD). Handgrip strength, measured using a Martin-Balloon-Vigorimeter, was assessed at baseline in a population-based sample of 852 men and women with good cognitive function in the Kuopio Ischemic Heart Disease cohort. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for cognitive outcomes. Relevant published studies were sought in MEDLINE, Embase and Web of Science from inception until October 2021 and pooled using random effects meta-analysis. During a median follow-up of 16.6 years, 229 dementia cases were recorded. Comparing extreme tertiles of HGS, the multivariable adjusted ...
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OBJECTIVE Multimorbidity and complex medications increase the risk of medication-related problems, especially in vulnerable home care patients. The objective of this study was to examine whether interprofessional medication assessment has... more
OBJECTIVE Multimorbidity and complex medications increase the risk of medication-related problems, especially in vulnerable home care patients. The objective of this study was to examine whether interprofessional medication assessment has an effect on medication quality among home care patients. DESIGN The FIMA (Finnish Interprofessional Medication Assessment) study was a randomized, controlled study comparing physician-led interprofessional medication assessment and usual care. SETTING AND PARTICIPANTS The FIMA study was conducted in home care settings in Finland. The participants were ≥65-year-old home care patients with ≥6 drugs daily, dizziness, orthostatic hypotension, or a recent fall. METHODS Primary outcome measures over the 6-month follow-up were number of drugs, drug-drug-interactions, medication-related risk loads, and use of potentially inappropriate medications (PIMs) examined by SFINX, RENBASE, PHARAO, and Meds75+ databases. The databases classified information as follows: A (no known pharmacologic or clinical basis for an increased risk), B (evidence not available/uncertain), C (moderately increased risk which may have clinical relevance), and D (high risk, best to avoid). Logistic regression adjusted for age, sex, and the baseline level of the outcome measure served as statistical methods. RESULTS The mean number of all drugs for home care patients (n = 512) was 15. The odds of drug-induced impairment of renal function (RENBASE D, P = .020) and medication-related risk loads for bleeding (PHARAO D, P = .001), anticholinergic effects (PHARAO D, P = .009), and constipation (PHARAO D, P = .003) decreased significantly in the intervention group compared with usual care. The intervention also reduced the odds of using PIMs (Meds75+ D, P = .005). There were no significant changes in drug-drug-interactions or number of drugs. CONCLUSIONS AND IMPLICATIONS FIMA intervention improved the medication quality of home care patients. Risks for renal failure, anticholinergic effects, bleeding, constipation, and the use of PIMs were reduced significantly.
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BACKGROUND Little is known if heart rate responses during and after exercise test may be associated with the risk of sudden cardiac death (SCD). Our aim was to determine if exercise heart rate reserve and recovery, providing non-invasive... more
BACKGROUND Little is known if heart rate responses during and after exercise test may be associated with the risk of sudden cardiac death (SCD). Our aim was to determine if exercise heart rate reserve and recovery, providing non-invasive indices, may predict SCD risk in general male population. METHODS We evaluated the impact of delayed heart rate reserve and slow heart rate recovery and the risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of randomly selected 1967 men aged 42-61 years at recruitment. Heart rate reserve was calculated as the difference between the maximal attained heart rate and resting heart rate, whereas heart rate recovery was defined as maximal heart rate minus the heart rate measured at 2 min of recovery, on a symptom-limited cardiopulmonary exercise testing. RESULTS During a median follow-up interval of 25 years, 209 events of SCD occurred. The age and examination adjusted relative hazards of SCD were in the lowest third of heart rate reserve 3.86 (95% confidence interval (CI) 2.56-5.80, p < 0.001) and the lowest third of heart rate recovery 2.86 (95% CI 1.95-4.20, p < 0.001) as compared to men in the highest third of heart rate reserve and heart rate recovery, respectively. After adjusting for potential confounders, the respective relative hazards were 1.96 (95% CI 1.24-3.12) and 1.75 (95% CI 1.16-2.64). Each unit increment (1 beat/min) in heart rate reserve and heart rate recovery decreased the incidence of SCD by 1-2%. CONCLUSIONS Delayed exercise heart rate reserve and slow heart rate recovery predicted the risk of SCD, suggesting that heart rate responses may be associated with an increased risk for SCD in general population.
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From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in... more
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory ...
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OBJECTIVE To identify and describe what professional competencies have been addressed by in-service training for health and social care professionals and what kind of teaching and evaluation methods have been used. DESIGN Cross-sectional... more
OBJECTIVE To identify and describe what professional competencies have been addressed by in-service training for health and social care professionals and what kind of teaching and evaluation methods have been used. DESIGN Cross-sectional descriptive study. METHODS A document analysis design was used to explore 7817 in-service training project documents relating to 203 projects carried out from 2002 to 2020. The project data were obtained from the websites run by the relevant health and social care organizations. RESULTS The most frequent competencies that were addressed were health promotion and clinical skills (17%), preventing social problems (16%) and promoting the wellbeing of children and families (15%) and older adults (14%). The main target groups were general health and social care professionals (19%). A total of 222 training interventions were used by the 203 projects and the most frequently used methods were conventional classroom education (56%), followed by coaching and orientation (12%) and theme days (9%). Only 38% of the projects measured the effects of the training and the main method was collecting feedback from participants. We also found that collaboration between projects was necessary to ensure that training was not duplicated and transparent reporting played a central role in that process. CONCLUSIONS In order to achieve successful in-service training for health and social care professionals, projects needed to recognize topical competence needs and provide the most appropriate training methods. Collaboration and transparent reporting helped to avoid duplication in training.
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Sosiaali- ja terveydenhuollossa työnjako voi kohdistua ammattilaisten, yksiköiden ja organisaatioiden tai toimialojen välille. Sillä voidaan vaikuttaa asiakkaiden ja potilaiden saamaan hoitoon ja palveluun sekä ammattiryhmien ja... more
Sosiaali- ja terveydenhuollossa työnjako voi kohdistua ammattilaisten, yksiköiden ja organisaatioiden tai toimialojen välille. Sillä voidaan vaikuttaa asiakkaiden ja potilaiden saamaan hoitoon ja palveluun sekä ammattiryhmien ja toimialojen tehtäviin. Tämän tutkimuksen tarkoituksena oli kuvata, miten työnjako on kuvattu sosiaali- ja terveysministeriön (STM) asiakirjoissa. Tutkimuksen tavoitteena on tuottaa tietoa sosiaali- ja terveydenhuollon työnjaon kehittämiseksi. Tutkimusmenetelmäksi valittiin dokumenttianalyysi. Aineistoksi valittiin STM:n vuosina 2006–2016 suomen tai ruotsin kielellä valtioneuvoston sähköisessä tietokannassa, Valtossa, julkaisemat asiakirjat, jotka kohdistuvat sosiaali- ja terveydenhuollon työnjakoon (n=352). Tästä muodostettiin kaksi osa-aineistoa, joista ensimmäinen (115 asiakirjaa, 709 työnjaon mainintaa) analysoitiin kuvailevan tilastotieteen menetelmin ja toinen (n=30 asiakirjaa) induktiivisella sisällönanalyysillä. STM:n dokumenteissa työnjaon kuvaukset ...
Data-driven prediction systems used in epidemiological studies are still unsatisfactory from a practical point of view. Different pitfalls should be considered while transferring technologies from research to practice. The proposed... more
Data-driven prediction systems used in epidemiological studies are still unsatisfactory from a practical point of view. Different pitfalls should be considered while transferring technologies from research to practice. The proposed k-Nearest Neighbors approach is designed to make disease-related predictions in a more holistic manner: we detect cases of novelty among unobserved subjects to identify situations when model predictions are not reasonably valid. Moreover, it copes with overlapping classes, finds new examples which cannot be labelled with the high confidence and reveals healthy subjects in the training data who might be at risk. Additionally, variable selection is built-in to select relevant predictors. The approach was applied to predict cardiovascular diseases based on the data collected within an ongoing follow-up study undertaken in Eastern Finland. According to the experimental results, our proposal allows increasing the accuracy of predictions made.
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Research Interests: Environmental Science, Aquatic Ecology, Climate Change, Limnology, Water quality, and 14 moreFreshwater Ecology, Great Lakes, Multidisciplinary, Climate Change Impacts, Biological Sciences, Lakes, Great Lakes Region of Africa, Freshwater, Temperature, Limnology of tropical lakes, Freshwater Biology and Limnology, Climate impacts, Aquatic science, and Water Quality
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Cardiorespiratory fitness (CRF) has a strong inverse relationship with several chronic disease outcomes, including some cancers. The association between CRF and prostate cancer is controversial. We aimed to assess the prospective... more
Cardiorespiratory fitness (CRF) has a strong inverse relationship with several chronic disease outcomes, including some cancers. The association between CRF and prostate cancer is controversial. We aimed to assess the prospective association of CRF with prostate cancer risk using a cohort study and review of the literature.
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1) Department of Biology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland (*corresponding author’s e-mail: ari.voutilainen@uef.fi) 2) Finnish Environment Institute, Freshwater Centre, Survontie 9, FI-40500... more
1) Department of Biology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland (*corresponding author’s e-mail: ari.voutilainen@uef.fi) 2) Finnish Environment Institute, Freshwater Centre, Survontie 9, FI-40500 Jyväskylä, Finland 3) Department of Biology, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland 4) Luode Consulting Oy, Olarinluoma 15 B, FI-02200 Espoo, Finland
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Post-analysis of predictive models fosters their application in practice, as domain experts want to understand the logic behind them. In epidemiology, methods explaining sophisticated models facilitate the usage of up-to-date tools,... more
Post-analysis of predictive models fosters their application in practice, as domain experts want to understand the logic behind them. In epidemiology, methods explaining sophisticated models facilitate the usage of up-to-date tools, especially in the high-dimensional predictor space. Investigating how model performance varies for subjects with different conditions is one of the important parts of post-analysis. This paper presents a model-independent approach for post-analysis, aiming to reveal those subjects’ conditions that lead to low or high model performance, compared to the average level on the whole sample. Conditions of interest are presented in the form of rules generated by a multi-objective evolutionary algorithm (MOGA). In this study, Lasso logistic regression (LLR) was trained to predict cardiovascular death by 2016 using the data from the 1984–1989 examination within the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), which contained 2682 subjects and 950 prese...
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Background Obesity and ethnicity play important roles in cardiovascular complications in patients with T2DM. This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults with prediabetes or type 2... more
Background Obesity and ethnicity play important roles in cardiovascular complications in patients with T2DM. This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults with prediabetes or type 2 diabetes mellitus (T2DM) and central obesity. Methods Study subjects were 60-74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants’ baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements. Results Among study subjects with prediabetes and central obesity (n = 298), fasting glucose, 2-h glucose, fasting insulin...
BACKGROUND Heavy alcohol use has been associated with altered circulating metabolome. We investigated whether changes in the circulating metabolome precede incident diagnoses of alcohol-related diseases. METHODS This is a prospective... more
BACKGROUND Heavy alcohol use has been associated with altered circulating metabolome. We investigated whether changes in the circulating metabolome precede incident diagnoses of alcohol-related diseases. METHODS This is a prospective population-based cohort study where the participants were 42-60-year-old males at baseline (years 1984-1989). Subjects who received a diagnosis for an alcohol-related disease during the follow-up were defined as cases (n = 92, mean follow-up of 13.6 years before diagnosis). Diagnoses were obtained through linkage with national health registries. We used two control groups: controls who self-reported similar levels of alcohol use as compared to cases at baseline (alcohol-controls, n = 92), and controls who self-reported only light drinking at baseline (control-controls, n = 90). A non-targeted metabolomics analysis of baseline serum samples was performed. RESULTS There were significant differences between the study groups in the baseline serum levels of 64 metabolites: in amino acids (e.g. glutamine [FDR corrected q-value = 0.0012]), glycerophospholipids (e.g. lysophosphatidylcholine 16:1 [q = 0.0008]), steroids (e.g. cortisone [q = 0.00001]), and fatty acids (e.g. palmitoleic acid [q = 0.0031]). The main finding was that after controlling for baseline levels of self-reported alcohol use and the biomarker of alcohol use, gamma-glutamyl transferase, and when compared to both alcohol-control and control-control group, the alcohol-case group had lower serum levels of asparagine (Cohen's d = -0.48 [95% CI -0.78 to -0.19] and d = -0.49 [-0.78 to -0.19], respectively) and serotonin (d = -0.45 [-0.74 to -0.15], and d = -0.46 [-0.75 to -0.16], respectively), with no difference between the two control groups (asparagine d = 0.00 [-0.29 to 0.29], and serotonin d = -0.01 [-0.30 to 0.29]). CONCLUSIONS Changes in the circulating metabolome, especially lower serum levels of asparagine and serotonin, are associated with later diagnoses of alcohol-related diseases, even after adjustment for the baseline level of alcohol use.
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Various data-driven models are often involved in epidemiological studies, wherein the availability of data is constantly increasing. Accurate and, at the same time, interpretable models are preferable from the practical point of view.... more
Various data-driven models are often involved in epidemiological studies, wherein the availability of data is constantly increasing. Accurate and, at the same time, interpretable models are preferable from the practical point of view. Finding simple and compact dependences between predictors and outcome variables makes it easier to understand necessary interventions and preventive measures. In this study, we applied a Fuzzy Logic-based model, which meets these requirements, to predict the coronary heart disease (CHD) progression during a 30-year follow-up. The Fuzzy Logic-based model was automatically designed with an ad hoc Genetic Algorithm using the data from the Kuopio Ischemic Heart Disease Risk Factor (KIHD) Study, a Finnish cohort of 2682 men who were middle-aged at baseline in 1980s. Using cross-validation, we found out that the sample from the KIHD study is heterogeneous and after filtering out 10% of outliers, the predictive accuracy increased from 65% to 73%. The generated rule bases include 19 fuzzy rules on average with maximum 7 variables in one rule from the initial set of 638 predictor variables. The selected predictors of CHD progression are informative and diverse representing physical aspects, behavior, and socioeconomics. The Fuzzy Logic-based model creates a comprehensive set of predictors that enables us to better understand the complexity of illnesses and their progression. Moreover, the Fuzzy Logic-based model has potential to provide tools to analyse and deal with heterogeneity in large cohorts.
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1) Department of Biology, University of Eastern Finland, Yliopistokatu 7, FI-80100 Joensuu, Finland 2) Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1C, FI-70211 Kuopio, Finland (*corresponding author’s... more
1) Department of Biology, University of Eastern Finland, Yliopistokatu 7, FI-80100 Joensuu, Finland 2) Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1C, FI-70211 Kuopio, Finland (*corresponding author’s e-mail: ari.voutilainen@uef.fi) 3) Natural Resources Institute Finland, Laasalantie 9, FI-58175 Enonkoski, Finland 4) Natural Resources Institute Finland, Survontie 9 A, FI-40500 Jyväskylä, Finland
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Fatty liver disease (FLD) and hypertension are separately associated with cardiovascular (CV) mortality. While the two conditions are established as separate predictors of CV outcomes, FLD and hypertension are interrelated in multiple... more
Fatty liver disease (FLD) and hypertension are separately associated with cardiovascular (CV) mortality. While the two conditions are established as separate predictors of CV outcomes, FLD and hypertension are interrelated in multiple ways. A biological interaction in respect to CV disease outcomes could exist between FLD and hypertension. In this study, we investigated the joint effect and interaction of FLD and hypertension regarding CV mortality using an interaction framework. Using a population-based cohort, we followed 1,569 middle-aged non-diabetic Finnish men for 34 years. We computed the fatty liver index and considered values ≥60 as indicative of FLD. We defined hypertension as either i) self-reported hypertension and a confirmed use of antihypertension medication, or ii) a mean systolic ≥160 or diastolic ≥105 blood pressure on baseline examination. The choice of the blood pressure measurement threshold to define hypertension was based on a sensitivity analysis. With adjust...
