Background: Randomised controlled trials demonstrate a 60% reduction in type 2 diabetes incidence through lifestyle modification programmes. The aim of this study is to determine whether such programmes are feasible in primary health care.

Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.

Study objective-To assess the relation between self rated health and mortality over a period of 23 years, taking into account medical history, cardiovascular risk factors, and education at the beginning of the follow up. Design-A cohort of random population samples. The baseline studies included a self administered questionnaire and a health examination. Mortality data were collected from the national mortality register using personal identification numbers. Setting-The provinces of North Karelia and Kuopio in eastern Finland. Participants-Random samples of working age people (n=21 302) from the population register. Main results-For self rated health, the age adjusted poor to good relative risk for all cause mortality was 2.36 (95% confidence intervals 2.10, 2.64) for men and 1.90 (1.63, 2.22) for women, and for cardiovascular mortality 2.29 (1.96, 2.68) for men and 2.34 (1.84, 2.96) for women. Adjusted for selected potentially fatal diseases from the subjects' medical histories, cardiovascular disease risk factors, and education, the corresponding relative risks for all cause mortality were 1.66 (1.47, 1.88) for men and 1.50 (1.26, 1.78) for women, and for cardiovascular mortality 1.54 (1.29, 1.82) for men and 1.63 (1.26, 2.10) for women. The association between self rated health and mortality attributable to external causes was fairly strong. Conclusions-Poor self rated health is a strong predictor of mortality, and the association is only partly explained by medical history, cardiovascular disease risk factors, and education.

Relevant information on the prevalence of chronic obstructive pulmonary disease (COPD) and its trends is scarce. In the present study, we compare the prevalence rates and potential determinants of COPD in two national population samples that were surveyed 20 yrs apart.In 1978-1980, a sample of 8,000 people was surveyed; subjects were representative of the Finnish population and were aged o30 yrs. Among those aged 30-74 yrs, acceptable spirometry was obtained from 6,364 (87%) subjects. In a similar survey conducted in 2000-2001, comparable spirometry was obtained from 5,495 (80%) participants. Airway obstruction was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity below the lower limit of normal and staged for severity on the basis of FEV1 % predicted.The age-adjusted prevalence rates of obstruction (stages I-IV) were rather similar in both surveys in males (4.7 versus 4.3%; p50.25), but were almost significantly higher in females in the later survey (2.2 versus 3.1%; p50.06). The rates of COPD stage II or higher were 3.9% in 1978-1980, and 3.6% in 2000-2001 (p50.36) for males, and 1.4 and 1.5% (p50.93), respectively, for females.In conclusion, no significant difference was found in the prevalence of COPD stages II-IV between similar population based surveys performed 20 yrs apart. Since COPD is mostly mild or moderate there is a strong case for early prevention.

The aim of this study was to compare the trends in the prevalence of back pain between several population subgroups and to assess the stability of the associations between back pain and its potential risk factors. Five cross-sectional surveys with independent random samples were conducted in two provinces in eastern Finland every fifth year from 1972 to 1992. There were 29,043 respondents aged 30-59 years. The respondents completed a questionnaire that asked about the occurrence of back pain during the preceding month. The prevalence of back pain varied between 46 and 50 percent among men and between 46 and 51 percent among women. In general, the trend for the entire sample was fairly stable, but the prevalence rates seemed to differ considerably between subgroups of the population. Back pain was more prevalent among those with lower education and income, those with blue-collar occupations, and those doing heavy work. The trends were significantly inconsistent (p < 0.05), for example, between the categories according to household income and, among men, between the categories according to body mass index, a suspected risk factor for back pain.