The Impact of Lifestyle and Cardiovascular Risk Factors in Midlife on the Health-Related Quality of Life among Old Men

Prevention of cardiovascular diseases is known to postpone death, but in an aging society it is important to ensure that those who live longer are neither disabled nor suffering an inferior quality of life. It is essential both from the point of view of the aging individual as well as that of society that any individual should enjoy a good physical, mental and social quality of life during these additional years. The studies presented in this thesis investigated the impact of modifiable risk factors, all of which affect cardiovascular health in the long term, on mortality and health-related quality of life (HRQoL). The data is based on the all male cohort of the Helsinki Businessmen Study. This cohort, originally of 3.490 men born between 1919 and 1934 has been followed since the 1960s. The socioeconomic status of the participants is similar, since all the men were working in leading positions. Extensive baseline examinations were conducted among 2.375 of the men in 1974 when their mean age was 48 and at this time the health, medication and cardiovascular risk factors of the participants were observed. In 2000, at the mean age of 73, the HRQoL of the survivors of the original cohort was examined using the RAND-36 mailed questionnaire (n=1.864). RAND-36, along with the equivalent SF-36, is the world s most widely used means of assessing generic health. The response rate was generally over 90%. Mortality was retrieved from national registers in 2000 and 2002. For the six substudies of this thesis, the impact of four different modifiable cardiovascular risk factors (weight gain, cholesterol, alcohol and smoking) on the HRQoL in old age was studied both independently and in combination. The follow-up time for these studies varies from 26 up to 39 years. Mortality is reported separately or included in the RAND-36 scores for HRQoL. Elevated levels of all the risk factors examined among the participants in midlife led to a diminished life expectancy. Among survivors, lower weight gain in midlife was associated with better HRQoL, both physically and mentally. Higher levels of serum cholesterol in middle age indicated both an earlier mortality and a decline in the physical component of HRQoL in a dose-response manner during the 39-year follow-up. Mortality was significantly higher in the highest baseline category of reported mean alcohol consumption (≥ 5 drinks/day), but fairly comparable in abstainers and moderate drinkers during the 29-year follow-up. When HRQoL in old age was accounted for mortality, the men with the highest alcohol consumption in midlife clearly had poorer physical and mental health in old age, but the HRQoL of abstainers and those who drank alcohol in moderation were comparatively similar. The amount of cigarette smoking in midlife was shown to have had a dose-response effect on both mortality and HRQoL in old age during the 26 year follow-up. The men smoking over 20 cigarettes daily in middle age lost about 10 years of their life-expectancy. Meanwhile, the physical functioning of surviving heavy smokers in old age was similar to men 10 years older in the general population. The impact of clustered cardiovascular risk factors was examined by comparing two subcohorts of men who were healthy in 1974, but with different baseline risk factor status. The men with low risk had a 50 % lower mortality during the 29-years follow-up. Their RAND-36 scores for the physical quality of life in old age were significantly better, and the 2002 questionnaire examining psychological well-being indicated also significantly better mental health among the low-risk group. The results indicate that different risk factor levels in midlife have a meaningful impact on life-expectancy and the quality of these extra years. Leading a healthy lifestyle improves both survival and the quality of life.

Fascial planes within subcutaneous fat in humans

We have used B-mode (brightness-mode) ultrasound to investigate the fascial planes within subcutaneous fat at the triceps and abdominal sites in a group of 17 women attending a weight control group over a 12 month period. In most subjects there was a single intralipid fascial plane at each site. As the thickness of adipose tissue increased, most of the change at the abdominal site was in the deep rather than the superficial layer of fat. At the triceps site both deep and superficial layers increased. Our findings confirm the presence of two different layers in human subcutaneous fat at the triceps and abdominal sites. These layers have been shown to be functionally different in animals and our study supports this in humans at the abdominal site.

Pathways to health : Determinants of health, health behaviour and health inequalities in early adulthood

There is increasing evidence that the origins of poor adult health and health inequalities can be traced back to circumstances preceding current socioeconomic position and living conditions. The life-course approach to examining the determinants of health has emphasised that exposure to adverse social and economic circumstances in earlier life or concurrent adverse circumstances due to unfavourable living conditions in earlier life may lead to poor health, health-damaging behaviour, disease or even premature death in adulthood. There is, however, still a lack of knowledge about the contribution of social and economic circumstances in childhood and youth to adult health and health inequalities, and even less is known about how environmental and behavioural factors in adulthood mediate the effects of earlier adverse experiences. The main purpose of this study was to deepen our understanding of the development of poor health, health-damaging behaviours and health inequalities during the life-course. Its aim was to find out which factors in earlier and current circumstances determine health, the most detrimental indicators of health behaviour (smoking, heavy drinking and obesity as a proxy for the balance between nutrition and exercise), and educational health differences in young adults in Finland. Following the ideas of the social pathway theory, it was assumed that childhood environment affects adult health and its proximal determinants via different pathways, including educational, work and family careers. Early adulthood was studied as a significant phase of life when many behavioural patterns and living conditions relevant to health are established. In addition, socioeconomic health inequalities seem to emerge rapidly when moving into adulthood; they are very small or non-existent in childhood and adolescence, but very marked by early middle age. The data of this study were collected in 2000 2001 as part of the Health 2000 Survey (N = 9,922), a cross-sectional and nationally representative health interview and examination survey. The main subset of data used in this thesis was the one comprising the age group 18 29 years (N = 1,894), which included information collected by standardised structured computer-aided interviews and self-administered questionnaires. The survey had a very high participation rate at almost 90% for the core questions. According to the results of this study, childhood circumstances predict the health of young adults. Almost all the childhood adversities studied were found to be associated with poor self-rated health and psychological distress in early adulthood, although fewer associations were found with the somatic morbidity typical of young adults. These effects seemed to be more or less independent of the young adult s own education. Childhood circumstances also had a strong effect on smoking and heavy drinking, although current circumstances and education in particular, played a role in mediating this effect. Parental smoking and alcohol abuse had an influence on the corresponding behaviours of offspring. Childhood circumstances had a role in the development of obesity and, to a lesser extent, overweight, particularly in women. The findings support the notion that parental education has a strong effect on early adult obesity, even independently of the young adult s own educational level. There were marked educational differences in self-rated health in early adulthood: those in the lowest educational category were most likely to have average or poorer health. Childhood social circumstances seemed to explain a substantial part of these educational differences. In addition, daily smoking and heavy drinking contributed substantially to educational health differences. However, the contribution of childhood circumstances was largely shared with health behaviours adopted by early adulthood. Employment also shared the effects of childhood circumstances on educational health differences. The results indicate that childhood circumstances are important in determining health, health behaviour and health inequalities in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing the unfortunate pathways leading to the development of poor health, health-damaging behaviour and health inequalities. It is crucially important to recognise the needs of children living in adverse circumstances as well as children of substance abusing parents. In addition, single-parent families would benefit from support. Differences in health and health behaviours between different sub-groups of the population mean that we can expect to see ever greater health differences when today s generation of young adults grows older. This presents a formidable challenge to national health and social policy as well as health promotion. Young adults with no more than primary level education are at greatest risk of poor health. Preventive policies should emphasise the role of low educational level as a key determinant of health-damaging behaviours and poor health. Keywords: health, health behaviour, health inequalities, life-course, socioeconomic position, education, childhood circumstances, self-rated health, psychological distress, somatic morbidity, smoking, heavy drinking, BMI, early adulthood

Smoking patterns and lung function : A longitudinal twin study

In many countries, the prevalence of smoking and smokers average cigarette consumption have decreased, with occasional smoking and daily light smoking (1-4 cigarettes per day, CPD) becoming more common. Despite these changes in smoking patterns, the prevalence of chronic obstructive pulmonary disease (COPD), a disorder characterized by a progressive decline in lung function, continues to rise globally. Smoking is the most important factor causing COPD, however, not all smokers develop the disease. Genetic factors partly explain the inter-individual differences in lung function and susceptibility of some smokers to COPD. No earlier research on the genetic and environmental determinants of lung function or on the phenomenon of light smoking exists in the Finnish population. Further, the association between low-rate smoking patterns and COPD remains partly unknown. This thesis aimed to study the prevalence and consistency of light smoking longitudinally in the Finnish population, to assess the characteristics of light smokers, and to examine the risks of chronic bronchitis and COPD associated with changing smoking patterns over time. A further aim was to estimate longitudinally the proportions of genetic and environmental factors that explain the inter-individual variances in lung function. Data from the Older Finnish Twin Cohort, including same-sex twin pairs born in Finland before 1958, were used. Smoking patterns and chronic bronchitis symptoms were consistently assessed in surveys conducted in 1975, 1981, and 1990. National registry data on reimbursement eligibilities and medication purchases were used to define COPD. Lung function data were obtained from a subsample of the cohort, 217 female twin pairs, who attended spirometry in 2000 and 2003 as part of the Finnish Twin Study on Ageing. The genetic and environmental influences on lung function were estimated by using genetic modeling. This thesis found that light smokers are more often female, well-educated, and exhibit a healthier lifestyle than heavy smokers. At individual level, light smoking is rarely a constant pattern. Light smoking, reducing from heavier smoking to light smoking, and relapsing to light smoking after quitting, are among patterns associated with an increased risk of chronic bronchitis and COPD. Constant light smoking is associated with an increased use of inhaled anticholinergics, a medication for CODP. In addition to smoking, other environmental factors influence lung function in the older age. During a three-year follow-up, new environmental effects influencing spirometry values were observed, whereas the genes affecting lung function remained mostly the same. In conclusion, no safe level of daily smoking exists with regard to pulmonary diseases. Even daily light smoking in middle-age is associated with increased respiratory morbidity later in life. Smoking reduction does not decrease the risk of COPD, and should not be recommended as an alternative to quitting smoking. In elderly people, attention should also be drawn to other factors that can prevent poor lung function.

Escenas de la vida de Santo Domingo de Guzmán

Resumen: “Escenas de la Vida de Santo Domingo de Guzmán” es el título otorgado a la bella obra atribuida al pintor Pere Nicolau, uno de los máximos representantes del Gótico Internacional en Valencia. Esta obra nos informa de la imagen simbólica de Santo Domingo, creada a partir de la literatura hagiográfica y las manifestaciones artísticas en la Edad Media, “cada una en su lenguaje, su riqueza y sus límites, y en ellos reside su belleza, su capacidad de sugerir y de permitirnos soñar o recrearnos”.

Pleitos y usurpaciones de tierras realengas en Córdoba a fines del siglo XV : la villa de Las Posadas

Resumen: Analizamos el problema de las apropiaciones ilícitas de tierras en el término jurisdicional de la ciudad de Córdoba a fines de la Edad Media, centrando la atención en la villa de Las Posadas y en los procesos judiciales.

Restricciones, privilegios y violencias : algunos aspectos sobre los mudéjares hispánicos (ss. XII-XV)

En el presente trabajo nos proponemos abordar algunos aspectos relacionados con las restricciones, los privilegios y la violencia, que se implementaron sobre los mudéjares de Castilla, Aragón y Valencia. En relación con los primeros, daremos cuenta del endurecimiento legal –real y eclesiástico– que se desplegó hacia los moros hispánicos y que regló casi todos los aspectos del vivir cotidiano y de sus prácticas religiosas. Sin embargo, los mudéjares y sus aljamas en algún área en particular, fueron sujetos de privilegios reales. Es por esto que analizaremos restricciones y privilegios como dos caras de un mismo proceso que se desplegó durante el tránsito de la baja edad media. Finalmente, indagaremos sobre los episodios de violencia hacia los mudéjares contrastando particularidades regionales, para conectar estos sucesos con la segregación y la restricción.

Filosofando en medio del caos : Agustín de Hipona y sus enseñanzas sobre la verdad y la justicia

Resumen: Este artículo tiene por objeto a uno de los filósofos medievales más importantes del pensamiento occidental: nos referimos a Agustín de Hipona. En este escrito intentaremos examinar y analizar, primero, el contexto biográfico, social y político de su época, ya que no podemos pretender comprender el pensamiento de un filósofo fuera de las circunstancias en que dicho pensamiento se gestó; luego de analizar el contexto histórico intentaremos justificar la postura que sostiene que San Agustín fue realmente un pensador medieval, a pesar de que no se sitúe dentro de los límites temporales que señala la tradición para la Edad Media. En segundo lugar, intentaremos poner de manifiesto sus enseñanzas acerca de la verdad y de la justicia; y, finalmente, intentaremos ubicarlas dentro de los esquemas clasificatorios de Jorge Saltor y Nicasio Barrera.

Unemployment rates and population changes in Spain

Published as an article in: Journal of Applied Economics, 2004, vol. VII, pages 47-76.

La pena de muerte en la Corona de Castilla en la Edad Media

[ES]A lo largo de este artículo se pasan revista a cinco cuentiones que muestran la evolución de la pena de muerte en la Corona de Castilla a lo largo de la Edad Media. En primer lugar, se presta atención al paso de la ejecución privada de la justicia a la pública y en qué casos se mantuvo la venganza, aunque con la autorización judicial. En segundo lugar, se pasa revista a las formas de aplicar la pena de muerte, privilegiando los siguientes tipos: el ahorcamiento por los pies, el asaeteamiento, el empozamiento y el encubamiento. En tercer lugar, se expone el ritual de ejecución de las penas capitales desde que el reo sale de la cárcel y es conducido al cadalso, hasta que el cuerpo es sepultado o queda expuesto a perpetuidad. En cuarto lugar, se reflexiona sobre la incidencia de la rebeldía o contumacia del acusado ante los requerimientos de la justicia en la imposición de la pena de muerte. En quinto y último lugar, se analizan las circunstancias que llevaron a la Corona de Castilla, a partir del último tercio del siglo XV, a relegar la pena de muerte entre el elenco punitivo y preferir castigos que tuvieran utilidad pública.

La violencia legal del sistema penal medieval ejercida contra las mujeres

[ES]A lo largo de estas páginas se analiza la igualdad o desigualdad de las mujeres respecto a los varones ante el control formalizado de la justicia penal a la hora de condenarlas a penas tan rigurosas como los azotes, el destierro o la horca; y ante el control informal ejercido por la familia, reprimiendo los comportamientos considerados ilícitos al margen de los tribunalesde justicia públicos.

El mundo de las supersticiones y el paso de la hechicería a la brujomanía en Euskal-Herria (siglos XIII al XVI)

[ES]En este artículo se pretende dar una visión global, tanto en la exposición de los hechos como en la interpretación de los mismos, del mundo de la brujería (hechicería, adivinación, etc.) y de la superstición (curanderismo, exorcismo, conjuros, bendiciones)en el País Vasco y Navarra durante la Edad Media y primera Edad Moderna.

La civilización vasca medieval: vida(s), cotidiana(s), mentalidad(es) y cultura(s)

[ES]A lo largo de las páginas de este trabajo se pasa revista a diversas cuestiones que permiten realizar una aproximación a las diversas formas de vida cotidiana y mentalidad del País Vasco y Navarra durante los siglos bajomedievales. Esas cuestiones aluden al primum vivere, al ciclo vital, al control de la vida privada de los individuos y pública de las comunidades por parte de las autoridades, las fiestas, las supersticiones y distintos aspectos relativos a la cultura, como literatura, historiografía y arte.

Fernando del Pulgar y la vejez

[ES]Aproximación a la consideración social de los ancianos a finales de la Edad Media y cómo ellos vivían su situación a través del ejemplo del cronista Fernando del Pulgar (Castilla siglo XV).