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Biomedical subjects

K Poikolainen

Publications and source records attributed to K Poikolainen.

At least 37 records · Page 2Linked to original sources
PubMed1999

Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis.

BACKGROUND: Psoriasis is seen as a disease that does not kill. However, it is associated with alcohol intake and smoking. Thus, there could be excess mortality due to causes related to alcohol intake and smoking among patients with psoriasis. DESIGN: A cohort was identified from the nationwide Hospital Discharge Register from January 1, 1973, through December 31, 1984, and mortality was followed up for 22 years by linkage with the Cause-of-Death Register, from January 1, 1973, through December 31, 1995. PATIENTS: A cohort of 3132 men and 2555 women admitted to inpatient treatment with psoriasis as the principal diagnosis. MAIN OUTCOME MEASURES: Date and underlying cause of death. RESULTS: We observed 1918 deaths in contrast to the 1211 deaths expected on the basis of the national mortality rates. The all-cause standardized mortality ratio (SMR) for men was 1.62 (95% confidence interval [CI], 1.52-1.71); for women, 1.54 (95% CI, 1.43-1.64). Among men, the highest SMRs were found for alcohol psychosis (8.91 [95% CI, 2.89-20.70]) and liver disease, ie, cirrhosis, fatty liver, and hepatitis (6.98 [95% CI, 5.34-8.96]). Among women, the highest SMR was found for liver disease (5.06 [95% CI, 2.70-8.65]). Excess mortality was high for all causes of death directly related to alcohol; the SMR for men was 4.46 (95% CI, 3.60-5.45); for women, 5.60 (95% CI, 2.98-8.65). CONCLUSIONS: Patients with moderate to severe psoriasis are at increased risk for death. Alcohol is a major cause for this excess mortality.

Alcohol Drinking↗
PubMed1999

Effectiveness of brief interventions to reduce alcohol intake in primary health care populations: a meta-analysis.

BACKGROUND: Earlier meta-analyses have not made a distinction between very brief (5- to 20-min) interventions and extended (several visits) brief interventions. METHODS: Literature searches identified seven publications, comprising 14 data sets, meeting the inclusion criteria: sampling from primary care populations, random allocation to intervention and to control groups, and follow-up time 6-12 months. RESULTS: For very brief interventions, the change in alcohol consumption was not significant among men nor among women. For extended brief interventions, the pooled effect estimate of change in alcohol intake was -51 g of alcohol per week (95% confidence interval -74, -29) among women. Among men the estimate was of similar magnitude, but significant lack of statistical homogeneity implied that the summary estimate was not meaningful. Significant statistical heterogeneity was observed when data on very brief interventions among men and women were pooled. That was the case also for gamma-glutamyltransferase activity. CONCLUSIONS: Extended brief interventions were effective among women. Other brief interventions seem to be effective sometimes, but not always, and the average effect cannot be reliably estimated. The reasons for the lack of uniform effectiveness should be explored.

Adolescent↗
PubMed1999

Trioxsalen bath PUVA did not increase the risk of squamous cell skin carcinoma and cutaneous malignant melanoma in a joint analysis of 944 Swedish and Finnish patients with psoriasis.

It has been suggested that trioxsalen bath and ultraviolet (UV) A (PUVA) is associated with a very low or no risk of non-melanoma skin cancer, but the numbers of patients in individual studies have been limited. In order to attain statistically relevant information about the cancer risk associated with trioxsalen bath PUVA, two follow-up studies were combined and the joined cancer incidence was analysed among 944 Swedish and Finnish patients with psoriasis. The mean follow-up time for skin cancer was 14.7 years. Standardized incidence ratios (SIR) were calculated as a ratio of observed and expected numbers of cases. The expected numbers of cases were based on the national cancer incidence rates in the respective countries. There was no excess of squamous cell skin carcinoma [SIR 1.1, 95% confidence interval (CI) 0.2-3.2] or malignant melanoma (SIR 0.9, 95% CI 0.1-3.2) in the combined cohort. Basal cell skin carcinoma was not studied. The incidence of all non-cutaneous cancers was not increased (SIR 1.1, 95% CI 0.8-1.4). A threefold excess risk of squamous cell skin carcinoma after trioxsalen bath PUVA could therefore be excluded, which is a markedly lower risk than that associated with oral 8-methoxypsoralen PUVA. The result needs to be confirmed in a future follow-up, however, as the number of patients with high PUVA exposures was low.

Adolescent↗
PubMed1998

Unemployment, sociodemographic background and consumption of alcohol before and during the economic recession of the 1990s in Finland.

BACKGROUND: Some studies suggest that people's alcohol consumption increases during unemployment whereas others suggest the opposite. All studies, however, deal with situations marked by relatively low national unemployment rates. We studied alcohol use among individuals in relation to unemployment, education, marital status and sex during times of both low and high unemployment in Finland. METHODS: A group of 44391 respondents, aged 18-64 years, from nationally representative, consecutive annual samples of 5000 people from 1982 to 1995 was utilized. Overall response rate for men was 77% and for women 80%. RESULTS: Univariate analyses indicated that unemployment was associated with the amount of reported alcohol use. However, when logistic regression was used to analyse interactions between alcohol consumption, unemployment, education and marital status, the picture changed. During a low unemployment period (e.g. 1982-1990), being unemployed was not associated with the upper consumption level of alcohol use (defined as > or = 8 drinks/week for men, > or = 5 for women); nor was it during a high unemployment period (1991-1995), except among single people. During a high unemployment period poorly educated, single, unemployed men (odds ratio [OR] = 1.6, 95% confidence interval [CI] : 1.1-2.4), showed a significantly higher risk of upper level of alcohol consumption than otherwise similar but employed men (OR = 0.8, 95% CI: 0.6-1.0). The reference group consisted of highly educated, married, employed men who did not exceed the upper drinking limit. Similarly, the risk of upper consumption level drinking was significantly higher among highly educated, unemployed single women (OR = 2.4, 95% CI: 1.388-4.3) than among otherwise similar but employed women (OR = 1.1, 95% CI: 1.0-1.386). CONCLUSION: Thus, unemployment was weakly but significantly related to the upper consumption level of alcohol use among single people during the recession but not in the preceding period of economic growth.

Adult↗
PubMed1997

Determinants of gamma-glutamyltransferase: positive interaction with alcohol and body mass index, negative association with coffee.

gamma-Glutamyltransferase is widely used as a marker of alcohol intake although its performance is poor. This might be related to other conditions influencing gamma-glutamyltransferase activity. The authors studied determinants of gamma-glutamyltransferase activity in a random sample (n = 6,010) drawn from the general population aged 25-64 years in Finland in 1992. In regression analysis, coffee intake and drinking boiled coffee were significantly (p < 0.01) negatively related to gamma-glutamyltransferase, whereas age, male gender, the number of cigarettes per day, serum total cholesterol and high density lipoprotein cholesterol, heart rate, and diastolic blood pressure were significantly positively related to gamma-glutamyltransferase. A significant (p = 0.02) positive interaction was observed between alcohol intake and body mass index. In logistic regression analysis, the proportion of elevated gamma-glutamyltransferase values (> or = 50 U/liter) was significantly decreased, compared with lifelong abstainers, at the alcohol intake level of < 40 g/week (odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.29-0.92) and significantly increased at the level of > or = 300 g/week (OR = 2.81, 95% CI 1.35-5.85) among nonobese subjects (body mass index < 27 kg/m2). Among obese subjects, the respective proportion was significantly increased at the alcohol intake level of > or = 40 g/week (OR = 2.02, 95% CI 1.11-3.68). The proportion of elevated gamma-glutamyltransferase values was significantly decreased at the coffee intake levels of both four to six cups a day (OR = 0.44, 95% CI 0.31-0.62) and seven or more cups a day (OR = 0.36, 95% CI 0.24-0.53). In addition, drinkers of boiled coffee had elevated gamma-glutamyltransferase values more often than drinkers of filtered or instant coffee (OR = 0.59, 95% CI 0.42-0.84). No effects of alcoholic beverage preference were observed. Elevated gamma-glutamyltransferase activities appear to be related to heavy alcohol intake among the nonobese and to very light intake among obese subjects. Coffee appears to decrease gamma-glutamyltransferase activity.

Adult↗
PubMed1997

Psychological defense styles in late adolescence and young adulthood: a follow-up study.

OBJECTIVE: The aims of this follow-up study were to examine in both sexes (1) the stability of defense styles from late adolescence to early adulthood and (2) the ability of adolescent defense styles to predict later psychiatric symptoms. METHOD: Defense styles were examined using the Defense Style Questionnaire. Five hundred sixteen high school students (337 females and 179 males) completed the questionnaire at 15 through 19 years of age, and again 5 years later. In the follow-up examination the General Health Questionnaire was used to assess psychiatric disturbance. RESULTS: Neurotic and immature defense style scores decreased significantly in both sexes, whereas mature defense style scores did not change significantly. Females had significantly higher neurotic defense style scores than males in both late adolescence and young adulthood. Psychiatric disturbance at follow-up was associated positively with baseline immature defense style scores in both sexes, and negatively with baseline mature defense style scores in females. CONCLUSIONS: Development of defenses was apparent as a decrease in neurotic and immature defense style scores. In both sexes, immaturity of defenses in late adolescence predicted psychiatric symptoms in young adulthood.

Adolescent↗
PubMed1997

Estimated numbers of deaths from coronary heart disease "caused" and "prevented" by alcohol: an example from Finland.

OBJECTIVE: Epidemiological studies show that moderate alcohol consumption rather than abstention is associated with a lower risk of coronary heart disease (CHD) mortality. Our objective was to adjust established methods for calculating attributable fractions to a situation where the risk function is J-shaped and to estimate the number of CHD deaths "caused" and "prevented" by alcohol in Finland. METHOD: Point estimates of relative risk were obtained by a meta-analysis. They were pooled by fitting a nonparametric cubic smoothing spline to the data. Alcohol consumption distribution was estimated from survey data (N = 4,818; 2,488 women). The consequences of various assumptions about changes in alcohol consumption distribution on CHD mortality were estimated. The most detailed analyses are presented for men aged 30-69. The results for the men and women aged 30-79 are summarized. RESULTS: Among men aged 30-69, the beneficial effects of light to moderate alcohol consumption "prevent" some 400 CHD deaths each year which corresponds to 12-14% of the observed CHD deaths. Around 20 CHD deaths are "caused" by alcohol consumption exceeding the estimated optimum level. Among men aged 70-79 and women aged 30-79, the numbers of CHD deaths "prevented" by alcohol consumption were approximately 200 and 100, respectively, whereas there were only a few CHD deaths "caused" by alcohol. CONCLUSIONS: Our best estimates suggest that approximately one-tenth of the observed number of CHD deaths among middle-aged men in Finland is "prevented" by alcohol, while the relative effect is considerably smaller among older men and all women.

Adult↗
PubMed1997

Risk factors for alcohol dependence: a questionnaire survey.

Several factors, known to associate with alcoholism, have not been studied together earlier as determinants of alcohol dependence, and taking into account possible interactions. A representative sample of 302 male and 312 female Finns, aged 19 to 81 years, answered a computerized questionnaire in January 1996. The diagnosis of alcohol dependence was based on the ICD-10 criteria. There were 66 (10.8%) subjects with current (past 12-month) ICD-10 alcohol dependence. After adjusting for other potential correlates in logistic regression analysis, alcohol dependence was more common among subjects high on both asocial behavior and on thinking that his or her behavior is determined mainly by chance or by other people (external control) than among the rest [odds ratio (OR) 4.4; 95% confidence interval (95% CI) 1.8-10.9]. Likewise, alcohol dependence was more common among subjects who recalled that they were highly stimulated when intoxicated by alcohol (OR 3.4; 95% CI 1.9-6.0). High predisposition to anxiety associated strongly with alcohol dependence among males (OR 13.8; 95% CI 4.4-43.1), but not among females (OR 2.5; 95% CI 0.7-9.1). Several of the aforementioned correlates may be modifiable risk factors for alcohol dependence.

Adult↗
PubMed1996

Alcohol intake and subjective health.

This cross-sectional analysis examined associations between alcohol intake and subjective health in a random sample (n = 6,040) drawn from the general population aged 25-64 years in Finland in 1992. Self-reported health was good for 3,375 persons and average or poor (suboptimal) for 2,665 persons. Crude odds ratios suggested a U-shaped pattern between alcohol intake and suboptimal health. The pattern took more of a J-shape after data were controlled for sex, age, education, marital status, lack of close friends, being on a disability pension, smoking, being an ex-drinker, and having decreased one's alcohol intake during the past 12 months because of health problems. An interaction was found between alcohol and smoking. The pattern of alcohol odds ratios showed a J-shaped association among never smokers, and a similar pattern was suggested among ex-smokers and current smokers. Among never smokers, the lowest risk was found at the alcohol consumption level of 100-199 g/week (odds ratio (OR) = 0.58, 95% confidence interval (CI) 0.38-0.89). The highest risk was found among persons who regularly smoked > or = 20 cigarettes per day and drank > or = 300 g/week (OR = 4.44, 95% CI 2.36-8.36). The risk for ex-drinkers did not differ from that for lifelong abstainers (OR = 0.89, 95% CI 0.62-1.28), but persons who had decreased their alcohol intake during the past 12 months because of health problems had a higher risk (OR = 1.21, 95% CI 1.05-1.39). The authors conclude that moderate alcohol intake is related to a self-perception of good health.

Adult↗
PubMed1996

Alcohol and overall health outcomes.

The evidence on alcohol and overall health outcomes other than death is briefly reviewed. Four studies deal with hospital admissions, three with leaves of absence, one with visits to physicians and one with subjective health status. Findings imply that moderate alcohol intake is good and heavy intake bad for health in general. Compared with abstaining, the benefits of moderate drinking are small, but the damage caused by heavy drinking is considerable. Some findings suggest that wine is more beneficial than beer or spirits. However, the evidence is not conclusive. More research is needed to clarify the optimal levels of intake, the effects of different patterns of drinking, and the possible differences between various types of beverages.

Adolescent↗
PubMed1995

Alcohol and mortality: a review.

The relation of alcohol intake to total mortality is J-shaped. Abstainers have modestly higher mortality than moderate drinkers but considerably lower [corrected] mortality than heavy drinkers. The higher mortality among abstainers cannot be explained by selection or the presence of other risk factors. Known biologic mechanisms support the conclusion that moderate drinking increases the lifespan. No major differences have been found between the effects of beer, wine or liquor. While drinking patterns and changes in these influence mortality over time, little is known about their significance. The lowest risk of death seems to be at the average intake level of one drink per day. However, due to several sources of error in the assessment of alcohol intake no precise limits of optimal or safe drinking can be recommended. Trials are needed to ascertain these limits. Drinkers should practice moderation and watch for any harmful effects of alcohol.

Adolescent↗
PubMed1995

Regional and social class variation in the relative risk of death from amenable causes in the city of Helsinki, 1980-1986.

BACKGROUND: Relative risk of death from causes amenable to health services' intervention was studied in a case-control design to ascertain regional and social class differences. METHODS: The data were 2091 deaths from amenable causes and 8364 randomly drawn living controls in 1980-1986 in the seven health districts in Helsinki, Finland. Logistic regression was used to adjust relative risk estimates for age, sex and marital status. RESULTS: Adjustments decreased the risk ratios. Compared with the Southern District, the Middle District had significantly higher adjusted relative risk (RR = 1.4; 95% confidence interval [CI]: 1.1-1.7). People with no address had even higher relative risk (RR = 3.1; 95% CI: 2.3-4.2). Compared with social group I, increased relative risks were found in social group II (RR = 1.3; 95% CI: 1.1-1.6), group III (RR = 2.0; 95% CI: 1.6-2.4), group IV (RR = 1.9; 95% CI: 1.5-2.5) and group VI (RR = 8.5; 95% CI: 6.9-10.6). Males had higher relative risk than females (RR = 2.4; 95% CI: 2.1-2.8). Of the dead with no address, 29% were pensioners and 41% had been registered unemployed or occupation was unknown; 48% were single and 17% divorced. CONCLUSIONS: Our results suggest that regional inequalities in health care between various districts in Helsinki are small. However, to a large extent two overlapping groups, social group VI and people with no address, seem to delineate a deprived group likely to need special help from health care.

Adolescent↗
PubMed1995

Life events and other risk factors for somatic symptoms in adolescence.

OBJECTIVE: To determine mental health risk factors related to somatic symptoms, common in adolescence. DESIGN: Cross-sectional study. SETTING: Ten schools, corresponding approximately to US senior high schools, in two cities in Finland. SUBJECTS: A total of 1429 adolescents with no serious disease or injury during the previous 12 months. RESULTS: Frequent or rather frequent occurrence of two or more symptoms was reported by 44% of the female students and 28% of the male students during the past 6 months. Regression analyses showed that among female students, somatic symptoms were associated positively with serious illness or injury in the family, an increased number of arguments between parents, and breaking up with boyfriends or girlfriends; among male students, symptoms were associated with an increased absence of a parent from the home and trouble with siblings; and among both sexes, they were associated with failing examinations. Among male students, changing to new schools was associated with fewer symptoms. Symptom scores associated positively with trait anxiety, trait depression, an immature defense style, and alcohol or drug use among both sexes. Among male students, smoking was associated with more symptoms, and among female students, high self-esteem was associated with fewer symptoms. CONCLUSIONS: These findings suggest that mental health risk factors are strong correlates of somatic symptoms among adolescents with no serious disease. Follow-up studies are needed to clarify the predictive value of these factors.

Adolescent↗