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Biomedical subjects

M Heliövaara

Publications and source records attributed to M Heliövaara.

At least 19 recordsLinked to original sources
PubMed1998

Is low selenium status a risk factor for lung cancer?

The hypothesis that low selenium may in some circumstances be a risk factor for lung cancer was investigated in a case-control study nested within a longitudinal study. Serum samples from 9,101 cancer-free individuals were collected and stored at -20 degrees C by the Finnish Mobile Clinic in 1968-1971 and 1973-1976. During follow-up until the end of 1991, 95 cases of lung cancer were diagnosed. Selenium concentrations were determined from the serum samples of the cases and 190 controls, individually matched for sex, age, and place of residence. Mean levels of serum selenium in cases and controls were 53.2 microg/liter and 57.8 microg/liter, respectively. The relative risk of lung cancer between the highest and lowest tertiles of serum selenium, adjusted for smoking, serum alpha-tocopherol, serum cholesterol, serum copper, serum orosomucoid, and body mass index (kg/m2), was 0.41 (95% confidence interval (CI) 0.17-0.94). The association was stronger at lower levels (<5.9 mg/liter) of alpha-tocopherol (relative risk=0.24, 95% CI 0.07-0.85). The association was also pronounced among current smokers and at higher levels of serum orosomucoid and serum copper. The relative risk for smokers who were twice ranked in higher selenium tertiles, at an interval of 4-7 years, in comparison with smokers who remained in the lowest tertile was 0.16 (95% CI 0.04-0.74). In accordance with the hypothesis, the findings suggest that very low selenium status may contribute to the risk of lung cancer.

Adult↗
PubMed1998

Trends of back pain in eastern Finland, 1972-1992, in relation to socioeconomic status and behavioral risk factors.

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.

Adult↗
PubMed1998

Epidemiology of rheumatoid arthritis in Finland.

OBJECTIVES: To review the work pertaining to rheumatoid arthritis (RA) morbidity in Finland and to compare the data with that available from other countries. METHODS: Extensive investigations in Finland of the epidemiology of RA, based on nationwide registers designed primarily for administrative purposes and on extensive population studies, frequently in combination. RESULTS: According to several surveys with somewhat different study designs, the prevalence of clinically significant RA is about 0.8% of the adult Finnish population. Five national health interviews from a 30-year period have revealed figures about 50% higher, but with no clear change in prevalence. The incidence of clinically significant RA is about 40 per 100,000 of the adult population, which is in accordance with the prevalence figures. The mean age at diagnosis increased by 7.6 years from 1975 to 1990. Between 1978 and 1980, 5.8% of the severe disability in the adult Finnish population was attributable to RA. Some evidence suggests that severe disability resulting from RA diminished during the 1980s, possibly because of joint replacement surgery. CONCLUSIONS: Monitoring sickness insurance statistics is a useful means of following the epidemiology of RA.

Adult↗
PubMed1998

Smoking and risk of colorectal cancer.

Tobacco smoking was studied in relation to colorectal cancer in 56 973 Finnish men and women initially free from cancer. Smoking status was determined by a health questionnaire. During a follow-up period of 28 years, from the baseline in 1966-72 to the end of 1994, 457 cases of colorectal cancer occurred. There was no significant association between baseline smoking status and colorectal cancer risk over the total follow-up period. The sex- and age-adjusted relative risk of colorectal cancer between smokers and non-smokers was 1.06 (95% confidence interval 0.84-1.33). For follow-up periods of 11-20 years, however, the relative risk was 1.57 (95% confidence interval 1.09-2.24). In a subgroup in which smoking habits were assessed twice, the relative risk of colorectal cancer among persistent smokers was 1.71 (95% confidence interval 1.09-2.68) compared with others. The results of the present prospective study are consistent with the possibility that smoking increases the risk of colorectal cancer after a relatively long induction period. To clarify the role of smoking in colorectal cancer development, further cohort studies are needed with long follow-up periods and allowing for control of dietary and other potential confounding factors.

Colorectal Neoplasms↗
PubMed1998

Serum androgen-anabolic hormones and the risk of rheumatoid arthritis.

OBJECTIVE: It has been hypothesised, mainly on the basis of indirect evidence, that low serum concentrations of androgen-anabolic hormones would play a causal part in the aetiology of rheumatoid arthritis (RA). METHODS: A case-control study was nested with a Finnish cohort of 19,072 adults who had neither arthritis nor a history of it at the baseline examination during 1973-1977. Pre-illness serum specimens for the assay of testosterone and dehydroepiandrosterone sulphate (DHEAS) were available from 116 cases who had developed RA by late 1989. Three controls per each incident case were individually matched for sex, age, and municipality. RESULTS: The mean testosterone concentration was 1.4 nmol/l in those 84 women who developed RA and 1.4 nmol/l in their controls; the corresponding figures for DHEAS were 5.2 mumol/l and 5.5 mumol/l, respectively. Mean testosterone concentration in the 32 male cases was 26.1 nmol/l and 26.4 nmol/l in their controls; the corresponding figures for DHEAS were 11.2 mumol/l and 10.1 mumol/l, respectively. Analysis by subgroups (rheumatoid factor positive and negative disease, pre-menopausal and postmenopausal women) and by hormone distributions showed no differences. CONCLUSION: The findings are not in line with the contention that low concentrations of testosterone and DHEAS play a part in the aetiology of RA.

Adult↗
PubMed1998

Lumbar spinal stenosis: assessment of long-term outcome 12 years after operative and conservative treatment.

The present study focuses on the long-term prognosis of radiographically verified stenosis of the lower lumbar spine. The purpose here was to describe the outcome 12 years after radiographic diagnosis of spinal stenosis and to identify factors predicting disability after operative or conservative treatment. Data were compiled on 75 patients (43 men and 32 women) with changes in functional myelography diagnostic for spinal stenosis. Their mean age at the interview 12 years later was 61 years. The sagittal diameter of the dural sac was measured from baseline myelographs at all intervertebral levels and was corrected for magnification. In the interview, subjective outcome assessment was obtained with a structured questionnaire, and the low-back disorder was scored using the Oswestry disability index. The sagittal diameter of the dural sac was severely stenotic (<7.0 mm) in 32 patients (26 operated), and moderately stenotic (7.0-10.5 mm) in 43 patients (31 operated). The severity of the stenosis significantly predicted disability, even when the effects of age, sex, therapy regimen, and body mass index were adjusted for. For moderate and severe stenosis, the adjusted mean Oswestry indices were 28.4 and 39.1, respectively (p = 0.01). Therapy as such (operative versus nonoperative) did not significantly correlate with later disability. The radiographic severity of lumbar spinal stenosis predicts disability independently of therapy regimen. Randomized clinical trials are needed to establish the indications for surgical and conservative treatment. Radiographic severity of the stenosis should be considered as an effect-modifying or confounding factor in clinical trials and other studies focusing on the outcome of lumbar spinal stenosis.

Aged↗
PubMed1997

Arm motion speed and risk of neck pain. A preliminary communication.

STUDY DESIGN: A sample of 486 Helsinki City Council workers, 35 to 54 years of age, was examined twice at a 1-year interval. OBJECTIVES: To investigate the speed of repetitive arm motion for its ability to predict neck pain. SUMMARY OF BACKGROUND DATA: Psychomotor factors have been suggested to play a role in the etiology of spinal disorders. It was hypothesized that motor skills, as reflected by arm motion speed, could provide protection against neck pain. METHODS: Both the baseline and follow-up examinations consisted of a questionnaire on the history of neck pain and of a number of tests, including arm motion speed and static and dynamic strength of the upper extremities. RESULTS: Of the 124 men and women who reported not having had neck pain during the 1 year before the baseline examination, 23 (19%) reported neck pain on reexamination. The incidence of neck pain was significantly higher both in the least and most rapid quintiles of arm motion speed than in the medium quintiles. This association was not confounded by age, sex, smoking, physical activity at work or at leisure, psychological distress score, or strength measures of the upper extremities, although these factors were significant covariates of the arm motion speed at baseline. When adjusted for these factors, the odds ratios of neck pain in the most and least rapid quintiles of arm motion speed were 8.68 (95% confidence interval 1.85-40.75) and 9.57 (95% confidence interval 2.21-41.52) respectively, compared with the medium quintiles. CONCLUSIONS: These results suggest that people with either very slow or very rapid arm motion speed may have an increased risk of neck pain. The etiology of neck pain is probably different on these two occasions.

Adult↗
PubMed1997

Does psychological distress predict disability?

STUDY OBJECTIVE: To evaluate psychological distress as a predictor of disability due to common chronic disorders. STUDY POPULATION AND METHODS: A 10-year follow-up study was carried out among a representative cohort (N = 8655) of 18-64 year old Finnish farmers, who had participated in a health survey in 1979 and were able to work at baseline. A record linkage with the nationwide register of the Social Insurance Institution was made to identify disability pensions granted between 1980 and 1990 in the cohort. The medical certificates of 1004 (11.6%) prematurely retired farmers were reviewed to confirm and classify disabling conditions. A sum score based on self-reports of 11 symptoms at the baseline was used as a measure of psychological distress. RESULTS: After adjustment for age, sex, smoking and body mass index, the cause-specific relative risks (RR) (95% confidence intervals [CI]) of disability in the highest quartile of the psychological distress score as compared with the lowest quartile were for myocardial infarction 2.34 (95% CI: 1.17-4.69), for depression 2.50 (95% CI: 1.09-5.72), for neck-shoulder disorders 1.98 (95% CI: 1.26-3.11), for unspecified low-back disorders 1.76 (95% CI: 1.24-2.49), for knee osteoarthritis 1.55 (95% CI: 0.91-2.63) and for trip osteoarthritis 0.89 (95% CI: 0.42-1.85). The corresponding RR for overall disability was 1.76 (95% CI: 1.44-2.14) in the highest quartile of psychological distress score as compared with the lowest quartile. CONCLUSIONS: Psychological distress is an independent risk factor for disability. Its predictive significance varies between disorders leading to functional deterioration. The association mechanisms are likely to vary from one disorder to another.

Adolescent↗
PubMed1997

Serum immunoglobulins and the risk of rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is associated with several autoantibodies that can precede the clinical disease. The immunoglobulin concentrations in serum samples before illness were studied to learn more about the immunological process before RA. METHODS: A case-control study was nested within a Finnish cohort of 19,072 adults who had neither arthritis nor a history of it at the baseline examination during 1973-1977. By late 1989, 124 had developed RA, of which 89 were positive for rheumatoid factor (RF). Three controls per each incident case were individually matched for sex, age, and municipality. The concentrations of IgG, IgA, and IgM were measured from stored serum samples. RESULTS: Serum IgG before illness was found to be directly proportional to the risk of RF positive RA, and a non-linear association was present between serum IgA and the risk of RF positive RA. These associations were constant between men and women and other subgroups of the study population and not confounded by serum orosomucoid concentration, level of education, smoking, alcohol intake or body mass index. As adjusted for these factors, the odds ratios (95% confidence intervals) of RF positive RA in the lowest, mid, and highest tertiles of IgG distribution were 1.00, 1.55 (0.81, 2.97), and 2.22 (1.16, 4.26), and in the tertiles of IgA 1.00, 2.23 (1.14, 4.36), and 1.78 (0.89, 3.57), respectively. The associations persisted throughout the entire observation period but were most distinct when the period to the onset of clinical RA was > or = 10 years. IgM carried no predictive significance. None of the serum immunoglobulins predicted the development of RF negative RA. CONCLUSIONS: Increased IgG levels may reflect some, at present unknown process in the early events leading to the development of RA, typically occurring > or = 10 years before the onset of clinical disease.

Adult↗
PubMed1996

Elevated lung cancer risk among persons with depressed mood.

Although it has been hypothesized that depressive persons have an excess risk of cancer, few prospective data are available. The association between depressiveness and subsequent incidence of lung cancer was studied in the nationally representative Mini-Finland Health Survey. The study population comprised 7,018 adult men and women, free from cancer at the baseline, carried out in 1978-1980. During a 14-year follow-up, 605 cancer cases occurred, of which 70 were male lung cancer patients. Mental problems and disorders were assessed at the baseline examination using standard interview techniques (General Health Questionnaire and Present State Examination). The relative risk of lung cancer between depressive persons and individuals with a normal depressiveness score was 3.32 (95% confidence interval 1.53-7.20). Neither adjustment for the potential confounding factors of age, education, geographic area, smoking, alcohol consumption, body mass index, serum cholesterol, leisure-time exercise, general health, and use of antidepressant medication nor exclusion of cancer cases occurring during the first 4 years of follow-up notably altered the results. There was a strong interaction between depressiveness and smoking. The relative risks of lung cancer between smokers and nonsmokers were 3.38 (95% confidence interval 1.09-10.52) at normal depressiveness score levels and 19.67 (95% confidence interval 2.57-150.7) at strongly elevated levels, respectively. It is possible that depressiveness modifies the effect of smoking on lung cancer risk either by biologic mechanisms or by affecting smoking behavior.

Adult↗
PubMed1996

Serum cholesterol and risk of rheumatoid arthritis in a cohort of 52 800 men and women.

Recent epidemiological studies have suggested that joint risk factors occur for rheumatoid arthritis (RA) and coronary heart disease. We studied serum cholesterol concentration for its association with the incidence or RA in 28 362 men and 24 444 women free from arthritis at baseline. During a mean follow-up of 21 yr, 161 men and 351 women developed RA. Of these incident cases, 119 men and 229 women were rheumatoid factor (RF) positive. The serum cholesterol concentration was directly proportional to the risk of RF-positive RA among women and RF-negative RA among men; the age-adjusted relative risks (95% confidence intervals) per S.D. (1.4 mM/l) of the cholesterol distribution were 1.20 (1.05-1.38) and 1.56 (1.15-2.10), respectively. No association was observed, however, for RF-negative RA among women or RF-positive RA among men. The results suggest that a still unknown factor closely associated with serum cholesterol may be involved in the aetiology of RA, but complex interactions with sex and RF status seem to occur.

Adolescent↗
PubMed1996

Has musculoskeletal pain become less prevalent?

The changes in the one-year prevalence rates of low-back, neck-shoulder and joint pains were studied in Finnish farmers during 1979-1992. A health survey was carried out among a representative sample of Finnish farmers (n = 11,368) with a postal questionnaire in 1979 and in another representative sample (n = 3237) using a computer-assisted telephone interview in 1992. Both surveys inquired for musculoskeletal symptoms during the previous year. The one-year prevalence of low-back and joint pain had decreased in all sex and age groups. The total prevalence of neck-shoulder pain had decreased slightly, but not significantly in either sex. The changes in the occurrence of musculoskeletal complaints from 1979 to 1992 may be attributed to the farming policy of the 1980s in Finland. This study is in line with earlier studies showing that musculoskeletal morbidity per se has not increased in the past decade. Even the reverse seems true, if morbidity is defined as trends in symptom occurrence.

Adult↗
PubMed1996

Overweight, gender and knee osteoarthritis.

A 10-year follow-up study was carried out among 6647 farmers aged 40-64 y to investigate associations between age, gender, body mass index (weight/height2) and the incidence of disabling knee osteoarthritis. After the follow-up (1980-1990) a record linkage with the Social Insurance Institution's register was made to identify disability pensions. All the medical certificates for the disability pensions (N = 965) were reviewed to find out the incident cases (N = 126). Age, female gender and body mass index were all independent predictors of disabling knee osteoarthritis. The relationship between body mass index and the incidence of disabling knee osteoarthritis was linear, the adjusted relative risk was 1.4 (95% CI, 1.2-1.5) per standard deviation of the index (3.8 kg/m2). In women, as compared with men, the adjusted relative risks (95% confidence intervals) of right unilateral, left unilateral and bilateral knee osteoarthritis were 7.0 (2.5-19.7), 3.3 (1.1-9.8) and 4.8 (2.4-9.3), respectively. Overweight is a strong risk factor for disabling knee osteoarthritis.

Adult↗
PubMed1995

Low back pain and subsequent cardiovascular mortality.

STUDY DESIGN: This was a prospective cohort study based on data of the Mini-Finland Health Examination Survey collected between 1978 and 1980, with follow-up until the end of 1991. OBJECTIVE: A number of studies have revealed associations between smoking, cardiovascular diseases, and low back pain. Therefore, it has been suggested that atherosclerosis could be involved in the etiology of low back pain. Low back pain was studied for its prediction of mortality and, in particular, deaths from cardiovascular disease. SUMMARY OF BACKGROUND DATA: Of a nationally representative sample of 8000 people older than 29 years, 7217 (90%) participated in a comprehensive health examination. At interviews, 5459 (76%) had a history of low back pain. In a standardized clinical examination, 1253 (17%) were diagnosed as having chronic low back pain. METHODS: The follow-up information on mortality and causes of death was obtained from the Central Statistical Office of Finland. RESULTS: By the end of 1991, 1487 of the examinees had died, 815 from any cardiovascular disease and 501 from coronary heart disease. Neither the history of back complaints nor chronic low back pain predicted mortality. CONCLUSION: That low back pain does not affect longevity disagrees with the hypothesis that atherosclerosis resulting in death from cardiovascular disease is etiologically linked to low back pain.

Adult↗
PubMed1995

Left handedness and risk of thoracic hyperkyphosis in prepubertal schoolchildren.

BACKGROUND: Hand dominance and spinal posture were studied for their prediction of the development of thoracic hyperkyphosis during the pubertal growth spurt. METHODS: The cohort consisted of all the fourth-grade school children of the Western School District of Helsinki, Finland, in the spring of 1986. They were examined annually from the mean age of 10.8 to 13.8 years. Handedness was determined at the baseline examination by observing the hand with which the child was writing. Anthropometric measurements, posture and growth were followed-up annually. A lateral standing radiograph was undertaken in those children who had pronounced thoracic kyphosis in spinal pantography. Kyphotic angles > or = 45 degrees were considered hyperkyphotic. RESULTS: In both girls and boys, left handedness was found to be a powerful determinant of hyperkyphosis. In left handed children the odds ratio (OR), adjusted for baseline spinal measurements, was 4.11 (95% confidence interval [CI]: 1.39-12.13). Hump size measured by the forward bending test also predicted significantly the development of thoracic hyperkyphosis (OR = 1.48; 95% CI: 1.23-1.76, per one degree). CONCLUSIONS: Left handedness may be a risk factor for thoracic hyperkyphosis during the pubertal growth spurt.

Anthropometry↗
PubMed1995

Incidence and risk factors of low-back pain in middle-aged farmers.

A 12-year follow-up study was carried out to evaluate the risk factors for unspecified low-back pain and sciatic pain. Middle-aged farmers who did not report any low-back or neck-shoulder pain during the previous year in a postal questionnaire in 1979 were included in the follow-up study in 1992 (n = 537). In total, 366 (68%) of these farmers were interviewed by telephone. In 1992, the one-year prevalence rates of unspecified low-back pain (13.3%) and sciatic pain (9.6%) were low. Full-time farmers had a significantly higher prevalence of sciatic pain than did part-time or retired farmers. In the logistic regression modelling of sciatic pain in men, the odds ratio was 9.6 (95% CI: 2.7-65.2) for current smokers and 13.1 (95% CI: 1.7-53.0) for ex-smokers as compared to never smokers. Mental stress, body height, body mass index and production factors did not predict unspecified low-back pain or sciatic pain. Farmers who are free of back problems in middle age seem to stay well in the long run despite the heavy work. The close association between smoking and the prevalence of sciatic pain found in men is in line with the hypothesis that smoking is a causal risk factor for lumbar disc disease.

Agriculture↗
PubMed1995

Parity and risk of rheumatoid arthritis in Finnish women.

Several recent case-control studies have suggested that nulliparity is a risk factor for rheumatoid arthritis (RA). We studied parity for its association with the incidence of RA in a cohort of adult Finnish women examined by the Mobile Clinic of the Social Insurance Institution in 1966-72. The 15,441 women were > or = 30 yr of age and had neither arthritis nor a history of it at the time of the baseline examination. They were followed up by examining records kept at the population register of the institution, to identify patients entitled to free anti-rheumatic medication. Up to late 1989, 269 women had developed RA. Of the incident cases, 176 were rheumatoid factor (RF)-positive. Compared with nulliparous women, the age-adjusted relative risks (95% confidence intervals) of parous women developing RF-positive RA, RF-negative RA or either type were 1.26 (0.82-1.92), 0.80 (0.48-1.32) and 1.06 (0.77-1.46), respectively. The number of childbirths presented an n-shaped relationship with the risk of RF-positive RA, but there were distinct differences between subpopulations. In female farmers the association was inverse, but in housewives and in other occupational groups (mainly employees) it was clearly positive. The results challenge the view that there is a causal relation between parity status and the development of RA.

Adult↗