Biomedical subjects
Publications and source records attributed to J Pikkarainen.
The Alcoscan test strip was applied as an assay for the screening of alcohol in vitreous humor and urine samples in autopsy cases and in saliva from drunken drivers. The method gives instant and reliable semi-quantitative information on the presence of alcohol and is valuable when considering the necessity of chemical sampling especially during autopsy.
All 291 fatal accidents (510 persons on board, 318 drowned) in water traffic in Finland in 1986-1988 were investigated by specific teams. Only some data of this extensive investigation are presented in this study. Staggering and falling in boat because of drunkenness, falling over and sinking of boat were the main causes of getting into water of the people aboard. Only 3.5% of the drowned had used life jackets and 9.7% of them could not swim. The reduced ability to swim because of alcohol and the exhaustion were in about half of the drowned the actual cause and the cold water in one third the background factor for drowning. The results indicate that fatal accidents in water traffic are a major problem of males (95.9%) and give important information for countermeasures.
Detection of offenders driving while intoxicated (DW) (mandatory BAC limit at 0.50%) in Finland was investigated. Almost every fifth offender was detected at road blocks and every tenth of them because of abnormal driving. Compared to the local police the national traffic police had arrested much more offenders for traffic violation (38% vs. 11%) but much less because of accidents (12% vs. 23%). The reason of detection was in a significant way dependent on the following variables: BAC, stage of inebriation, vehicle, day of week and hour of day. The risk of detection is very low, i.e. about 1 to 300. However, the risk has doubled from 1979 to 1984, but thereafter slightly declined. The study provides information for the strategy of the police in traffic supervision.
Fatal intoxications in the 15-34 age group in the five Nordic countries during the years 1984 and 1985 (Sweden only in 1984) were investigated. The known drug addicts were studied separately. The highest incidence of intoxications, calculated per 10(5) population, was found in Finland (11.3), followed by Denmark (10.3), Sweden (8.5), Iceland (7.2) and Norway (6.6). The percentage of intoxications caused by drugs was 92 in Denmark, 71 in Norway, 66 in Sweden, 50 in Finland and 17 in Iceland. Ethanol intoxications were seen 5-7 and 2-3 times as frequently in Finland and in Iceland, respectively, than in the other three countries. Carbon monoxide intoxications accounted for two-thirds of all fatal intoxications in Iceland. Drug addicts accounted for 62% of all fatal intoxications in the Danish material. The corresponding figures were 33% in the Norwegian, 16% in the Swedish and 5% in the Finnish material. No deaths in drug addicts were found in Iceland. Most drug addicts in Denmark, Norway and Sweden died of hard drugs and most in Norway and Sweden, from heroin or morphine, whereas in Denmark other strong analgesics, such as methadone, dextropropoxyphene and ketobemidone, accounted for 40% of all hard-drug-related fatal intoxications. To a certain extent the results reflect differences in the legal autopsy routines in the various Nordic countries. However, the ascertainment of drug addicts is assumed to be near-complete in each country.
In Finland a nationwide screening programme for congenital hypothyroidism (CHT) has operated since 1980 with complete coverage. Among the total of 307,000 newborns screened, the incidence per 100,000 was 24.6 for thyroid dysgenesis and 4.0 for dyshormonogenesis. We conclude that, when screening is based on cord serum TSH, the false-positive results are caused mainly by difficult delivery. The most important factors associated with dyshormonogenesis were CHT in the family, origin from a geographic risk area, and origin of both mother and father from the same community. These reflect the autosomal recessive inheritance. The risk factors for dysgenesis were female gender, CHT in the family, birth in a geographic risk area, and birth during a risk period of the year.
Silicosis was produced experimentally in rats by single intratracheal injections of various doses of SiO2 dust. The weight of the lungs as well as the contents of total nitrogen, collagen, nucleic acids (especially RNA), and lipids increased in accordance with the dose and the time interval. Fibrogenic stimulation in vitro was shown by the supernatant of the homogenized lung in the incorporation of proline into incubated granulation tissue or lung fibroblasts. The fibrogenic factor-activity depended more on the time interval after the injection than on the SiO2 dose. Electrophoresis of the soluble proteins in the silicotic rat lungs showed a protein of 16,000 Da, which was dependent on the time interval following SiO2 administration as well as on the dose itself, and which originated from macrophages. This protein was purified by repeated gel-filtration chromatography. It stimulated collagen synthesis in granulation-tissue cells at a concentration of about 10(-10) M in a dose-dependent way. It was acidic by amino acid composition but differed from calmodulin which also increased collagen synthesis in granulation-tissue cells in vitro. The ability of non-fractionated macrophage preparations to stimulate the incorporation of proline into collagen correlated inversely with the gross alkaline RNase activity.
This study on fatal intoxications in the Nordic countries indicates an over-representation of drug addicts in Denmark, Norway and Sweden. All cases of fatal intoxications in persons 15-34 years of age submitted to medicolegal autopsy and subsequent toxicological examination in the Nordic countries during 1984-1985 included in the study. A comparison between the Nordic countries is possible because the same definition of a drug addict and classification of drugs are used. The numbers of fatal intoxications among drug addicts per 10(5) population were 6.3 in Denmark, 2.1 in Norway, 1.3 in Sweden, 0.6 in Finland and none in Iceland. About 70 per cent of the drug addicts in Norway and Sweden died from heroin/morphine intoxication. In Denmark only 55 per cent of the drug addicts died from heroin/morphine and 36 per cent died from overdoses of the legal drugs methadone, dextropropoxyphene and ketobemidone.
All natural deaths of motor vehicle drivers and bicyclists in traffic were retrospectively studied from the police and forensic autopsy protocols in the province Uusimaa in 1982-1985. Of the cases 57 were males and 3 females. The annual prevalence of natural deaths at wheel greatly increased with the age and was 260 and 231 per 1 million drivers and bicyclists aged 60-69 years, respectively. The most common underlying cause of death was chronic ischaemic heart disease, often known before (42%), and often combined with acute myocardial infarction (62%). In about half of the cases there were injuries. However, only in 5 cases the injuries had contributed so death. The presence of alcohol and drugs did not play any role. These deaths differed significantly by the event and demography of the parties from those killed in traffic accidents. The results suggest that sudden deaths at wheel are not very common in Finland. However, in all kinds of traffic deaths the police investigation should be completed by the forensic autopsy.
Explore the source record for details and available documents.
727 consecutive drunken drivers were studied for laboratory markers of excessive alcohol consumption. Serum gamma-glutamyltransferase and alanine aminotransferase showed no differences and aspartate aminotransferase and blood alcohol concentration only small differences between groups of first and repeating drunk driving offenders. The best laboratory test to differentiate the repeating offenders with probably more serious alcohol problems from the first offenders was in our material serum acetate, the mean serum acetate level of the repeating offenders being highly significantly (P less than 0.001) higher than that of the first offenders or nonalcoholic controls. Serum acetate also differentiated first offenders from nonalcoholic controls (P less than 0.001). Our results suggest that serum acetate could be used for the screening of problem drinking among drunken drivers.
The legal limit for drinking and driving in Britain is 80 mg/dl (17.4 mmol/l) of alcohol in the blood. This was chosen 20 years ago on the basis of studies that have recently been reanalysed. Changes in public opinion, the results of recent research, and the evaluation of other countermeasures, such as random breath testing, show that there are good grounds for revising the legal limit downwards. It is suggested that the legal limit should be reduced from 80 mg/dl to 50 mg/dl (10.9 mmol/l) and random breath testing introduced as in most Nordic countries. A zero limit is proposed for learner and first year drivers, who are likely to have accidents even with low concentrations of alcohol in their blood.
To study the relation between blood and liver selenium levels in hepatic disorders we measured the selenium concentrations of whole blood, serum and liver tissue obtained at laparoscopy in 17 patients with different kinds of liver diseases. As compared to healthy controls the mean concentration of selenium was decreased by 24% (p less than 0.001) in the whole blood of the patients (n = 15). Similarly, the mean concentration of selenium in serum was 35% lower in the patients than in the controls (p less than 0.001). As compared to the control samples obtained at autopsy the selenium content of liver was decreased by 13% (p less than 0.05) in the patients. Significant positive correlations were found between the selenium content of the liver and the whole blood (r = 0.62, p less than 0.05) as well as also between liver and serum (r = 0.52, p less than 0.05) selenium concentrations. In conclusion, the present study suggests that in patients with liver disorders the selenium concentrations are decreased not only in the blood but also in the liver tissue. Whether this means a decreased activity of hepatic glutathione peroxidase and, further, an increased possibility of oxidative cell injury, remains open.
Since the introduction of random breath testing in Finland in 1977 the drinking and driving rate has halved, and there has been an appreciable reduction in the rates of death and injury from road accidents associated with drinking. The results of Finnish studies indicate that random breath testing deters social drinkers and detects problem drinkers. Problem drinkers are more likely to be driving in morning traffic, when vulnerable road users such as children are about, and are more likely to be detected by random breath testing than by any other police activity. Random breath testing is a popular measure and has not only saved lives but has paid for itself by savings in health service and other resources. Introducing random breath testing into Britain could save at least 400 lives a year. The main recommendation of the Blennerhassett report of 1976--discretionary testing--is compared with the success of random breath testing in Finland.
A direct and objective method of measuring compliance to medication is presented. Digoxin is used as a marker in capsules of either gemfibrozil or placebo with a minimal dose of 4.4 micrograms twice a day. Compliance is estimated by measuring the ratio of urinary digoxin to creatinine concentration. By choosing two cut-off points of this ratio patients who are taking their capsules regularly and those who have taken no capsules at all could be distinguished from others. Reduced dosage was easily detected in the marker results. During regular intake of three quarters of the dose, 53% of the samples would have classified the patient to the good compliance group. With half of the dose, 24% of samples and with a quarter of the dose, 5% of samples would have classified the subject to good compliance. Since the digoxin marker was planned for compliance measurements in the Helsinki Heart Study, a primary prevention study of coronary heart disease, it was tested under the conditions of a clinical trial. Digoxin concentrations were measured using a routine method normally applied to serum but shown to be valid for urine. The results of the urinary assays were not affected by storage at room temperature, as occurs during postal transport of samples, nor were they affected by freezing, routinely used for the storage of samples in clinical trials. The results therefore suggest that the digoxin marker represents a particularly effective method to study compliance to medication during such long-lasting clinical investigations.
For 576 working men the relationship between reported recent alcohol consumption, serum ferritin, mean cell volume, and gamma glutamyl transferase was studied. Serum ferritin was significantly increased in heavy drinkers, but as a screening test it failed to yield a useful advantage over a combination of mean cell volume and gamma glutamyl transferase.
Alcohol intake was measured in 54 men aged 32-45 who were moderate or heavy drinkers--first by questionnaire and then more thoroughly by diary. Blood was drawn for the measurement of suggested biological markers of alcohol intake after the completion of the questionnaire and at the end of two consecutive diary periods. Partial correlations, controlling for smoking, exercise and age, between daily alcohol intake and markers were low and increased only slightly when diary data were analyzed instead of questionnaire data. No improvement was observed when mean intake per drinking day or the highest daily intake during a diary period was substituted in the analyses for mean daily intake. Significant associations (p less than .05) were found for mean cell volume (MCV), serum high-density lipoprotein cholesterol (HDL) and alkaline phosphatase (AFOS), but not for serum gamma-glutamyl transferase (GGT), the HDL: cholesterol ratio or ferritin. Correlations between intake reported by diary and intake predicted by a multivariate model with MCV, HDL, AFOS and GGT as regressors were significant (p less than .05) and higher than any of the bivariate correlation coefficients but were low (r = .30-.31). Low correlations seem to result from the inherent weakness of the suggested markers rather than from inaccuracies in the measurement of alcohol intake.
National cord blood screening for congenital hypothyroidism has operated in Finland with complete coverage since 1980. A low frequency of false positives, 0.08%, was achieved by supplementing the TSH screen with a T4 determination in borderline samples. Among 175188 infants the incidence of (unconfirmed) hypothyroidism was 1/2637. The median age at start of therapy was 6 days. The programme imposed a 2-3 week therapy on the false positive cases. This did not appear to cause any adverse effects. A mechanism for masking congenital hypothyroidism was observed: two athyroid infants were euthyroid at birth because of feto-fetal transfusion.
Explore the source record for details and available documents.