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Biomedical subjects

K Seppä

Publications and source records attributed to K Seppä.

At least 19 recordsLinked to original sources
PubMed2002

Matrix metalloproteinase-9 is elevated in serum of alcohol abusers.

BACKGROUND: Moderate alcohol consumption has been shown to protect against coronary heart disease. However, excessive alcohol use has been suggested to have detrimental effects on the cardiovascular system. We examined whether there is an association between alcohol abuse and circulating levels of matrix metalloproteinase-9 (MMP-9), which has been linked to unstable coronary heart disease and arterial inflammation. DESIGN: Serum MMP-9 concentrations were compared between 40 male alcoholics (mean age 42 years) with ethanol consumption > 1000 g week(-1) and 40 social drinker males with an ethanol consumption of < 200 g week(-1) (mean age 45 years). RESULTS: The mean serum MMP-9 concentration was significantly higher in sera of alcoholics compared to control subjects (70.9 +/- 47.7 g L(-1) and 43.1 +/- 19.2 g L(-1), respectively; P = 0.001). Within the alcoholic group, MMP-9 concentration did not correlate with age, gamma glutamyl transferase, carbohydrate-deficient transferrin, aspartate aminotransferase, alanine aminotransferase or alkaline phosphatase. CONCLUSION: Our finding of elevated MMP-9 concentrations in sera of chronic alcohol abusers helps understand the mechanisms of cardiovascular risk among these subjects.

Adult↗
PubMed2001

Primary health care nurses' and physicians' attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers.

AIMS: To identify barriers to healthcare providers carrying out competent brief interventions to help heavy drinkers to reduce their drinking. DESIGN AND PARTICIPANTS: A questionnaire on attitudes, skills, knowledge, training needs and suggestions for implementation of brief interventions was mailed to all nurses and physicians working in primary health care in two Finnish cities. One hundred and sixty-seven primary health care nurses and 84 physicians returned the questionnaire. FINDINGS AND CONCLUSIONS: The response rates among nurses varied between 66 and 99% and among physicians between 76 and 95% depending on the issue. Factors related to knowledge seem to be a barrier to the adoption of brief intervention: only 18% of respondents reported having enough knowledge to provide competent brief intervention and half of the respondents reported wanting more training. Contrary to expectations, physicians consider themselves to be better equipped to do brief intervention than nurses. Practical training in using alcohol questionnaires and on the content of brief intervention would help promote it. Such training was seen as important by 90% of the respondents. Giving more information on the evidence in favour of brief intervention would also be useful.

Adult↗
PubMed2000

Alcohol consumption and its relation to lipid-based cardiovascular risk factors among middle-aged women: the role of HDL(3) cholesterol.

To study the association of alcohol consumption and lipid-based cardiovascular risk factors among middle-age women, cross-sectional analysis among 274 middle-aged healthy women with different drinking habits and a follow-up analysis of alcoholic women during abstinence was performed. Serum total cholesterol, low and high-density lipoprotein cholesterol (LDL and HDL cholesterol), triglycerides (TG), apolipoproteins A1 (Apo A1) and B (Apo B), and HDL-cholesterol subfractions 2 (HDL(2)) and 3 (HDL(3)) were measured. All lipid values except LDL cholesterol positively correlated with self-reported alcohol consumption. When alcoholics were excluded the correlation was significant only for HDL cholesterol, HDL(3), and Apo A1. The increasing trend of HDL cholesterol, HDL(3) and Apo A1 were clearly seen first in women consuming >20-40 g/day of absolute alcohol. Alcohol consumption >40 g/day increased all lipid values except LDL cholesterol. Abstinence for 2 weeks caused a significant decrease in HDL(3) cholesterol, and an increase in LDL cholesterol and Apo B. The results indicate that among middle-aged women the Apo A1 and HDL cholesterol via its HDL(3) but not HDL(2) subfraction might play a role in the beneficial coronary consequences associated with moderate alcohol consumption. However, the increasing beneficial trend first appears when daily drinking exceeds 20 g/day.

Adult↗
PubMed2000

Brief intervention for female heavy drinkers in routine general practice: a 3-year randomized, controlled study.

BACKGROUND: Today, heavy drinking is a common health hazard among women. The evidence in favor of providing some kind of brief intervention to reduce drinking is quite convincing. However, we do not know if intervention works in a natural environment of routine health care. The purpose of this study was to evaluate the effectiveness of long-lasting, brief alcohol intervention counseling for women in a routine general practice setting. METHODS: In five primary care outpatient clinics in a Finnish town, 118 female early-phase heavy drinkers who consulted their general practitioners for various reasons were given brief alcohol intervention counseling. Intervention groups A (n = 40) and B (n = 38) were offered seven and three brief intervention sessions, respectively, over a 3-yr period. The control group C (n = 40) was advised to reduce drinking at baseline. Main outcome measures were self-reported weekly alcohol consumption, carbohydrate-deficient transferrin, mean corpuscular volume (MCV), aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase. RESULTS: Depending on the outcome measure and the study group, clinically meaningful reduction of drinking was found in 27% to 75% of the heavy drinkers. Within all the groups, MCV significantly decreased. However, there were no statistically significant differences between study groups A, B, and C in the mean changes between the beginning and endpoint in the main outcome measures. CONCLUSIONS: The present study indicated that minimal advice, as offered to group C, was associated with reduced drinking as much as the brief intervention, as offered to groups A and B, given over a 3-yr period. Furthermore, in the routine setting of the general practice office, the effectiveness of the brief intervention may not be as good as in special research conditions. The factors possibly reducing the effectiveness in a routine setting are unknown. Thus, different methods of implementing brief intervention need to be evaluated to find better ways to support general practice personnel in their efforts to help heavy-drinking female patients to reduce their drinking.

Adult↗
PubMed1999

Drinking habits and prevalence of heavy drinking among primary health care outpatients and general population.

AIMS: To identify the target group for brief alcohol intervention in primary health care and to compare the prevalence of heavy drinking in two different primary health care populations and the general population in the same geographical area. DESIGN: Drinking data were collected from outpatients of primary health care by a questionnaire containing the CAGE test and quantity-frequency alcohol consumption questions and from a sample of the general population by a telephone survey, including the CAGE. The index of heavy drinking was for men three, and for women two, affirmative answers in CAGE which though not specifically a consumption questionnaire is a good marker of heavy drinking. SETTING: Two different primary health care populations (primary health care clinic and occupational health care clinic) and the general population in a Finnish health care area. PARTICIPANTS: Consecutive 1861 primary health care clinic and 2942 occupational health care clinic outpatients and 544 randomly selected adults in the general population, contacted by telephone. FINDINGS: The primary health care clinic patients drank significantly more per occasion than the patients of the occupational health care clinic (75 vs. 66 g. in men; 33 vs. 27 g. in women) and fewer times per week (0.8 vs. 0.9 in men; 0.5 vs. 0.6 in women). The patients in the primary health care clinic also reported drinking more per week (76 vs. 67 g. in men; 23 vs. 19 g. in women); among women the difference was significant. Among men the prevalences of heavy drinking in the primary health care clinic, occupational health care clinic and general population were 20%, 17% and 16%, respectively (p > or = 0.05). Among women the corresponding figures were 9%, 6% and 13% (p < 0.05). CONCLUSIONS: The high prevalence of heavy drinking found in the study confirms the importance of brief intervention by general practitioners. The study also indicates that prevalence and drinking habits depend on the type of clinic and heavy drinkers in general may not be over-represented in primary health care. This study raises the question, especially among women, of how to reach and to provide health advice to those heavy drinkers who do not attend primary health care facilities.

Adult↗
PubMed1999

Sialic acid: new potential marker of alcohol abuse.

BACKGROUND: A number of laboratory markers are suggested for the detection and monitoring of alcohol abuse. However, there is still a need to find better indicators of alcohol abuse. Sialic acid (SA) is the name for a series of acyl-derivatives of neuraminic acids that occur as nonreducing terminal residues of glycoproteins or glycolipids in biological fluids and cell membranes. In this study, we investigated the diagnostic value of SA as a marker of alcohol abuse. METHODS: Sera from social drinkers (n = 38) and alcoholics (n = 77) were analyzed for sialic acid by a colorimetric assay and for carbohydrate-deficient transferrin (CDT) by a radioimmunoassay method. Mean corpuscular volume (MCV), gamma-glutamyltransferase (GGT), aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) were determined by using routine methods. RESULTS: The sialic acid levels of both female and male subjects were significantly (p < 0.001) increased among alcoholic subjects when compared with social drinkers. SA levels were decreased after 3 weeks of treatment. The sensitivity and specificity for SA, respectively, were 57.7 and 95.5 for women and 47.8 and 81.3 for men. The respective values for CDT were 57.7 and 95.5 for women and 78.3 and 100.0 for men; for GGT, 60.0 and 95.5 for women and 60.9 and 87.5 for men; for MCV, 52.4 and 95.5 for women and 47.8 and 100.0 for men; for ASAT, 53.8 and 95.5 for women and 43.5 and 100.0 for men; and for ALAT, 38.5 and 90.9 for women and 39.1 and 87.5 for men. Among women, SA and GGT, and among men CDT, showed the largest area under receiver operation curve. CONCLUSION: This study indicated that sialic acid levels were elevated by high alcohol consumption and reduced during abstinence, especially among women. Thus, sialic acid seems to be an interesting marker that needs further evaluation as a diagnostic tool for alcohol abuse.

Adult↗
PubMed1999

Patterns of comorbidity in relation to functioning (GAF) among general hospital psychiatric referrals. European Consultation-Liaison Workgroup.

Improvement of services for physically ill patients with concurrent psychiatric problems is a noteworthy issue in general hospitals. Among 1249 general hospital in-patients referred for psychiatric consultation, concurrent mental and behavioural disorders (ICD-10) were diagnosed in 84% of cases. Any concurrent mental and behavioural disorder was associated with dramatically low functioning (GAF = 46), indicating serious psychosocial impairment. This is a striking new finding of clinical importance. The effect on functioning was similar for substance use disorders, other mental disorders, and combined mental and substance use disorders (dual diagnoses), with no gender differences. This finding highlights the need for specialized interventions among general hospital in-patients referred for psychiatric consultation.

Adolescent↗
PubMed1999

Binge drinking and ambulatory blood pressure.

-The effect of alcohol drinking in raising blood pressure (BP) is rapidly reversible. However, there is only limited information on the effect of binge drinking on BP values. In this study, 20 healthy men who were all social drinkers drank alcohol (2.2 g/kg) in controlled circumstances on a Saturday evening. Ambulatory BP measurement (ABPM) values were compared with ABPM values of the same subjects during the previous sober Saturday, separately throughout 6 hours of intoxication, throughout 6 hours when blood alcohol levels decreased, and throughout 6 hangover hours. During the intoxication period, both mean systolic BP and mean diastolic BP were 5 mm Hg higher (P=0.0183 and P=0.0529, respectively) and the pulse was 18 beats per minute faster (P=0.0001) compared with the corresponding sober period during the previous weekend. While blood alcohol levels decreased after drinking, mean systolic BP was 4 mm Hg lower (P=0. 0331), diastolic BP was 5 mm Hg lower (P=0.0058), and pulse was 15 bpm faster (P=0.0001) than during the sober weekend. No statistically significant difference was found between the weekends in BP values during the hangover period. Drinking seems to increase both systolic and diastolic BP during intoxication but not during hangover. During the period when blood alcohol levels are decreasing, usually at night, both pressure levels fall to less than the basic level. These major and rapid changes in BP values might increase the likelihood of strokes, which are seen in increased numbers among young adults, especially during weekends and holidays.

Adult↗
PubMed1998

Chromatographically identified alcohol-induced haemoglobin adducts as markers of alcohol abuse among women.

BACKGROUND: Alcohol-induced changes in haemoglobin have been suggested as potential biochemical markers of alcohol abuse. In this study, we investigated the diagnostic value of alcohol-induced haemoglobin adducts among women. METHODS: Whole (Hb fractions) and affinity-purified (AHb fractions) haemolysates from 87 women in three groups (a) social drinkers (n=31), (b) heavy drinkers (n=27) and (c) alcoholic subjects (n=29) - were analysed by HPLC-CEC. RESULTS: Three fractions (HbA 1a2, HbA1dl and AHbA1d1) showed significant differences (P<0.05) between the groups and a significant positive correlation (P<0.05) with self-reported alcohol consumption (r=0.58-0.76) as determined by the Malmö modified Michigan Alcoholism Screening Test (MmMAST) and structured CAGE questionnaire (r=0.58-0.76). HbA1a2, HbA1d1 and AHbA1d1 had specificities of 97%, 97% and 100% respectively and detected 41%, 33% and 78% of heavy drinkers with overall accuracies (OAs) of 71%, 67% and 90%. Sensitivities in the detection of alcoholic subjects were 86% (OA=92%), 76% (OA=87%) and 81 % (OA=91%) respectively. The fractions had higher OAs than traditional markers of alcohol abuse. CONCLUSION: This study indicates that at least three alcohol-induced haemoglobin adducts occurring in vivo can be measured with promising diagnostic efficiency among women.

Adult↗
PubMed1998

Selective acceleration of auditory processing in chronic alcoholics during abstinence.

Simultaneous auditory processing between the hemispheres was studied with a whole-head magnetometer in 13 abstinent chronic alcoholics and 10 healthy control subjects. Auditory stimuli were presented monaurally with interstimulus intervals of 0.5 and 2.5 sec in different blocks. The N100m response, which contributes to stimulus detection, was significantly accelerated in the hemisphere ipsilateral to the ear stimulated in abstinent alcoholics. The MMNm response reflecting automatic stimulus-change detection peaked earlier in alcoholics, and the ipsilateral N100m latency correlated significantly with the abstinence duration. These results suggest that auditory processing is accelerated in the auditory cortex ipsilateral to the stimulated ear in chronic abstinent alcoholics and that the accelerated processing is at least partly reversible. This may be caused by the hyperexcitation in the brain related to the ethanol withdrawal.

Adult↗
PubMed1998

Carbohydrate-deficient transferrin and conventional alcohol markers as indicators for brief intervention among heavy drinkers in primary health care.

Brief intervention is a promising treatment for heavy drinking. The present study examined the diagnostic value of carbohydrate-deficient transferrin (CDT), mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) in detecting early-phase heavy drinkers for brief intervention treatment in primary health care. Laboratory data were collected from consecutive 20- to 60-year-old, early-phase heavy drinkers (329 males and 136 females), who were willing to undergo brief intervention treatment in five primary health care outpatient clinics. An elevated value of at least 1 of the 5 markers studied was found in 75% of the male and in 76% of the female heavy drinkers. The sensitivities of CDT, MCV, AST, ALT and GGT values were low; in men, respectively, 39%, 28%, 12%, 28%, and 33%, and in women 29%, 40%, 20%, 29%, and 34%. However, marker combinations, including CDT, reached a good level of sensitivity; the best triple combination (CDT or MCV or GGT) was positive in 69% of the men and 70% of the women. According to logistic regression, the age of the patient had an increasing effect on MCV, ALT and GGT. High body mass index increased all transaminases and decreased CDT and MCV. Smoking increased MCV and decreased AST. Thus, primary health care marker combinations, especially those including CDT, should be considered for the detection of early-phase heavy drinkers for brief intervention treatment.

Adult↗
PubMed1998

Five-shot questionnaire on heavy drinking.

To develop an effective, but short, questionnaire to detect heavy drinking, we combined two questions from AUDIT and three from CAGE. We have tested earlier this new Five-Shot questionnaire among male alcoholics who all had a total score of at least 4/7. The purpose of the present study was to find out the effectiveness of the Five-Shot questionnaire among middle-aged men. In the present study, the Five-Shot questionnaire was distributed to all (n = 853) 40-year-old men attending health screening in a Finnish town. The participation percentage in the screening was 70.3%. Self-reported alcohol consumption was used as a gold standard; 557 of these men gave a self-report that they consumed less absolute alcohol than 140 g/week (moderate drinkers), and 70 reported consuming > or = 280 g/week (heavy drinkers). None of the individual Five-Shot questions was superior to any other in detecting heavy drinkers. The cut-off point > or = 3 for Five-Shot gave a 77% sensitivity in detecting heavy drinkers, with a specificity of 83% and an overall accuracy of 83%. The corresponding figures with > or = 2.5 cut-off were 96%, 76%, and 78%. The commonly used cut-off for CAGE, > or = 2, gave a result of 47%, 87%, and 83%, respectively. The area under the receiver operating characteristic curve for the CAGE was clearly worse, compared with that of the Five-Shot. The new Five-Shot questionnaire seems to be efficient in differentiating between moderate and heavy drinkers. It is also easy and fast for physicians to use in different health-care settings. Thus, it can serve as a good aid in early detection of heavy drinking.

Adult↗
PubMed1998

Physical and mental comorbidity of substance use disorders in psychiatric consultations. European Consultation-Liaison Workgroup.

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.

Adult↗
PubMed1998

Comparison of carbohydrate-deficient transferrin, immunoglobulin A antibodies reactive with acetaldehyde-modified protein and acetaldehyde-modified albumin with conventional markers of alcohol consumption.

Carbohydrate-deficient transferrin (CDT) has emerged as the best new marker for alcohol abuse. Recently plasma immunoglobulin A (IgA) reactivity with acetaldehyde (AcH)-modified proteins, or the modified proteins per se, have been proposed as a markers for high levels of alcohol consumption. In this study, we have compared CDT, IgA reactivity with AcH adducts (IgA ASR), and AcH-modified albumin with conventional markers of high alcohol intake in groups with well-defined drinking histories. The plasma activity of ALT, AST, and gamma-glutamyltransferase increased steadily with increasing alcohol consumption. CDT and AcH-modified albumin showed a similar pattern, whereas IgA ASR appeared only to be elevated after a threshold level of consumption had been reached. Neither CDT IgA ASR or AcH-modified albumin correlated strongly with any of the conventional markers or each other. This study shows that CDT, IgA ASR, AcH-modified albumin, and the conventional markers are not related, but suggests that the concurrent use of CDT and IgA ASR may lead to better identification of high alcohol intake.

Acetaldehyde↗