Biomedical subjects
M Paunio
Publications and source records attributed to M Paunio.
Blood donation, body iron stores, and risk of myocardial infarction. Confidence intervals and possible selection bias call study results into question.
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Serum high density lipoprotein cholesterol, alcohol, and coronary mortality in male smokers.
OBJECTIVE: To determine whether the increase in mortality from coronary heart disease with high concentration (> 1.75 mmol/l) of high density lipoprotein cholesterol could be due to alcohol intake. DESIGN: Cohort study. SETTING: Placebo group of the alpha tocopherol, beta carotene cancer prevention (ATBC) study of south western population in Finland. PARTICIPANTS: 7052 male smokers aged 50-69 years enrolled to the ATBC study in the 1980s. MAIN OUTCOME MEASURES: The relative and absolute rates adjusted for risk factors for clinically or pathologically verified deaths from coronary heart disease for different concentrations of high density lipoprotein cholesterol with and without stratification for alcohol intake. Similar rates were also calculated for different alcohol consumption groups. RESULTS: During the average follow up period of 6.7 years 258 men died from verified coronary heart disease. Coronary death rate steadily decreased with increasing concentration of high density lipoprotein cholesterol until a high concentration. An increase in the rate was observed above 1.75 mmol/l. This increase occurred among those who reported alcohol intake. Mortality was associated with alcohol intake in a J shaped dose response, and those who reported consuming more than five drinks a day (heavy drinkers) had the highest death rate. Mortality was higher in heavy drinkers than in non-drinkers or light or moderate drinkers in all high density lipoprotein categories from 0.91 mmol/l upward. CONCLUSIONS: Mortality from coronary heart disease increases at concentrations of high density lipoprotein cholesterol over 1.75 mmol/l. The mortality was highest among heavy drinkers, but an increase was found among light drinkers also.
Hepatitis C genotypes in Finland determined by RFLP.
Genotyping of hepatitis C virus (HCV) is important because of its clinical and epidemiological implications. We report here the distribution of HCV genotypes in various patient groups in Finland using a rapid and reliable HCV typing method based on restriction fragment length polymorphism (RFLP) of the amplified DNA from the 5' non-coding region of the genome. The reaction product from the primary, diagnostic PCR (nested, one tube system) was used in genotyping. From 264 Finnish sera we identified HCV genotypes 1a (14%), 1b (24%), 2b (20%). 3a (41%) and 1a + 1b (1%). Only one patient with genotype 2a was identified. From four Egyptian blood donors, types 1b and 4 were found. Genotype 3a was more often associated with i.v. drug abuse and younger age profile (less than 30 years).
The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program.
BACKGROUND: In the 1970s measles, mumps, and rubella were rampant in Finland, and rates of immunization were inadequate. In 1982 a comprehensive national vaccination program began in which two doses of a combined live-virus vaccine were used. METHODS: Public health nurses at 1036 child health centers administered the vaccine to children at 14 to 18 months of age and again at 6 years, and also to selected groups of older children and young adults. Vaccination was voluntary and free of charge. In follow-up studies, we focused on rates of vaccination, reasons for noncompliance, adverse reactions, immunogenicity, persistence of antibody, and incidence of the three diseases. Since 1987, paired serum samples have been collected from all patients with suspected cases of measles, mumps, or rubella. RESULTS: Over a period of 12 years, 1.5 million of the 5 million people in Finland were vaccinated. Coverage now exceeds 95 percent. The vaccine was efficient and safe, even in those with a history of severe allergy. No deaths or persistent sequelae were attributable to vaccination. The most frequent complication requiring hospitalization was acute thrombocytopenic purpura, which occurred at a rate of 3.3 per 100,000 vaccinated persons. The 99 percent decrease in the incidence of the three diseases was accompanied by an increasing rate of false positive clinical diagnoses. In 655 vaccinated patients with clinically diagnosed disease, serologic studies confirmed the presence of measles in only 0.8 percent, mumps in 2.0 percent, and rubella in 1.2 percent. The few localized outbreaks were confined to patients in the partially vaccinated age groups. There are now fewer than 30 sporadic cases of each of the three diseases per year, and those are probably imported. CONCLUSIONS: Over a 12-year period, an immunization program using two doses of combined live-virus vaccine has eliminated indigenous measles, mumps, and rubella from Finland. Serologic studies show that most reported sporadic cases are now due to other causes, but a continued high rate of vaccination coverage is essential to prevent outbreaks resulting from exposure to imported disease.
Association of alcohol consumption and Helicobacter pylori infection in young adulthood and early middle age among patients with gastric complaints. A case-control study on Finnish conscripts, officers and other military personnel.
There is growing evidence that Helicobacter pylori is responsible for a variety of gastric and duodenal changes which can eventually lead to stomach cancer. Little is known about risk factors for H. pylori infection. We re-analyzed the association of alcohol with H. pylori positivity in 451 conscripts, officers and other military personnel endoscoped due to gastric complaints in the Central Military Hospital of Finland in 1987 and 1988. Serology and culture were done in all patients. Alcohol consumption histories were obtained by use of a self-administered questionnaire. We observed a high odds ratio (OR) of H. pylori infection among young adults who were heavy alcohol consumers compared to non-drinkers (OR 5.32, 95% confidence interval: 1.09-25.95). There was evidence of a dose response when heavy and moderate drinkers were compared to non-drinkers (Mantel-Haenszel chi 2 for trend, p = 0.02) in young adulthood. A subgroup of young respondents who reported drinking all classes of alcohol (including hard liquor) showed an even stronger association and more significant dose-response. Multivariate techniques revealed a qualitative interaction of alcohol with H. pylori positivity in different age groups and among old people an inverse association of H. pylori and alcohol consumption was observed. These findings, if confirmed independently, might have implications for preventing a variety of gastric and duodenal lesions, since they allow identification of high risk groups.
HDL cholesterol and mortality in Finnish men with special reference to alcohol intake.
BACKGROUND: There is substantial evidence that a low serum level of HDL cholesterol (HDLC) is a risk factor for coronary deaths. However, data on older people are scarce, and previous studies have not examined this association in relation to alcohol intake. METHODS AND RESULTS: Coronary mortality, all-cause mortality, and mortality due to alcohol and violence were related to HDLC levels among 7052 male smokers 50 to 69 years old in south and west Finland enrolled from 1984 to 1988 in the ATBC (AT, alpha-tocopherol; BC, beta-carotene) Study placebo group. During the average follow-up period of 4.7 years, 620 men died; 222 of these deaths were from coronary heart disease and 82 from causes related alcohol and violence. HDLC levels were inversely associated with coronary mortality, irrespective of age, whereas high total cholesterol was positively associated with coronary mortality among the younger men, 50 to 59 years of age, but not among the older men, 60 to 69 years old. Correction for temporal variation in HDLC measurement indicated a 43% stronger inverse association between HDLC and coronary mortality compared with that based only on a single value. The inverse association of HDLC and coronary mortality was less marked at higher levels of alcohol intake. All-cause and alcohol- and violence-related mortality were positively associated with HDLC among the younger men. All-cause mortality showed a U-shaped dose response among men > or = 60 years old. CONCLUSIONS: Previous studies may have underestimated the beneficial effect of high HDLC because of regression-dilution bias and the confounding effect of heavy alcohol intake. This study supports the view that, particularly among older men, lipoprotein fractions may be more appropriate for screening than total cholesterol.
Increase of vaccination coverage by mass media and individual approach: intensified measles, mumps, and rubella prevention program in Finland.
In the 1970s, mass vaccination projects were started in various parts of the world against measles and congenital rubella, with eradication as the final goal. In many developing and industrial countries, including Finland, the elimination of measles failed because of low vaccination coverage. In Finland, a combined measles, mumps, and rubella (Virivac) vaccination program was started in 1982. Computerized recording of the vaccinated children was considered necessary and was integrated with the population registry to identify the hard-to-reach families. Several interventions improved compliance: a mass media campaign and notification of nonvaccinated children to local health professionals and parents. All successive campaigns increased vaccination coverage significantly, with the notification of parents about their nonvaccinated child being especially effective. A vaccination coverage of over 96% was achieved, which theoretically prevents measles, mumps, and rubella transmission.
Low-level air pollution and upper respiratory infections in children.
Effects of low-level air pollution were studied in one polluted city and two reference cities in northern Finland by comparing the frequency of upper respiratory infections over a 12-month period in 1982 as reported by parents of children ages 14 through 18 months (n = 679) and 6 years (n = 759). A similar comparison was carried out between children living in the more polluted and less polluted areas of the polluted city. The annual mean and the greatest half-hour concentrations of sulfur dioxide (23 and 807 micrograms/m3), particulates (31 and 291 micrograms/m3), nitrogen oxides (15 and 160 micrograms/m3), and hydrogen sulfide (2 and 177 micrograms/m3) in the polluted city were mainly due to industrial sources. In the reference cities, air pollution was produced mainly by traffic and heating. Adjusted odds ratios (OR) for one or more upper respiratory infections of residents in the polluted city vs those in the reference cities were 2.0 (95% confidence interval [CI] = 1.3-3.2) in the younger age group and 1.6 (95% CI = 1.1-2.1) in the older age group. Within the polluted city, OR calculated for living in more vs less polluted areas were 2.0 (95% CI = 1.0-4.0) in the younger and 1.6 (95% CI = 1.0-2.7) in the older children. The present results suggests that, for children, air pollution can be hazardous in concentrations lower than those recorded in earlier studies from Britain and central Europe. The synergistic effect of sulfur dioxide, particulates, nitrogen oxides, hydrogen sulfide, and other pollutants may be a contributing factor.
[Finnish eradication of measles, mumps and rubella].
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Mumps and rubella eliminated from Finland.
Many countries use trivalent measles-mumps-rubella (MMR) vaccine for their mumps and rubella immunization programs. In Finland, a national 2-dose MMR vaccination program for children, free of charge and on a voluntary basis, was launched in 1982. Serological confirmation of all suspected cases of mumps and rubella has been required since 1987. Despite intensive surveillance, no persistent sequelae or deaths attributable to vaccination have been detected. Indigenous mumps and rubella were eliminated in 1996, but 4 imported cases of mumps and 2 of rubella occurred from 1997 to 1999. Lack of secondary cases indicates sufficient immunity in the community. Compared with an epidemic year, up to thousands of cases of mumps meningoencephalitis and orchitis and around 50 cases of congenital rubella syndrome are now avoided annually. A 2-dose vaccine regimen in children during the last 17 years (1983-1999) has interrupted circulation of the target viruses entirely. Finland is the first country documented to be free of indigenous mumps and rubella (measles was eliminated in 1996). Despite the ongoing possibility of imported disease, major outbreaks probably can be avoided by maintaining high vaccination coverage and the 2-dose policy. JAMA. 2000;284:2643-2647.
Increased mercury exposure in inhabitants living in the vicinity of a hazardous waste incinerator: a 10-year follow-up.
A hazardous-waste-treatment plant that housed an incinerator began operation in 1984, before which a baseline survey of the surrounding population and environment was conducted; 10 y later, investigators studied the same subjects. Researchers focused on mercury exposure because mercury concentrations were present in the stack emissions, and environmental monitoring revealed mercury concentrations near the plant. In 1984 and 1994 the median hair mercury concentrations were 0.5 mg/kg and 0.8 mg/kg, respectively. During the 10-y period, median hair total mercury concentrations increased by 0.35 mg/kg in workers (n = 11); by 0.16 mg/kg, 0.13 mg/kg, and 0.03 mg/kg in individuals who lived 2 km (n = 45), 2-4 km (n = 38), and 5 km (n = 30) from the plant, respectively; and by 0.02 mg/kg in the reference group (n = 55). In summary, mercury exposure increased as distance from the plant decreased; however, the increase in exposure was minimal and, on the basis of current knowledge, did not pose a health risk.