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Biomedical subjects

Markku Heliövaara

Publications and source records attributed to Markku Heliövaara.

18 recordsLinked to original sources
PubMed2007

Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To assess the effectiveness of decompressive surgery as compared with nonoperative measures in the treatment of patients with lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: No previous randomized trial has assessed the effectiveness of surgery in comparison with conservative treatment for spinal stenosis. METHODS: Four university hospitals agreed on the classification of the disease, inclusion and exclusion criteria, radiographic routines, surgical principles, nonoperative treatment options, and follow-up protocols. A total of 94 patients were randomized into a surgical or nonoperative treatment group: 50 and 44 patients, respectively. Surgery comprised undercutting laminectomy of the stenotic segments in 10 patients augmented with transpedicular fusion. The primary outcome was based on assessment of functional disability using the Oswestry Disability Index (scale, 0-100). Data on the intensity of leg and back pain (scales, 0-10), as well as self-reported and measured walking ability were compiled at randomization and at follow-up examinations at 6, 12, and 24 months. RESULTS: Both treatment groups showed improvement during follow-up. At 1 year, the mean difference in favor of surgery was 11.3 in disability (95% confidence interval [CI], 4.3-18.4), 1.7 in leg pain (95% CI, 0.4-3.0), and 2.3(95% CI, 1.1-3.6) in back pain. At the 2-year follow-up, the mean differences were slightly less: 7.8 in disability (95% CI, 0.8-14.9) 1.5 in leg pain (95% CI, 0.3-2.8), and 2.1 in back pain (95% CI, 1.0-3.3). Walking ability, either reported or measured, did not differ between the two treatment groups. CONCLUSIONS: Although patients improved over the 2-year follow-up regardless of initial treatment, those undergoing decompressive surgery reported greater improvement regarding leg pain, back pain, and overall disability. The relative benefit of initial surgical treatment diminished over time, but outcomes of surgery remained favorable at 2 years. Longer follow-up is needed to determine if these differences persist.

Aged↗
PubMed2006

Prevalence and determinants of lateral and medial epicondylitis: a population study.

Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study. The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001. Of the 5,871 subjects, 4,783 (81.5%) were included in this study. The prevalence of definite lateral epicondylitis was 1.3%, and that of medial epicondylitis was 0.4%. The prevalence did not differ between men and women and was highest in subjects aged 45-54 years. Current smoking (adjusted odds ratio (OR) = 3.4, 95% confidence interval (CI): 1.4, 8.3) and former smoking (OR = 3.0, 95% CI: 1.3, 6.6) were associated with definite lateral epicondylitis. An interaction (p = 0.002) was found between repetitive movements of the arms and forceful activities for the risk of possible or definite lateral epicondylitis (for both repetitive and forceful activities vs. no such activity: OR = 5.6, 95% CI: 1.9, 16.5). Smoking, obesity, repetitive movements, and forceful activities independently of each other showed significant associations with medial epicondylitis. Epicondylitis is relatively common among working-age individuals in the general population. Physical load factors, smoking, and obesity are strong determinants of epicondylitis.

Adult↗
PubMed2006

Self-reported and test-based mobility limitations in a representative sample of Finns aged 30+.

AIMS: The object of the present study was to acquire a comprehensive and accurate picture of mobility limitations in the Finnish adult population. METHODS: A nationally representative sample of 8,028 persons aged 30+ with high participation was interviewed and examined in the Health 2000 Survey conducted in 2000-01. Mobility limitations were measured by self-reports and performance tests. RESULTS: Perceived running difficulties were already common among persons in middle age, while difficulties in moving about indoors were frequent only among persons aged 75+. A third of women and a fifth of men aged 55+ could not reach a walking speed of 1.2 m/s. Working-aged women were more limited than men only in physically demanding tasks, but in the elderly the gender difference was evident in most mobility tasks. A substantial disagreement was found between the self-reported and test-based indicators in stair climbing. Supplementary data collection, carried out to increase participation in the health examination, as well as inclusion of institutionalized persons, provided a more complete estimate of the prevalence of mobility limitations among the elderly. CONCLUSIONS: Both self-reported and performance-based indicators are needed to achieve a comprehensive view of disability and its variation between population groups. Exclusion of institutionalized persons and low participation lead to underestimation of the occurrence of limitations. The number of persons suffering from mobility problems will increase with ageing of the population, which accentuates the importance of early intervention to maintain functional ability, especially in women.

Activities of Daily Living↗
PubMed2006

Low metacarpal index predicts hip fracture: a prospective population study of 3,561 subjects with 15 years of follow-up.

BACKGROUND: Metacarpal index (MCI), measured from hand radiographs as the ratio between combined cortical thickness and bone diameter, has been suggested for assessment of bone mass and risk of osteoporotic fracture. We studied MCI for its ability to predict hip fractures. METHODS: Hand radiographs were taken and MCI determined in 3,561 subjects from a representative population sample of 8,000 Finns who were 30 years of age or over in 1978-80. Record linkage to the National Hospital Discharge Register identified 117 subjects who had been hospitalized for primary treatment of hip fracture by the end of 1994. RESULTS: High age, low body mass index, tall stature and smoking at baseline showed, independently of each other, significant associations with low MCI. Low MCI was a strong predictor of hip fracture. When adjusted for all potential confounding factors, the relative risk of hip fracture per decrement of MCI by one standard deviation (0.1) was 1.5 (95% CI 1.2-1.8). INTERPRETATION: Low MCI is associated with known risk factors of osteoporosis and predicts hip fracture. Since hand radiographs are easily available at low cost, measurements of MCI can be used as an alternative approach to find osteoporotic individuals with a high risk of hip fracture.

Absorptiometry, Photon↗
PubMed2006

Schizophrenia, neuroleptic medication and mortality.

BACKGROUND: There is an excess of death from natural causes among people with schizophrenia. AIMS: Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample of 7217 Finns aged >/= 30 years. METHOD: A comprehensive health examination was carried out at baseline. Schizophrenia was determined using the Present State Examination and previous medical records. RESULTS: During a 17-year follow-up, 39 of the 99 people with schizophrenia died. Adjusted for age and gender, the relative mortality risk between those with schizophrenia and others was 2.84 (95% CI 2.06-3.90), and was 2.25 (95% CI1.61-3.15) after further adjusting for somatic diseases, bloodpressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education. The number of neuroleptics used at the time of the baseline survey showed a graded relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk factors for premature death, the relative risk was 2.50 (95% CI1.46-4.30) per increment of one neuroleptic. CONCLUSIONS: There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Adult↗
PubMed2005

A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings.

Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.

Adult↗
PubMed2005

Dietary patterns and the incidence of type 2 diabetes.

Major dietary patterns were studied for the ability to predict type 2 diabetes mellitus in a cohort of 4,304 Finnish men and women aged 40-69 years and free of diabetes at baseline in 1967-1972. Factor analysis was used to identify dietary patterns from dietary data that were collected using a 1-year dietary history interview. A total of 383 incident cases of type 2 diabetes occurred during a 23-year follow-up. Two major dietary patterns were identified. The pattern labeled "prudent" was characterized by higher consumption of fruits and vegetables, and the pattern labeled "conservative" was characterized by consumption of butter, potatoes, and whole milk. The relative risks (adjusted for nondietary confounders) between the extreme quartiles of the pattern scores were 0.72 (95% confidence interval: 0.53, 0.97; p(trend) = 0.03) for the prudent pattern and 1.49 (95% confidence interval: 1.11, 2.00; p(trend) = 0.01) for the conservative pattern. Thus, the prudent dietary pattern score was associated with a reduced risk and the conservative pattern score was associated with an increased risk of type 2 diabetes. In light of these results, it appears conceivable that the risk of developing type 2 diabetes can be reduced by changing dietary patterns.

Adult↗
PubMed2005

Allergic rhinitis and pharmacological management in elite athletes.

INTRODUCTION: Only a few studies have examined the occurrence of atopy and clinically apparent allergic disease and their pharmacological management in elite athletes. The aim of the study was to assess the frequency of allergic rhinitis and the use of antiallergic medication within the subgroups of elite athletes as compared with a representative sample of young adults of the same age. METHODS: A cross-sectional survey was carried out in 2002. All the athletes (N = 494) financially supported by the National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, the use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1504) served as controls. RESULTS: The endurance athletes reported physician-diagnosed allergic rhinitis more often (36.1%) than other athletes (23.4%) or control subjects (20.2%). The use of antiallergic medication was reported by 33.3, 15.7, and 15.6% of those, respectively. Among both athletes and controls, females reported the use of antiallergic medication more often than males. Only half of those athletes reporting allergic rhinitis had used antiallergic medication during the past year. After adjusting for age and sex, OR (95% CI) for allergic rhinitis and the use of antiallergic medication were 2.24 (1.48-3.39) and 2.79 (1.82-4.28), respectively, in endurance athletes as compared with the controls. CONCLUSIONS: Endurance athletes have physician-diagnosed allergic rhinitis, and they use antiallergic medication more often than athletes in other events or control subjects. Only half of those athletes reporting allergic rhinitis take antiallergic medication. More attention needs to be paid to the optimal management of allergic rhinitis, especially in highly trained endurance athletes.

Adolescent↗
PubMed2004

Obesity and unhealthy life-years in adult Finns: an empirical approach.

BACKGROUND: Obesity is more strongly related to morbidity and disability than to mortality. Obese individuals are thus expected to have more unhealthy life-years than normal-weight persons. The objective of the present study was to quantify the number of excess unhealthy life-years in obese individuals. METHODS: A representative cohort of 19 518 Finnish men and women aged 20 to 92 years was followed for 15 years. Participation rate was 83%. Obesity was defined as a body mass index of 30.0 or higher. The number of unhealthy life-years due to premature work disability, hospitalization for coronary heart disease, and need for long-term medication was calculated per category of body mass index. RESULTS: During the follow-up of 15 years, obese men who never smoked aged 20 to 64 years had, on average, 0.63 more years of work disability, 0.36 more years of coronary heart disease, and 1.68 more years of longterm medication use, than normal-weight counterparts. Obese women had, respectively, 0.52, 0.46, and 1.49 more years from these conditions than normal weight women. The excess risks of morbidity and disability due to obesity were highest in the youngest age groups and exceeded those of mortality in all age groups. Obese men and women 65 years and older who never smoked had, respectively, 1.71 and 1.41 excess unhealthy life-years (not statistically significant) due to premature need for long-term medication compared with normal-weight subjects, but no excess unhealthy life-years due to coronary heart disease. CONCLUSIONS: Obesity has a lifetime impact on disability and morbidity. A further increase in obesity will lead to an increase in unhealthy life-years and in direct and indirect health care costs.

Adult↗
PubMed2004

Risk factors for rheumatoid arthritis.

Both genetic and environmental factors contribute to the development of rheumatoid arthritis (RA). A long-term latent process often precedes the onset of arthritis. Hence, the ultimate causes of RA cannot be clarified by studying only the inflamed joints. Longitudinal studies focusing on risk factors are crucial in approaching the true aetiology. At present, most information gained from epidemiological studies is contradictory or vague. For instance, there is no consensus concerning the long-term effects of pregnancy or the putative protective role of oral contraceptives. There is no doubt that diet plays a role, but no specific nutrient has proved to be either protective or deleterious. Smoking is the only environmental risk factor that has been firmly verified epidemiologically for RA. It can be reasonably regarded as a contributory cause of RA. Studying the immunological effects of exposure to cigarette smoke may offer an opportunity to combine information from basic and epidemiological research to clarify the causal chains leading to RA.

Alleles↗
PubMed2004

Asthma medication in Finnish olympic athletes: no signs of inhaled beta2-agonist overuse.

INTRODUCTION: Occurrence of asthma has been reported to be frequent in endurance athletes and especially high in winter sport athletes. Recently, the International Olympic Committee has restricted the use of inhaled beta2-agonists and requires documentation for their use. However, epidemiologic data comparing the use of antiasthmatic medication in different sport events are mostly missing. METHODS: A cross-sectional questionnaire survey was carried out in 2002. All the athletes (N = 494) financially supported by National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1 504) served as controls. RESULTS: Physician-diagnosed asthma was more common in athletes as compared with controls (13.9% vs 8.4%). Use of any asthma medication was reported by 9.6% of the athletes and by 4.2% of the controls. No difference was observed in the frequency of asthma medication used by winter or summer sport athletes (10.0% vs 9.4%). Inhaled beta2-agonists were used by 7.4% and 3.0% of the athletes and controls, respectively. After adjusting for age, sex, and smoking, odds ratio with 95% confidence interval for use of any asthma medication was 0.69 (0.17-2.92) for motor skills demanding events, 1.87 (0.85-4.11) for speed and power sports, 3.00 (1.68-5.37) for team sports, and 4.16 (2.22-7.78) for endurance events as compared with controls. None of the athletes used antiasthmatic medication without physician diagnosis. CONCLUSIONS: The frequency of antiasthmatic medication is clearly lower than the occurrence of physician-diagnosed asthma in Finnish Olympic athletes. No evidence of overuse of inhaled beta2-agonists is found.

Administration, Inhalation↗
PubMed2004

Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality.

BACKGROUND: This study was designed to investigate the prevalence of osteoarthritis in the carpometacarpal joint of the thumb in adults thirty years of age or older in Finland. METHODS: Between 1978 and 1980, a representative population sample of 8000 Finns thirty years of age or older were invited to have a comprehensive health examination; 90% accepted. Hand radiographs were made of 3595 subjects. Since the examination, the subjects have been followed systematically to assess work disability and mortality by reviewing registers covering the whole population. RESULTS: The age-adjusted prevalence of thumb carpometacarpal osteoarthritis of Kellgren grade 2, 3, or 4 was 7% for men and 15% for women. After adjustment for age, sex, and other alleged risk factors, body mass index was found to be directly proportional to the prevalence of thumb carpometacarpal osteoarthritis in both sexes. The adjusted odds ratio was 1.29 (95% confidence interval, 1.15 to 1.43) per 5-kg/m(2) increment in body mass index. No significant association was found between the physical workload history and thumb carpometacarpal osteoarthritis. Restricted mobility of the thumb and local tenderness and swelling were frequently found in conjunction with radiographic evidence of thumb carpometacarpal osteoarthritis. Advanced (grade-3 or 4) thumb carpometacarpal osteoarthritis predicted the total mortality rate in men (adjusted relative risk, 1.32; 95% confidence interval, 1.03 to 1.69). Radiographic signs of thumb carpometacarpal osteoarthritis did not predict work disability. CONCLUSIONS: and CLINICAL RELEVANCE: Obesity is a strong determinant of thumb carpometacarpal osteoarthritis in both sexes. The effect of thumb carpometacarpal osteoarthritis on disability and mortality in the general population is modest. Because of the rarity of ensuing disability, carpometacarpal osteoarthritis of the thumb is likely to be underdiagnosed in clinical practice.

Adult↗
PubMed2002

Does good trunk extensor performance protect against back-related work disability?

In this cohort study, dynamic trunk extensor performance was studied as a predictor of permanent work disability due to back disorders. As part of the comprehensive Mini-Finland Health Survey in 1978-80, the back muscle performance of 535 persons (267 men, 268 women) was measured using standardized repetitive arch-up and sit-up tests. At baseline, the participants were between 30 and 64 years of age. Retirements were followed for 12 years on average. During the follow-up, 56 subjects developed permanent work disability; 15 of these cases were back-related. Good dynamic trunk extensor performance was predictive of a decreased incidence of work disability due to chronic back disorders but not work disability due to other diseases. The risk of back-related work disability in the three highest quartiles in relation to the lowest quartile of dynamic trunk extension capacity was 0.28 (95% confidence interval, 0.09-0.94). Our study suggests that good dynamic trunk extension performance may protect against back-related permanent work disability.

Adult↗
PubMed2002

Associations of body mass index and obesity with physical activity, food choices, alcohol intake, and smoking in the 1982-1997 FINRISK Studies.

BACKGROUND: Recent increases in the prevalence of obesity worldwide are suggested to be caused largely by an environment that promotes sedentariness and excessive food intake. OBJECTIVE: We investigated associations of body mass index (BMI) and obesity with physical activity, food choices, alcohol consumption, and smoking history. In addition, we examined the consistency of these associations over time, with the aim of assessing whether the significance of lifestyle variables as correlates of obesity increased over a 15-y period. DESIGN: Independent cross-sectional surveys were carried out in 1982, 1987, 1992, and 1997. Altogether, 24604 randomly selected men and women (aged 25-64 y) participated in these surveys. The subjects' weights and heights were measured, and data on lifestyle were collected with self-administered questionnaires. RESULTS: In men and women, perceived general health, leisure-time physical activity, and daily vegetable consumption were inversely associated with obesity, as were bread consumption in women and activity at work in men. Consumption of sausages, milk, and sour milk and heavy work (in women only) were positively associated with obesity. Obesity was also associated with alcohol consumption and smoking history. Most associations were constant over the 15-y period. However, the inverse associations of BMI with physical activity in women and with perceived health in men seemed to strengthen over time. CONCLUSIONS: A physically active lifestyle with abstention from smoking, moderate alcohol consumption, and consumption of healthy foods maximizes the chances of having a normal weight. The significance of avoiding sedentariness increases over time as a factor associated with normal weight.

Adult↗
PubMed2002

Flavonoid intake and risk of chronic diseases.

BACKGROUND: Flavonoids are effective antioxidants and may protect against several chronic diseases. OBJECTIVE: The association between flavonoid intake and risk of several chronic diseases was studied. DESIGN: The total dietary intakes of 10 054 men and women during the year preceding the baseline examination were determined with a dietary history method. Flavonoid intakes were estimated, mainly on the basis of the flavonoid concentrations in Finnish foods. The incident cases of the diseases considered were identified from different national public health registers. RESULTS: Persons with higher quercetin intakes had lower mortality from ischemic heart disease. The relative risk (RR) between the highest and lowest quartiles was 0.79 (95% CI: 0.63, 0.99: P for trend = 0.02). The incidence of cerebrovascular disease was lower at higher kaempferol (0.70; 0.56, 0.86; P = 0.003), naringenin (0.79; 0.64, 0.98; P = 0.06), and hesperetin (0.80; 0.64, 0.99; P = 0.008) intakes. Men with higher quercetin intakes had a lower lung cancer incidence (0.42; 0.25, 0.72; P = 0.001), and men with higher myricetin intakes had a lower prostate cancer risk (0.43; 0.22, 0.86; P = 0.002). Asthma incidence was lower at higher quercetin (0.76; 0.56, 1.01; P = 0.005), naringenin (0.69; 0.50, 0.94; P = 0.06), and hesperetin (0.64; 0.46, 0.88; P = 0.03) intakes. A trend toward a reduction in risk of type 2 diabetes was associated with higher quercetin (0.81; 0.64, 1.02; P = 0.07) and myricetin (0.79; 0.62, 1.00; P = 0.07) intakes. CONCLUSION: The risk of some chronic diseases may be lower at higher dietary flavonoid intakes.

Adult↗
PubMed2002

Physical workload and the risk of severe knee osteoarthritis.

OBJECTIVES: This study investigated the impact of physical workload on the risk of severe knee osteoarthritis (OA) leading to knee arthroplasty. METHODS: In this case-referent study, the cases were 55- to 75-year-old men (N=55) and women (N=226) who had undergone their first knee arthroplasty operation for primary knee OA in the Kuopio University Hospital in 1992-1993. The referents (N=524) were from the same source population and were matched with the cases for age and gender. Information on explanatory variables was obtained by a computer-assisted telephone interview. Exposure was assessed up to 49 years of age. RESULTS: After adjustment for body mass index, knee injury and leisure-time physical activity, an increased relative risk of knee OA was found for a history of high physical workload. The odds ratio (OR) was 1.53 [95% confidence interval (95% CI) 0.42-5.56] for the men and 2.03 (95% CI 1.03-3.99) for the women as compared with those with low physical workload. With respect to generic risk factors, climbing already at a medium level of exposure was associated with an increased risk of knee OA among the men (OR 3.06, 95% CI 1.25-7.46) and kneeling and squatting was a risk factor for both genders. Of the different trades, agriculture, forestry, fishing, transportation, and traffic showed the highest risks of knee OA. CONCLUSIONS: The results of this study agree with the hypotheses that heavy physical loading increases the risk of knee OA and that cumulative physical stress has a deleterious effect on the knee joint.

Age Distribution↗