Publications by authors named "Aalto M"

128 Publications

Requirement of a homolog of glucosidase II beta-subunit for EFR-mediated defense signaling in Arabidopsis thaliana.

Mol Plant 2010 Jul 9;3(4):740-50. Epub 2010 May 9.

Division of Genetics, Department of Biosciences, Viikki Biocenter, University of Helsinki, POB 56, FIN-00014, Helsinki, Finland.

EFR is a plasma-membrane resident receptor responsible for recognition of microbial elongation factor Tu (EF-Tu) and thus triggering plant innate immunity to fend off phytopathogens. Functional EFR must be subject to the endoplasmic reticulum quality control (ERQC) machinery for the correct folding and proper assembly in order to reach its final destination. Genetic studies have demonstrated that ERD2b, a counterpart of the yeast or mammalian HDEL receptor ERD2 for retaining proteins in the endoplasmic reticulum (ER) lumen, is required for EFR function in plants (Li et al., 2009). In this study, we characterized the Arabidopsis glucosidase II beta-subunit via the HDEL motif against the non-redundant protein database. Data mining also revealed that the glucosidase II beta-subunit gene has a highly similar expression pattern to ERD2b and the other known ERQC components involved in EFR biogenesis. Importantly, the T-DNA insertion lines of the glucosidase II beta-subunit gene showed that EFR-controlled responses were substantially reduced or completely blocked in these mutants. The responses include seedling growth inhibition, induction of marker genes, MAP kinase activation, and callose deposition, triggered by peptide elf18, a full mimic of EF-Tu. Taken together, our data indicate a requirement of the glucosidase II beta-subunit for EFR function.
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http://dx.doi.org/10.1093/mp/ssq017DOI Listing
July 2010

Alcohol consumption and all-cause mortality among elderly in Finland.

Drug Alcohol Depend 2010 Jan 25;106(2-3):212-8. Epub 2009 Sep 25.

National Institute for Health and Welfare, Helsinki, Finland.

Aims: To estimate the gender-specific prevalences of alcohol consumption levels and to investigate the association between heavy drinking and all-cause mortality among elderly males.

Design: A cohort derived from a nationally representative sample of Finns aged >65 years was followed for six years. Number of subjects was 1569 (72.7% of the original sample, 65.3% females, weighted n=1357).

Measurements: Alcohol consumption was retrospectively measured by beverage-specific quantity and frequency over a 12-month period. Mortality data were obtained from the official Cause-of-Death Register. Cox proportional hazards models were used to analyse the relative risks (RRs) of death.

Findings: The prevalence of heavy drinking (>8 standard drinks per week) was 20.3% in males and 1.2% in females. Over one-tenth (11.4%) of males reported drinking > or =15 standard drinks per week. Relative death risks suggested a J-curved relationship between alcohol consumption levels and mortality. However, significant curvilinear relationship was not found, when using alcohol consumption as continuous variable. The multivariate adjusted RR of death among moderate drinkers (1-7 drinks per week) vs. abstinent subjects was 0.41 (95% CI=.23-.72). Males drinking > or =15 standard drinks per week had a two-fold multivariate adjusted risk of death (RR=2.11, 95% CI=1.19-3.75) compared with abstinent males. The level of alcohol consumption by females was too low for analysis.

Conclusions: Heavy drinking is common among Finnish elderly males but not among females. The present study shows an increased all-cause mortality risk for males drinking, on average, more than two standard drinks per day.
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http://dx.doi.org/10.1016/j.drugalcdep.2009.08.017DOI Listing
January 2010

[Alcohol and working life].

Duodecim 2009 ;125(8):905-11

Diacor terveyspalvelut, Porkkalankatu 22 C, 00180 Helsinki.

Alcohol-related harm constitutes a significant factor decreasing work productivity. Of heavy alcohol users, most participate in working life. According to labour contract law, a person attending the workplace inebriated can be fired. If the employer applies a deferral to treatment practice, the drug- or alcohol-addicted person can be provided with the choice of therapy and rehabilitation instead of terminating the employment. According to the recent recommendation by the trade unions, organizations should have a program for preventing substance abuse. The employer should take care of the worker's intoxicant education and train the foremen to intervene in the situations on time.
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August 2009

[Early recognition and therapy of heavy use of alcohol].

Authors:
Mauri Aalto

Duodecim 2009 ;125(8):891-6

Terveyden ja hyvinvoinnin laitos, PL 30, 00271 Helsinki.

Heavy use of alcohol can be divided into three groups: at-risk drinking, problem drinking and alcohol dependence. Advisory recommendations for limits of excessive use of alcohol are available. In patient care, the limits stated for heavy alcohol intake constitute only one aspect affecting clinical consideration. Interview and the AUDIT questionnaire (Alcohol Use Disorders Identification Test) are reliable means of elucidating the patient's alcohol usage. Persons at an early stage of heavy alcohol drinking should be subjected to mini-intervention during the medical consultation.
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August 2009

AUDIT and its abbreviated versions in detecting heavy and binge drinking in a general population survey.

Drug Alcohol Depend 2009 Jul 22;103(1-2):25-9. Epub 2009 Apr 22.

National Institute for Health and Welfare, Helsinki, Finland.

Background: The aim of this study was to define optimal cut points for the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated versions (AUDIT-C, AUDIT-QF, and AUDIT-3), and to evaluate how effectively these questionnaires detect heavy drinking in the general population.

Methods: The study population consisted of a sub-sample of the National FINRISK Study. A stratified random sample of 3216 Finns, aged 25-64, was invited to a health check. Of these, 1851 (57.6%) completed the AUDIT and participated in person in the Timeline Followback (TLFB) interview regarding their alcohol consumption. The TLFB-based definition of heavy drinking was used as a primary gold standard (for males > or =16 standard drinks average in a week or > or =7 drinks at least once a month; for females, respectively, > or =10 and > or =5 drinks). Areas under receiving operating characteristics curves (AUROCs), sensitivities and specificities were used to compare the performance of the tests.

Results And Conclusions: The AUDIT and its abbreviated versions are valid for detecting heavy drinking also in a general population sample. However, performance seems to vary between the different versions and accuracy of each test is achieved only by using tailored cut points according to gender. The AUDIT and AUDIT-C are effective for both males and females. The optimal cut points for males were found to be >/=7 or 8 for AUDIT and > or =6 for AUDIT-C. Among females the optimal cut points were found to be > or =5 for AUDIT and > or =4 for AUDIT-C. The study also indicates that AUDIT-QF among females and AUDIT-3 among males are relatively effective. The cut points for detecting all heavy drinkers (including binge drinkers without exceeding weekly thresholds) were lower than for detecting heavy drinkers excluding those who are only binge drinkers.
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http://dx.doi.org/10.1016/j.drugalcdep.2009.02.013DOI Listing
July 2009

Neural encoding of sound duration persists in older adults.

Neuroimage 2009 Aug 22;47(2):678-87. Epub 2009 Apr 22.

Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada M6A 2E1.

Speech perception depends strongly on precise encoding of the temporal structure of sound. Although behavioural studies suggest that communication problems experienced by older adults may entail deficits in temporal acuity, much is unknown about the effects of age on the neural mechanisms underlying the encoding of sound duration. In this study, we measured neuromagnetic auditory evoked responses in young, middle-aged and older healthy participants listening to sounds of various durations. The time courses of cortical activity from bilateral sources in superior temporal planes showed specific differences related to the sound offsets indicating the neural representation of onset and offset markers as one dimension of the neural code for sound duration. Model free MEG source analysis identified brain areas specifically responding with an increase in activity to increases in sound duration in the left anterior insula, right inferior frontal, right middle temporal, and right post-central gyri in addition to bilateral supra-temporal gyri. Sound duration-related changes in cortical responses were comparable in all three age groups despite age-related changes in absolute response magnitudes. The results demonstrated that early cortical encoding of the temporal structure of sound presented in silence is little or not affected by normal aging.
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http://dx.doi.org/10.1016/j.neuroimage.2009.04.051DOI Listing
August 2009

Phylogeny of chitinases and its implications for estimating horizontal gene transfer from chitinase-transgenic silver birch (Betula pendula).

Environ Biosafety Res 2008 Oct-Dec;7(4):227-39. Epub 2008 Oct 29.

Botanical Museum, P.O. Box 7, 00014 University of Helsinki, Finland.

Chitinases are hydrolytic enzymes that have been employed in biotechnology in attempts to increase plants' resistance against fungal pathogens. Genetically modified plants have given rise to concerns of the spreading of transgenes into the environment through vertical or horizontal gene transfer (HGT). In this study, chitinase-like sequences from silver birch (Betula pendula) EST-libraries were identified and their phylogenetic relationships to other chitinases were studied. Phylogenetic analyses were used to estimate the frequency of historical gene transfer events of chitinase genes between plants and other organisms, and the usefulness of phylogenetic analyses as a source of information for the risk assessment of transgenic silver birch carrying a sugar beet chitinase IV gene was evaluated. Thirteen partial chitinase-like sequences, with an approximate length of 600 bp, were obtained from the EST-libraries. The sequences belonged to five chitinase classes. Some bacterial chitinases from Streptomyces and Burkholderia, as well as a chitinase from an oomycete, Phytophthora infestans, grouped together with the class IV chitinases of plants, supporting the hypothesis that some class IV chitinases in bacteria have evolved from eukaryotic chitinases via horizontal gene transfer. According to our analyses, HGT of a chitinase IV gene from eukaryotes to bacteria has presumably occurred only once. Based on this, the likelihood for the HGT of chitinase IV gene from transgenic birch to other organisms is extremely low. However, as risk is a function of both the likelihood and consequences of an event, the effects of rare HGT event(s) will finally determine the level of the risk.
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http://dx.doi.org/10.1051/ebr:2008019DOI Listing
March 2009

Drinking habits and prevalence of heavy drinking among occupational healthcare patients.

Scand J Prim Health Care 2009 ;27(1):53-7

Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.

Objective: To estimate the proportion of heavy drinkers among occupational healthcare patients and evaluate their characteristics.

Design: Patients visiting their doctor in six occupational health clinics were asked to complete a questionnaire containing the Alcohol Use Disorders Identification Test (AUDIT) and other questions concerning health.

Setting: Occupational health services.

Subjects: A total of 757 patients participated in the study.

Main Outcome Measure: Heavy drinking was defined as having a score of 10 or more (men) or 8 or more (women) in the AUDIT questionnaire.

Results: Of the men 114 (29%) and of the women 48 (13%) were heavy drinkers. Only smoking differentiated both male and female heavy drinkers from moderate drinkers among the clinically relevant characteristics.

Conclusion: There are a considerable number of heavy drinkers among occupational healthcare patients. Heavy drinkers do not have any particularly specific characteristics except for the drinking that distinguish them from other patients. Thus, screening is necessary to identify heavy drinkers in occupational healthcare settings.
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http://dx.doi.org/10.1080/02813430802588691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410478PMC
February 2009

Hazardous drinking: prevalence and associations in the Finnish general population.

Alcohol Clin Exp Res 2008 Sep 8;32(9):1615-22. Epub 2008 Jul 8.

Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.

Background: Hazardous drinking, defined as consuming alcohol on a risky level and not meeting the diagnostic criteria of alcohol use disorders (AUDs), has been suggested for a new complementary nondependence diagnosis. This study aimed to investigate the prevalence and associations of hazardous drinking in comparison to AUDs, moderate drinking, and abstinence.

Methods: A national representative sample of Finns was examined in the Health 2000 Survey. For 4477 subjects aged 30 to 64 years (76%, 2341 females), both the quantity frequency data about alcohol consumption and Composite International Diagnostic Interview (CIDI) data concerning AUD diagnoses were available. The nationally recommended limits for hazardous dinking were used (males: 24 drinks, females: 16 drinks/wk). Logistic regression models were used to analyze associations.

Results: The prevalence of hazardous drinking was 5.8%. Hazardous drinking was more prevalent among males than females (8.5% vs. 3.1%). It was most prevalent among the subjects aged 40 to 49 years (7.3%), divorced or separated (8.3%), unemployed (8.2%) and subjects living in the southern (Helsinki) region (7.5%). AUDs versus hazardous drinking were more likely to be in males versus females and in the unemployed versus employed. Subjects aged 40 and over had higher odds for hazardous drinking versus AUDs. The odds for hazardous versus moderate drinking were higher for males versus females (adjusted odds ratio = 3.24), for subjects aged over 40 years, unemployed versus employed and cohabiting, divorced/separated or unmarried subjects versus married subjects.

Conclusion: The high prevalence of hazardous drinking makes it an important public health concern. Hazardous drinkers have different sociodemographic characteristics as compared to people in other alcohol use categories.
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http://dx.doi.org/10.1111/j.1530-0277.2008.00740.xDOI Listing
September 2008

Audit questionnaire as part of community action against heavy drinking.

Alcohol Alcohol 2008 Jul-Aug;43(4):442-5. Epub 2008 Apr 24.

Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital, PO Box 2000, FIN-33 521, Tampere, Finland.

Aims: The purpose of the present study was to find out how well the alcohol questionnaire, AUDIT, as part of a wide community action was noticed, and if it had any effects especially among heavy drinkers.

Methods: As part of local community action campaign ('Booze Weeks'), the AUDIT pamphlet was delivered to all households (90,000) in Tampere, Finland, and 500 randomly selected inhabitants were interviewed on telephone.

Results: More than three quarters of those consuming alcohol had noticed the 'Booze Weeks' campaign and considered it necessary. Inhabitants who drank most frequently were also the most likely to have noticed the campaign and the AUDIT pamphlet.

Conclusions: As part of a wide community action, home-delivered self-help material is often noticed especially by heavy drinkers. They might come to realize their own heavy drinking and seek professional treatment.
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http://dx.doi.org/10.1093/alcalc/agn028DOI Listing
August 2008

Carnitine deficiency and L-carnitine supplementation in lysinuric protein intolerance.

Metabolism 2008 Apr;57(4):549-54

Department of Pediatrics, University of Turku, 20520 Turku, Finland.

The aim of the study was to investigate the prevalence and mechanisms of development of carnitine deficiency in patients with lysinuric protein intolerance (LPI). In our cohort of 37 Finnish patients with LPI, 8 (8-52 years of age) have been diagnosed with hypocarnitinemia. Their free and total serum carnitine levels, acyl carnitine profiles, renal function, diet, and medication were compared with the data from 8 age- and sex-matched patients with LPI not treated with carnitine supplementation. In patients with LPI, hypocarnitinemia was strongly associated with female sex, renal insufficiency, and the use of ammonia-scavenging drugs. Of the 8 hypocarnitinemic patients, 3 complained of muscle weakness, and their symptoms disappeared during carnitine supplementation. Oral lysine supplementation did not correct hypocarnitinemia in our patients. The patients with LPI are at considerable risk for carnitine deficiency. Supplementation of hypocarnitinemic LPI patients with oral L-carnitine improved serum total carnitine values, but the ratio of free and total carnitine remained subnormal in all supplemented patients except one. Furthermore, decreased ratio of free and total serum carnitine was common even in LPI patients with normal total serum carnitine concentration.
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http://dx.doi.org/10.1016/j.metabol.2007.11.019DOI Listing
April 2008

[Not Available].

Authors:
Mauri Aalto

Duodecim 2007 ;123(11):1293-8

Kansanterveyslaitos, mielenterveyden ja alkoholitutkimuksen osasto, Helsinki.

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April 2008

Binge drinking and its detection among middle-aged men using AUDIT, AUDIT-C and AUDIT-3.

Drug Alcohol Rev 2007 May;26(3):295-9

Medical School, Department of General Practice, University of Tampere, Finland.

Binge (heavy episodic) drinking is common, but there is little knowledge on how this drinking pattern could be detected. This study compares three structured questionnaires among binge drinking middle-aged men. All 45-year-old men in the city of Tampere, Finland, were asked to fill in the Alcohol Use Disorders Identification Test (AUDIT). Based on the interview on their drinking the men were divided into non-binging moderate drinkers (n = 352), binging moderate drinkers (n = 130), non-binging heavy drinkers (n = 10) and binging heavy drinkers (n = 63). The complete AUDIT, AUDIT-C (first three AUDIT questions inquiring quantity-frequency) and AUDIT-3 (the third binging-frequency question of AUDIT) in detecting binge drinking were compared. The complete AUDIT was effective in detecting binge drinkers by a cut-off score of >or=8 or >or=7. The optimal cut-off score for AUDIT-C was >or= 6 and that for AUDIT-3 >or=2. The area under the curve (AUC) among all risky drinkers (binging moderate and binging heavy and non-binging heavy drinkers) for AUDIT was 0.824 (95% CI 0.789 - 0.859), for AUDIT-C 0.829 (95% CI 0.795 - 0.864) and for AUDIT-3 0.779 (0.739 - 0.818). The complete AUDIT and its short versions are applicable in populations where binging is the dominant drinking pattern, but the cut-off scores should be tailored to individual cultures.
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http://dx.doi.org/10.1080/09595230701247756DOI Listing
May 2007

Primary health care physicians' definitions on when to advise a patient about weekly and binge drinking.

Addict Behav 2007 Jul 13;32(7):1321-30. Epub 2006 Nov 13.

Department of Mental Health and Alcohol Research, National Public Health Institute, PO Box 33, FIN-00251 Helsinki, Finland.

Objective: Little is known about the level of alcohol consumption at which physicians think that they should advise their patients to reduce drinking. This is especially true concerning the amounts consumed per one drinking occasion. The aim of the present study was to examine these issues and also characteristics of physicians possibly associated with their different opinions.

Method: Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was 61.0%.

Results: The physicians reported that on average 14.8 drinks (one drink=12 g of absolute alcohol)/week for males and 10.6 drinks/week for females to be the threshold that would cause them to advise their patients. Corresponding figures for one drinking occasion were 6.6 and 4.9 drinks/week. In linear regression analyses physicians' AUDIT scores, use of brief intervention, experience as a physician and age explained the variance of all or some reported thresholds, but all the variables explained only about 10% of the phenomena.

Conclusions: Compared to the official Finnish recommendations regarding the definition of heavy drinking, the physicians reported similar levels of drinking per occasion for deciding to advise their patients, but rather low levels concerning weekly drinking. This may lead to extra workload for physicians and thus hamper implementation of brief intervention. Physicians' characteristics seem to be a decidedly minor issue in implementing drinking limits in health care.
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http://dx.doi.org/10.1016/j.addbeh.2006.09.003DOI Listing
July 2007

Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women.

Alcohol Clin Exp Res 2006 Nov;30(11):1884-8

Department of Mental Health and Alcohol Research, National Public Health Institute, FIN-00251 Helsinki, Finland.

Background: There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women.

Methods: All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking.

Results: In the Timeline Followback, the mean+/-SD weekly reported alcohol consumption was 45+/-67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff > or =6, for the AUDIT-C with cutoff > or =5, for the Five Shot with cutoff > or =2.0, for the AUDIT-PC with cutoff > or =4, and for the AUDIT-QF with cutoff > or =4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires.

Conclusions: The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender.
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http://dx.doi.org/10.1111/j.1530-0277.2006.00233.xDOI Listing
November 2006

Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review.

Scand J Prim Health Care 2006 Mar;24(1):5-15

Department of Health and Society, Division of Social Medicine and Public Health Science, Linköping University, Sweden.

Objective: To review systematically the available literature on implementation of brief alcohol interventions in primary healthcare in order to determine the effectiveness of the implementation efforts by the health are providers. KEY QUESTION: To what extent have the efforts to implement brief alcohol interventions in primary healthcare environments been successful?

Method: Literature search from Medline, Cinahl, PsychLIT, Cochrane.

Setting: Primary healthcare.

Material: A total of 11 studies encompassing 921 GPs, 266 nurses, 88 medical students, and 44 "non-physicians" from Europe, the USA, and Australia.

Main Outcome Measures: Material utilization, screening, and brief intervention rates.

Answer: Intervention effectiveness (material utilization, screening, and brief intervention rates) generally increased with the intensity of the intervention effort, i.e. the amount of training and/or support provided. Nevertheless, the overall effectiveness was rather modest. However, the studies examined were too heterogeneous, not scientifically rigorous enough, and applied too brief follow-up times to provide conclusive answers.
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http://dx.doi.org/10.1080/02813430500475282DOI Listing
March 2006

Implementation of brief alcohol intervention in primary health care: do nurses' and general practitioners' attitudes, skills and knowledge change?

Drug Alcohol Rev 2005 Nov;24(6):555-8

Tampere University Hospital, Department of Psychiatry, Finland.

Brief alcohol intervention reduces heavy drinking, but its implementation has been challenging. The purpose was to evaluate self-reported changes in attitudes, skills and knowledge regarding brief intervention among nurses and general practitioners (GPs) during an implementation project. A questionnaire survey was used before and after the implementation to all nurses and GPs working at the time in the seven primary health-care centres of the city of Tampere, Finland. Several positive changes indicate an increased amount of knowledge regarding brief intervention among the professionals during the implementation. This was found especially among the nurses. The success in increasing the knowledge can also be seen in a decrease of training needs. Instead, attitudes and skills among the professionals did not seem to develop positively. Increasing motivational skills especially seems to be the future challenge.
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http://dx.doi.org/10.1080/09595230500292904DOI Listing
November 2005

Do primary care physicians' own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey.

Drug Alcohol Depend 2006 Jun 15;83(2):169-73. Epub 2005 Dec 15.

Department of Mental Health and Alcohol Research, National Public Health Institute, P.O. Box 33, FIN-00251 Helsinki, Finland.

Background: To define whether the Alcohol Use Disorders Identification Test (AUDIT) scores of primary care physicians themselves predict their willingness to use brief alcohol intervention.

Methods: Cross-sectional self-administered questionnaire survey to all 3193 physicians providing primary health care in Finland. The response rate was 1909 (59.8%). Odds ratios from multinomial regression analysis were calculated for self-reported frequency (never, occasionally or regularly) of conducting brief interventions by physicians with AUDIT scores of 0-1, 2, 3, 4, 5-7 or >or=8.

Results: The prevalence of heavy drinkers based on AUDIT score (>or=8) was 14.5% among all physicians, 7.0% among females and 27.0% among males. Of the respondents 9.4% reported doing brief intervention regularly and 50.0% occasionally. AUDIT scores did not significantly predict either regular or occasional use of brief intervention. Instead, some other independent predictors for more frequent use of brief intervention were found. These included having a specialist licence in general practice or occupational health care and the location of the practice, but not gender or age.

Conclusions: The present results indicate that in general heavy drinking among primary care physicians do not explain the low frequency with which brief intervention is used in primary health care.
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http://dx.doi.org/10.1016/j.drugalcdep.2005.11.010DOI Listing
June 2006

Use of laboratory markers and the audit questionnaire by primary care physicians to detect alcohol abuse by patients.

Alcohol Alcohol 2005 Nov-Dec;40(6):520-3

National Public Health Institute, PO Box 33, FIN-00251 Helsinki, Finland.

Aims: To evaluate how often laboratory markers [Mean corpuscular volume (MCV), Gamma-glutamyl transferase, Aspartate aminotransferase, Alanine aminotransferase, or Carbohydrate-deficient transferrin (CDT)] and the Alcohol Use Disorders Identification Test (AUDIT) are used to detect alcohol abuse in primary health care.

Methods: Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was (65.7%).

Results: CDT was used at least occasionally by 43.4% of the physicians. Corresponding figures were 53.4% for conventional alcohol laboratory markers (MCV, transaminases) and 67.0% for AUDIT. Almost all the respondents used some laboratory marker to detect alcohol abuse. The use of brief alcohol intervention was associated with the greater likelihood that a physician uses different methods to detect alcohol abuse. The data also indicates that gender, age, and having a specialist licence influence activity in using different methods.

Conclusions: Considering the ambivalences in relation to alcohol issues in health care, the use of CDT and AUDIT are reasonably frequent. This may indicate that tools to facilitate the work may also help in adapting new activities.
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http://dx.doi.org/10.1093/alcalc/agh219DOI Listing
February 2006

A brief intervention for risky drinking--analysis of videotaped consultations in primary health care.

Drug Alcohol Rev 2004 Jun;23(2):167-70

Department of General Practice, Medical School, University of Tampere, Finland.

In order to study activity in conducting brief alcohol intervention, a total of 83 consecutive consultations by eight general practitioners were videotaped. The categorization included the nature of the patient's health problems and whether alcohol consumption was elicited. The discussions were compared to previously given instructions. Alcohol consumption was elicited in 9/34 of the consultations where enquiry was indicated by the instructions, and rarely in any other situations. The activity among the individual physicians varied, but none of them elicited systematically in all situations with indication. No information was given to any of these patients concerning the relation between their symptoms and alcohol consumption. In conclusion, enquiring and advising on alcohol were seldom performed. More training is needed, especially on how to inform individual patients of the health risks of alcohol.
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http://dx.doi.org/10.1080/09595230410001704145DOI Listing
June 2004

Usefulness, length and content of alcohol-related discussions in primary health care: the exit poll survey.

Alcohol Alcohol 2004 Nov-Dec;39(6):532-5. Epub 2004 Sep 6.

Department of Mental Health and Alcohol Research, National Public Health Institute, PO Box 33, FIN-00251 Helsinki, Finland.

Aims: To evaluate patients' opinions of the usefulness of alcohol-related discussions with general practitioners (GPs), the time used for the discussion and its main content.

Methods: Exit poll survey to 2000 consecutive patients right after GP consultations.

Results: The response rate was 60.2% (1203/2000). Of the patients 11.6% (139/1203) reported that they were asked and/or advised about alcohol during the consultation. The time used for discussion about alcohol was mostly <4 min; longer for heavy than for non-heavy drinkers. Main topics of the discussion dealt with quantities consumed and harm caused by alcohol. The majority of the patients (81%) reported that discussions concerning alcohol were useful. In that respect heavy drinkers did not differ from non-heavy drinkers.

Conclusions: Discussions about alcohol in primary health care were rare and short, but patients' opinions about their usefulness were mainly positive.
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http://dx.doi.org/10.1093/alcalc/agh090DOI Listing
February 2005

Alcohol drinking among emergency patients--alcometer use and documentation.

Alcohol Alcohol 2004 May-Jun;39(3):262-5

Department of General Practice, Tampere University, Finland.

Aims: To measure physicians' use of the alcometer (breath analysis test) and their documentation of alcohol-related findings among their patients.

Methods: Over one weekend, during which 100 adults attended the emergency clinic of a university hospital, data were collected on patients' alcohol consumption, physicians' use of an alcometer and alcohol-related documentation. Heavy drinkers were defined by the patient's response to a written questionnaire: Five-Shot total score >or=3 points, and/or >or=7 drinks per one occasion.

Results: The questionnaire was filled in by 96 patients; 26 (27%) were heavy drinkers. The alcometer was used in 7% of patients including 5 of 26 (19%) of the heavy drinkers. For only 12/26 (46%) heavy drinkers was there written information on alcohol use in the medical record. For 6 of the 20 patients whose visit was primarily considered by the physician to be alcohol-related, no documentation on alcohol appeared in the records. When documentation was present, drinking quantities were not usually recorded.

Conclusions: It is a challenge to increase the emergency clinic staff's activity in detection and documenting alcohol abuse.
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http://dx.doi.org/10.1093/alcalc/agh050DOI Listing
August 2004

The role of general practitioners' working style and brief alcohol intervention activity.

Addiction 2003 Oct;98(10):1447-51

Tampere University Hospital, Department of Psychiatry, Finland.

Aims: To examine correlates of general practitioners' (GP) activity delivery of brief alcohol interventions to patients with particular reference to their 'working style'.

Design: A postal questionnaire survey.

Setting And Participants: All 75 GPs in the Community Primary Health Care Centre of the City of Tampere, Finland.

Measurements: Measures of working style classifying GPs into 'problem solving' versus 'technological', self-reported brief advice activity and other demographic details.

Findings And Conclusions: Of the respondents (response rate 85%) 45% (29/64) reported carrying out brief alcohol interventions. Male GPs provided brief interventions more often than female GPs (71% versus 36%, P = 0.017). The respondents had mainly positive attitudes to brief interventions for excessive drinkers. The working style typology did not show any relationship with brief intervention activity.
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http://dx.doi.org/10.1046/j.1360-0443.2003.00487.xDOI Listing
October 2003

Myometrial inflammation in human delivery and its association with labor and infection.

Am J Clin Pathol 2003 Aug;120(2):217-24

Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.

The presence of inflammation in decidual and myometrial samples as defined by histopathologic examination and the association between the myometrial inflammation and different maternal infectious morbidity and labor-related clinical variables were evaluated in 648 consecutive women who underwent cesarean section at various gestational periods. Altogether, 1,205 histologic (559 decidual and 646 myometrial) samples were studied. In normal pregnancies, myometrial inflammatory lesions were detected rarely before parturition, indicating their abnormality in these cases. After ruptured fetal membranes with advanced cervical dilatation and in patients with clinical chorioamnionitis, myometrial samples commonly were infiltrated by leukocytes, up to moderate and marked densities. Moderate to marked myometrial inflammation showed no diagnostic value in high-risk term parturients for the prediction of postoperative endometritis. Our study is the first to show the frequency of myometrial inflammation in nonselected consecutive pregnant women and, thus, is important for better understanding the myometrial inflammatory response during human parturition.
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http://dx.doi.org/10.1309/KC6K-DTX9-8LFY-B3J7DOI Listing
August 2003

Oral supplementation corrects plasma lysine concentrations in lysinuric protein intolerance.

Metabolism 2003 Jul;52(7):935-8

Department of Pediatrics, University of Turku, Finland.

In lysinuric protein intolerance (LPI), intestinal absorption and renal tubular reabsorption of arginine, ornithine, and lysine are impaired due to a defective cationic amino acid transporter. Deficiency of arginine and ornithine restricts the function of the urea cycle, leading to hyperammonemia after protein load, and to strong protein aversion. Mealtime supplements of citrulline, another urea cycle intermediate that uses other transport mechanisms, prevent postprandial hyperammonemia and improve protein tolerance. Deficiency of lysine, an essential amino acid, most probably also contributes to the symptoms of LPI. We investigated possibilities to improve the availability of lysine for tissues by increasing plasma lysine concentration. Six patients with LPI were started on short-term oral lysine supplementation that was administered with their regular citrulline doses and standard low-protein meals. L-Lysine in consecutive doses of 0.55 and 1.1 mmol/kg caused profuse diarrhea in first 3 patients. To avoid gastrointestinal side effects, the 3 other patients were started on smaller lysine supplements of only 0.05 mmol/kg per dose, given 3 times daily for 3 days. All pre- and postprandial plasma lysine concentrations remained within normal range in 2 of the 3 patients studied. Even after the larger doses, no significant effects on the urea cycle were seen. We conclude that low-dose oral lysine supplementation normalizes plasma lysine concentration in patients with LPI, and is safe and well tolerated at least in short-term use.
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http://dx.doi.org/10.1016/s0026-0495(03)00089-1DOI Listing
July 2003

Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study.

Drug Alcohol Rev 2003 Jun;22(2):169-73

Tampere University Hospital, Department of Psychiatry, Finland.

The objective of this study was to identify possible obstacles to carrying out competent early identification and brief intervention (EIBI) of heavy drinkers in primary health care. Qualitative focus group discussion method study applying the deductive framework approach. Six focus groups involving 18 general practitioners and 19 nurses were recruited from primary health care of the City of Tampere, Finland. Possible obstacles are: (1) confusion regarding the content of early-phase heavy drinking, (2) lack of self-efficacy among primary health care professionals, (3) sense of lacking time needed for carrying out brief intervention, (4) not having simple guidelines for brief intervention, (5) sense of difficulty in identifying of early-phase heavy drinkers, and (6) uncertainty about the justification for initiating discussion on alcohol issues with patients. The main actions to be taken to promote brief intervention are to educate professionals about the content of early-phase heavy drinking and to produce directing, but not excessively demanding guidelines for carrying out EIBI. Probably successful personal experiences carrying out EIBI can improve professionals' self-efficacy and give to them final justification for discussion alcohol issues with their patients.
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http://dx.doi.org/10.1080/09595230100100606DOI Listing
June 2003

Biodegradation of chemicals in a standardized test and in environmental conditions.

Chemosphere 2003 May;51(6):529-37

Finnish Environment Institute, PO Box 140, FIN-00251 Helsinki, Finland.

The estimation of biodegradation rates is an important source of uncertainty in chemical risk assessment. The existing OECD tests for ready biodegradability have been developed to devise screening methods to determine whether a chemical is potentially easily biodegradable, rather than to predict the actual rate, of biodegradation in the environment. However, risk assessment needs degradation rates. In practice these rates are often estimated (default values) from ready biodegradability tests. These tests have many compromising arbitrary features compared to the situation in the real environment. One important difference is the concentration of the chemical. In wastewater treatment or in the environment many chemicals are present at ng l(-1) to microg l(-1) levels whereas in the tests the concentrations exceed 10-400 mg carbon per litre. These different concentrations of the chemical will lead to different growth kinetics and hence different biodegradation rates. At high concentrations the chemical, if it is degradable, can serve as a primary substrate and competent microorganisms will grow exponentially, resulting in a sigmoid biodegradation curve. At low environmental concentrations the chemical does not serve as a primary substrate, and therefore does not support significant growth of the degraders, and the substrate has a linear biodegradation rate. In this study the biodegradation rates of two reference chemicals, aniline and 4-chloroaniline, were compared in a standard method and in more realistic conditions at low concentrations, using 14C-labelled substances and different sources of inocula. Biomass evolution during the tests was monitored by adenosine triphosphate measurement and also on the basis of the residual 14C-activity in the particulate matter. The results partly support the thesis that low concentrations lead to different biodegradation kinetics compared to the concentrations used in the standard tests. Furthermore the biodegradation rates of the chemicals studied, particularly of 4-chloroaniline, in Finnish natural waters appeared to be lower than those reported in some other countries.
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http://dx.doi.org/10.1016/S0045-6535(02)00861-5DOI Listing
May 2003

Primary health care professionals' activity in intervening in patients' alcohol drinking during a 3-year brief intervention implementation project.

Drug Alcohol Depend 2003 Jan;69(1):9-14

Department of Psychiatry, Tampere University Hospital, PO Box 2000, FIN-33521 Tampere, Finland.

Aim: The study examined the change of primary health care professionals' activity in asking patients about alcohol and giving advice to heavy drinkers during a 3-year brief intervention implementation project.

Method: A patient questionnaire survey after consultation blind to the primary health care professionals before and after the implementation project. Brief intervention implementation was based on action research. Subjects were 1,000 consecutive 16-65-year-old patients consulting general practitioners at two primary health care centres at baseline and follow-up, of whom 655 and 768, respectively, participated.

Results: No statistically significant differences were found regarding asking or advising about alcohol between baseline and 3-year follow-up. Of all patients, 19.1% (125/655) at baseline versus 19.7% (151/768) at follow-up were last asked about alcohol during the consultation in question or during past year (P=0.784). Likewise, of heavy drinkers, 30.9% (30/97) versus 33.9 (38/112) were asked (P=0.644). Of heavy drinkers, 13.4 (13/97) versus 14.9% (17/114) were advised about alcohol during the consultation in question (P=0.754).

Conclusion: The activity to do brief intervention remained stable. This may be due to the short follow-up time, the way brief intervention was implemented in the present study or the saturation in the activity reached already before the present study.
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http://dx.doi.org/10.1016/s0376-8716(02)00228-4DOI Listing
January 2003

Primary health care professionals' activity in intervening in patients' alcohol drinking: a patient perspective.

Drug Alcohol Depend 2002 Mar;66(1):39-43

Department of Psychiatry, Tampere University Hospital, P.O. Box 2000, FIN-33521, Tampere, Finland.

Aim: To test the hypothesis that primary health care professionals' activity in intervening in patients' alcohol drinking is low.

Method: A patient questionnaire survey after consultation blind to the primary health care professionals. Subjects were 1000 16-65 -year-old consecutive patients consulting a general practitioner. The response rate was 66.5%.

Results: Of all participants 6.3% and of excessive drinkers 11.9% were asked about alcohol drinking at the consultation in question. Of all 64.7% and of excessive drinkers 52.4% had never been asked about drinking. Of all 6.0% and of excessive drinkers 19.0% were advised about alcohol drinking at the consultation in question.

Conclusion: Alcohol drinking is rarely brought up in discussion by primary health care professionals, even in the case of excessive drinkers.
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http://dx.doi.org/10.1016/s0376-8716(01)00179-xDOI Listing
March 2002
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