Publications by authors named "Mauri Aalto"

47 Publications

Withdrawal from Long-Term Use of Unusually High-Dose Oxazepam.

Case Rep Psychiatry 2021 5;2021:2140723. Epub 2021 Nov 5.

Department of Psychiatry, Central Hospital of Southern Ostrobothnia, Hanneksenrinne 7, FI-60220 Seinäjoki, Finland.

Benzodiazepine (BZD) misuse is a worldwide problem that healthcare professionals encounter in daily practice. High-dose BZD withdrawal is usually a long process that may require referral to an inpatient rehabilitation unit. Relapses after withdrawal are common. BZD withdrawal can cause complications including seizures, suicidal behavior, anxiety, and depression. Guidelines describe tapering protocols for modest doses; however, protocols for exceptionally high-dose BZD withdrawal are not well described. Herein, we describe a BZD tapering protocol for a patient with daily use of high-dose (1800 mg) oxazepam (OXP). The BZD tapering was administered in an inpatient psychiatric hospital, and the outcome was evaluated monthly after discharge for three months. This report describes a unique case of high-dose OXP withdrawal and also outlines an optional protocol to apply when clinicians encounter these unusual cases.
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http://dx.doi.org/10.1155/2021/2140723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589494PMC
November 2021

Combined effects of lifestyle risk factors on fatty liver index.

BMC Gastroenterol 2020 Apr 15;20(1):109. Epub 2020 Apr 15.

Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Hanneksenrinne 7, 60220, Seinäjoki, Finland.

Background: Factors of lifestyle may have a major impact on liver-related morbidity and mortality. We examined independent and joint effects of lifestyle risk factors on fatty liver index (FLI), a biomarker of hepatic steatosis, in a population-based cross-sectional national health survey.

Methods: The study included 12,368 participants (5784 men, 6584 women) aged 25-74 years. Quantitative estimates of alcohol use, smoking, adiposity and physical activity were used to establish a total score of risk factors, with higher scores indicating an unhealthier lifestyle. FLI was calculated based on an algorithm including body mass index, waist circumference, serum gamma-glutamyltransferase and triglycerides.

Results: The occurrence of FLI ≥ 60% indicating fatty liver increased from 2.4% in men with zero risk factors to 81.9% in those with a total risk score of 7-8 (p <  0.0005 for linear trend) and in women from 0 to 73.5% (p <  0.0005). The most striking individual impacts on the likelihood for FLI above 60% were observed for physical inactivity (p <  0.0005 for both genders) and alcohol consumption (p <  0.0005 for men). Interestingly, coffee consumption was also found to increase with increasing risk factor scores (p <  0.0005 for linear trend in both genders).

Conclusions: The data indicates that unfavorable combinations of lifestyle risk factors lead to a high likelihood of hepatic steatosis. Use of FLI as a diagnostic tool may benefit the assessment of interventions aimed at maintaining a healthy lifestyle and prevention of liver-related morbidity.
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http://dx.doi.org/10.1186/s12876-020-01270-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157978PMC
April 2020

Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status.

PLoS One 2019 20;14(6):e0218463. Epub 2019 Jun 20.

Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland.

Background: Adopting a healthy lifestyle is associated with prolonged life expectancy. The main modifiable lifestyle-related risk factors are hazardous alcohol drinking, smoking, excess body weight and lack of physical activity. Our aim was to estimate the impact of unfavourable lifestyle factors on abnormalities in laboratory tests reflecting liver status, inflammation and lipid metabolism in a population-based cross-sectional study.

Methods: The study included 22,273 participants (10,561 men, 11,712 women) aged 25-74 years from the National FINRISK Study. Data on alcohol use, smoking, body weight, and physical activity were recorded from structured interviews. The risk scores for the various life style factors were established on a 0-8 scale and used to stratify the population in classes to allow estimates of their joint effects. Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques.

Results: Consistent dose-response relationships were observed between the number of unfavourable risk factors and serum levels of GGT, ALT, CRP, cholesterol, HDL, LDL and triglycerides (p < 0.0005 for linear trend in all comparisons). When compared with those with zero risk factors, the multivariable-adjusted odds ratios (ORs) for abnormalities in all biomarkers were significantly higher in those with a sum of risk score two or more. The most striking increases in ORs in the group with the highest numbers of risk factors were observed among men in serum GGT: 26.6 (12.4-57.0), ALT: 40.3 (5.3-307.8), CRP: 16.2 (7.8-33.7) and serum triglycerides: 14.4 (8.6-24.0).

Conclusions: The data support the view that the presence of unfavourable life style risk factors is associated with distinct abnormalities in laboratory tests for liver function, inflammation and lipid status. Such biomarkers may prove to be of value in the assessment of interventions aimed at reducing unfavourable risk factors and in helping individuals in long-term maintenance of lifestyle modifications.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218463PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586311PMC
February 2020

Liver enzymes in alcohol consumers with or without binge drinking.

Alcohol 2019 08 16;78:13-19. Epub 2019 Mar 16.

Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220, Seinäjoki, Finland. Electronic address:

Background: While alcohol use is linked with a wide variety of health problems, the question of whether differences in drinking patterns could yield different outcomes has remained unclear.

Patients And Methods: We measured liver enzymes (ALT, GGT) from alcohol consumers with or without binge drinking from a population-based sample in Finland, where binge-type drinking is common. Data on alcohol use, diet, body weight, lifestyle (smoking, coffee consumption, physical activity), and health status were collected from 19225 subjects (9492 men, 9733 women), aged 25-74 years. The participants were subsequently classified to subgroups, both according to the frequencies of binge drinking and the amounts of regular alcohol intake (low-, medium-, and high-risk drinking).

Results: The quantity of regular alcohol use was roughly linearly related with GGT and ALT activities. ANOVA analyses of the trends according to the frequency of binge drinking showed a significant GGT increase in both men (p < 0.0005) and women (p < 0.0005), and a significant increase of ALT in men (p < 0.0005). In those with low-risk overall consumption, markedly higher GGT (p < 0.0005) and ALT (p < 0.0005) occurred in those with binge drinking more than once a month, compared with those with no such occasions. Binge drinking occurring ≤1/month also resulted in higher GGT (p < 0.0005) and ALT (p < 0.05) activities.

Conclusions: These results emphasize possible adverse consequences of binge drinking on hepatic function even in those with low-risk overall consumption. The pattern of drinking should be more systematically implicated in clinical recommendations for drinking reduction.
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http://dx.doi.org/10.1016/j.alcohol.2019.03.001DOI Listing
August 2019

Laboratory test based assessment of WHO alcohol risk drinking levels.

Scand J Clin Lab Invest 2019 Feb - Apr;79(1-2):58-64. Epub 2019 Feb 5.

d National Institute for Health and Welfare (THL) , Helsinki , Finland.

Low-risk thresholds for alcohol use differ across various national guidelines. To assess the novel WHO risk drinking levels in light of alcohol-sensitive common laboratory tests, we analysed biomarkers of liver status, inflammation and lipid profiles from a population-based survey of individuals classified to abstainers and different WHO risk drinking levels defined in terms of mean alcohol consumption per day. The study included 22,327 participants aged 25-74 years from the National FINRISK Study. Data on alcohol use, health status, diet, body weight and lifestyle (smoking, coffee consumption and physical activity) were recorded from structured interviews. Alcohol data from self-reports covering the past 12 months were used to categorize the participants into subgroups of abstainers and WHO risk drinking categories representing low, moderate, high and very high risk drinkers. Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques. Alcohol risk category was roughly linearly related with the occurrence of elevated values for GGT, ALT and CRP. Alcohol drinking also significantly influenced the incidence of abnormalities in serum lipids. Significantly higher odds for abnormal GGT, ALT and altered lipid profiles remained in alcohol drinkers even after adjustment for age, waist circumference, physical inactivity, smoking and coffee consumption. A more systematic use of laboratory tests during treatment of individuals classified to WHO risk drinking categories may improve the assessment of alcohol-related health risks. Follow-ups of biomarker responses may also prove to be useful in health interventions aimed at reducing alcohol consumption.
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http://dx.doi.org/10.1080/00365513.2019.1571625DOI Listing
August 2019

Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers?

PLoS One 2017 5;12(12):e0188574. Epub 2017 Dec 5.

National Institute for Health and Welfare (THL), Helsinki, Finland.

Objectives: To estimate the prevalence and risk factors for abnormal liver enzymes in a large age- and gender stratified population-based sample of apparently healthy individuals with or without alcohol consumption and other health-related risk factors (adiposity, physical inactivity, smoking).

Methods: Data on alcohol use, smoking, diet and physical activity were recorded using structured questionnaires from 13,976 subjects (6513 men, 7463 women, aged 25-74 years) in the national FINRISK studies. Alcohol data was used to categorize the participants into abstainers, light drinkers, moderate drinkers and heavy drinkers. Serum gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) activities were measured using standard kinetic methods.

Results: Male light drinkers, moderate drinkers and heavy drinkers showed significantly higher relative risks of abnormal GGT than abstainers: 1.37 (95% confidence interval 1.11 to 1.71, p < 0.01), 2.72 (2.08 to 3.56, p < 0.0005), and 6.10 (4.55 to 7.17, p < 0.0005), respectively. Corresponding values for women were 1.22 (0.99 to 1.51, p = 0.065), 1.90 (1.44 to 2.51, p < 0.0005), and 5.91 (3.80 to 9.17, p < 0.0005). Estimated threshold doses for a significant GGT elevation was 14 standard weekly alcohol doses for men and 7 for women. Excess body weight and age over 40 years modulated the thresholds towards smaller quantities of alcohol. The risk of abnormal GGT was also significantly influenced by physical inactivity and smoking. The relative risks of abnormal ALT activities were increased in male heavy drinkers, especially in those presenting with adiposity and sedentary lifestyle.

Conclusions: Alcohol use markedly increases the risk for abnormal liver enzyme activities in those presenting with age over 40 years, obesity, smoking or sedentary lifestyle. The data should be considered in public health recommendations and in the definitions of safe limits of alcohol use.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0188574PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716536PMC
December 2017

The association of alcohol use and quality of life in depressed and non-depressed individuals: a cross-sectional general population study.

Qual Life Res 2018 05 29;27(5):1217-1226. Epub 2017 Nov 29.

Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.

Purpose: To compare the associations of alcohol-related variables with Quality of Life (QoL) in depressed and non-depressed individuals of the general population.

Methods: This cross-sectional study utilized data from the FINRISK 2007 general population survey. A subsample (n = 4020) was invited to participate in an interview concerning alcohol use. Of them, 2215 (1028 men, 1187 women; response rate 55.1%) were included in the analyses. Bivariate associations between mean weekly alcohol consumption, frequency of binge drinking, Alcohol Use Disorders Identification Test (AUDIT)-score and QoL were analysed according to categorization into depressed and non-depressed using the Beck Depression Inventory, Short Form. Linear regression models were calculated in order to determine the associations of the alcohol variables and QoL after adjusting for socio-demographic variables as well as somatic and mental illness.

Results: Depressed individuals had lower mean QoL and higher AUDIT-scores than non-depressed respondents. Bivariate correlations showed that mean weekly alcohol consumption, frequency of binge drinking and AUDIT-scores were statistically significantly associated with impaired QoL in depressed individuals. Abstinence was not associated with QoL. After adjustment for covariates, frequency of binge drinking and AUDIT-score were statistically significantly associated with QoL in depressed individuals and AUDIT-score in the non-depressed group. When analysing all respondents regardless of depression, both AUDIT-score and binge drinking were associated with QoL.

Conclusions: Of the alcohol-related variables, binge drinking and alcohol problems indicated by AUDIT-score contributed to impaired QoL in depressed individuals and both should be assessed as part of the clinical management of depression.
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http://dx.doi.org/10.1007/s11136-017-1741-zDOI Listing
May 2018

Predictors of Persistence of Risky Drinking in Adults: An 11-Year Follow-Up Study.

Eur Addict Res 2017 6;23(5):231-237. Epub 2017 Oct 6.

The National Institute for Health and Welfare (THL), Helsinki, Finland.

Aim: To examine the long-term predictors of persistence of risky drinking in a baseline group of risky drinkers in whom alcohol use disorder had not been diagnosed.

Methods: The data was derived from a representative sample of the Finnish adult population aged 30 years or more, surveyed at 2 time points in the years 2000 (n = 5,726) and 2011 (n = 3,848, 67.2% of the baseline sample). Risky drinking was defined using BSQF-measurement (for men, 21 standard UK drinks or more per week; for women 14+ drinks) and not having alcohol abuse or alcohol dependence. The sample of risky drinkers in baseline comprised 642 persons, of whom 380 (59.2%) people provided follow-up data. Multivariable logistic regression models were estimated to identify determinants of persistence of risky drinking.

Results: The rate for persistence of risky drinking was 48.7%. Persistence was predicted by daily smoking, low physical activity, and male gender, whereas higher age and later onset of drinking predicted cessation of risky drinking. Daily smoking remained an independent predictor after adjusting for other risk factors.

Conclusions: Health behaviour predicts the persistence of risky drinking in a study population of adults aged 30 and over. These factors should be taken into account when assessing the long-term prognosis on risky drinking.
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http://dx.doi.org/10.1159/000481347DOI Listing
August 2018

Screening for At-Risk Drinking in a Population Reporting Symptoms of Depression: A Validation of the AUDIT, AUDIT-C, and AUDIT-3.

Alcohol Clin Exp Res 2015 Jul 8;39(7):1186-92. Epub 2015 Jun 8.

Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.

Background: Excessive alcohol use is common in patients presenting with symptoms of depression. The aim of this study was to evaluate how the Alcohol Use Disorders Identification Test (AUDIT) and its most commonly used abbreviated versions perform in detecting at-risk drinking among subjects reporting symptoms of depression.

Methods: A subsample (n = 390; 166 men, 224 women) of a general population survey, the National FINRISK 2007 Study, was used. Symptoms of depression were measured with the Beck Depression Inventory-Short Form and alcohol consumption with the Timeline Follow-back (TLFB). At-risk drinking was defined as ≥280 g weekly or ≥60 g on at least 1 occasion in the previous 28 days for men, 140 and 40 g, respectively, for women. The AUDIT, AUDIT-C, and AUDIT-3 were tested against the defined gold standard, that is, alcohol use calculated from the TLFB. An optimal cutoff was designated as having a sensitivity and specificity of over 0.75, with emphasis on specificity. The AUDIT and its abbreviations were compared with carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase.

Results: At-risk drinking was common. The AUDIT and AUDIT-C performed quite consistently. Optimal cutoffs for men were ≥9 for the AUDIT and ≥6 for AUDIT-C. The optimal cut-offs for women with mild symptoms of depression were ≥5 for the AUDIT and ≥4 for AUDIT-C. Optimal cutoffs could not be determined for women with moderate symptoms of depression (specificity <0.75). A nearly optimal cutoff for women was ≥5 for the AUDIT. The AUDIT-3 failed to perform in women, but in men, a good level of sensitivity and specificity was reached at a cutoff of ≥2. With standard threshold values, the biochemical markers demonstrated very low sensitivity (9 to 28%), but excellent specificity (83 to 98%).

Conclusions: Screening for at-risk drinking among patients presenting with symptoms of depression using the full AUDIT is recommended, although the AUDIT-C performed almost equally well. Cut-offs should be adjusted according to gender, but not according to the severity of depressive symptoms. The AUDIT and its abbreviations were superior to biochemical markers.
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http://dx.doi.org/10.1111/acer.12763DOI Listing
July 2015

Impacts of common factors of life style on serum liver enzymes.

World J Gastroenterol 2014 Sep;20(33):11743-52

Joanna Danielsson, Päivikki Kangastupa, Onni Niemelä, Department of Laboratory Medicine, Seinäjoki Central Hospital and University of Tampere, 60220 Seinäjoki, Finland.

Aim: To investigate the impacts of gender, age and factors of life style (alcohol, overweight, coffee and smoking) on serum liver enzymes.

Methods: Serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) were measured from 6269 apparently healthy individuals (2851 men, 3418 women, mean age 45 ± 12 years, range 25-74 years) in a national cross-sectional health survey. All subjects underwent detailed clinical examinations and interviews including the amount and pattern of alcohol use, coffee consumption and smoking habits.

Results: In this population with a mean ± SD alcohol consumption of 65 ± 105 g/wk and body mass index (BMI) of 26.1 ± 4.3 kg/m(2), both ALT and GGT were significantly influenced by alcohol use (P < 0.001) and BMI (P < 0.001), whereas smoking increased only GGT (P < 0.001). A significant effect of age on ALT was seen in men (P < 0.001) whereas not in women. Significant two-factor interactions of alcohol use in men were observed with age (ALT: P < 0.01; GGT: P < 0.001) and BMI (GGT: P < 0.05). For ALT, a significant interaction also occurred between BMI and age (P < 0.005). In contrast, women showed significant interactions of alcohol use with BMI (GGT: P < 0.05), smoking (GGT: P < 0.001), and coffee consumption (GGT: P < 0.001).

Conclusion: Life-style associated changes in liver enzymes may reflect health risks, which should be considered in the definition of normal limits for liver enzymes.
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http://dx.doi.org/10.3748/wjg.v20.i33.11743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155364PMC
September 2014

Health-related quality of life in alcohol dependence: a systematic literature review with a specific focus on the role of depression and other psychopathology.

Nord J Psychiatry 2014 Aug 15;68(6):369-84. Epub 2013 Nov 15.

Jonna Levola, A-clinic Foundation, Research Unit ; Helsinki , Finland , and National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services ; Helsinki , Finland.

Background: Health-related quality of life (HRQOL) is considered a valid measure of treatment effectiveness in addictions. However, alcohol research has lagged behind other biomedical fields in using HRQOL outcomes as primary or secondary endpoints. Previous work has suggested that psychiatric co-morbidity may mediate the relationship between alcohol dependence and HRQOL.

Aim: The goal was to summarize the literature on HRQOL and its domains in the context of alcohol dependence. A specific focus was on the impact of depression and other psychopathology on these areas of life.

Materials And Methods: A database search of MEDLINE and PsychINFO was performed within the scope of PARADISE (Psychosocial fActors Relevant to brAin DISorders in Europe); a European Commission funded coordination action. Using pre-defined eligibility criteria, 42 studies were identified. A systematic approach to data collection was employed.

Results And Conclusions: Alcohol dependence was shown to affect overall HRQOL and its domains, including general health, physical and mental health, general and social functioning, activities of daily living, pain and sleep. The evidence demonstrating that alcohol dependence is a primary cause of impairments in overall HRQOL, general health, mental and physical health and social functioning was fairly strong. Treatment interventions helped improve HRQOL and its aforementioned domains. The reduction or cessation of alcohol use facilitated these improvements; however, it was not reported to be predictive of improvement in all instances where improvement was reported. Depression was associated with further decreases in HRQOL. Personality disorders contributed to the severity of social functioning impairment.
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http://dx.doi.org/10.3109/08039488.2013.852242DOI Listing
August 2014

[Addiction psychiatry in specialized care--towards more precise differential diagnosis].

Duodecim 2013 ;129(19):2079-84

Psykiatria, Etelä-Pohjanmaan sairaanhoitopiiri ja Terveyden ja hyvinvoinnin laitos (THL).

A mental disorder and a substance abuse problem are often present simultaneously. Possible underlying substance abuse is surveyed in examining psychic symptoms. Screening of the substance abuse problem facilitates revealing the presence of previously unrecognized substance abuse problems. Screening of alcohol abuse with the AUDIT questionnaire is necessary for all patients in psychiatric specialized care. The DAST-20 questionnaire is utilized in the screening of drug abuse. The DSM-IV diagnosis system and the PRISM interview define more closely the differential diagnosis associated with dual diagnoses. Treatment of a substance abuse problem related to severe mental disorders should be conducted in an integrated manner by the same treatment unit.
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December 2013

Goal-related outcome after acute alcohol-pancreatitis -- a two-year follow-up study.

Addict Behav 2013 Dec 21;38(12):2805-9. Epub 2013 Jul 21.

Tampere University Hospital, Finland. Electronic address:

The aim of this study was to find out if an acute pancreatitis leads the patients to reduce their alcohol consumption and if there are factors predicting the outcome. We also observed which factors affected the choice of patient's personal drinking goal, e.g., abstinence or moderate drinking, how this goal changed during the follow-up and how the goal affected the change in drinking habits. In 2001-2005, 120 patients treated in Tampere University Hospital for their first alcohol-related acute pancreatitis were interviewed before discharge from the hospital and at the two-year follow-up. All patients had at least one intervention session for their alcohol use. Of the patients 87 (72.5%) completed the study. The alcohol consumption level and its changes, personal drinking goal of the patients, the factors affecting the choice and the changes of the goal were observed. Most (96.4%) of the patients were willing to reduce their drinking. At follow-up, 34 (40.5%) patients succeeded in reducing their alcohol consumption under the pre-set moderate drinking level. The only factor predicting alcohol use was the number of hospitalization days due to the acute alcohol-related pancreatitis (p=0.015). Those who chose abstinence seemed to succeed more often in stopping drinking or reducing their drinking below risk levels as compared to those with moderation goal (47.9% vs. 28.6%, p=0.075). The only abstinence-goal predicting factor was the concern of the relatives, friends or doctors (p=0.001). All 6 patients who needed intensive care chose abstinence-goal. During the follow-up period the goal changed. At baseline, the majority chose abstinence but two years after pancreatitis, the majority was striving for moderate drinking. A serious illness seems to be a good opportunity to change and to motivate patients. Even if abstinence is recommended to patients with alcohol-related pancreatitis, communication of individual goals is important in the motivation process of the patients.
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http://dx.doi.org/10.1016/j.addbeh.2013.07.008DOI Listing
December 2013

Individual and joint impacts of ethanol use, BMI, age and gender on serum gamma-glutamyltransferase levels in healthy volunteers.

Int J Mol Sci 2013 Jun 4;14(6):11929-41. Epub 2013 Jun 4.

Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, and University of Tampere, Seinäjoki 60220, Finland.

Excessive ethanol consumption, obesity and increasing age may all lead to increased serum levels of gamma-glutamyltransferase (GGT) enzyme, which plays a key role in the metabolism of extracellular reduced glutathione. However, as yet, the interactions between the various modulators of GGT activities have remained poorly defined. We analyzed data from 15,617 apparently healthy individuals (7254 men and 8363 women, mean age 46 ± 13 years, range 25-74 years) who participated in a national cross-sectional health survey in Finland between 1997 and 2007. All subjects underwent detailed clinical examinations and interviews, including the amount of ethanol use and smoking habits. GGT levels were measured from all participants, and the individual and joint impacts of the different study variables on GGT levels were assessed. Significant individual effects were noted for ethanol use (p < 0.001), body mass index (BMI) (p < 0.001), age (p < 0.001) and smoking (p < 0.001). In men, significant two-factor interactions occurred between ethanol use and age (p < 0.020). Among those over 40 years of age, ethanol consumption was found to be a stronger determinant of increased GGT levels than in men below 40 years, whereas in the latter age group, BMI was found to predominate. In women, a significant two-factor interaction occurred between ethanol and BMI (p = 0.010), whereas it did not with ethanol use and age. The data underscores the role of ethanol consumption and age as major determinants of increased GGT levels in men, whereas in women, a relatively stronger impact was noted for ethanol intake and BMI. In light of the ability of GGT enzyme to modulate crucial redox-sensitive functions, the present findings also support the use of GGT as a biomarker of oxidative stress.
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http://dx.doi.org/10.3390/ijms140611929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709764PMC
June 2013

μ-Opioid receptor gene (OPRM1) polymorphism A118G: lack of association in Finnish populations with alcohol dependence or alcohol consumption.

Alcohol Alcohol 2013 Sep-Oct;48(5):519-25. Epub 2013 May 30.

Ministry of Social Affairs and Health, Department of Occupational Safety and Health, PO Box 33, FI-00023 Government, Finland.

Aims: The molecular epidemiological studies on the association of the opioid receptor µ-1 (OPRM1) polymorphism A118G (Asn40Asp, rs1799971) and alcohol use disorders have given conflicting results. The aim of this study was to test the possible association of A118G polymorphism and alcohol use disorders and alcohol consumption in three large cohort-based study samples.

Methods: The association between the OPRM1 A118G (Asn40Asp, rs1799971) polymorphism and alcohol use disorders and alcohol consumption was analyzed using three different population-based samples: (a) a Finnish cohort study, Health 2000, with 503 participants having a DSM-IV diagnosis for alcohol dependence and/or alcohol abuse and 506 age- and sex-matched controls; (b) a Finnish cohort study, FINRISK (n = 2360) and (c) the Helsinki Birth Cohort Study (n = 1384). The latter two populations lacked diagnosis-based phenotypes, but included detailed information on alcohol consumption.

Results: We found no statistically significant differences in genotypic or allelic distribution between controls and subjects with alcohol dependence or abuse diagnoses. Likewise no significant effects were observed between the A118G genotype and alcohol consumption.

Conclusion: These results suggest that A118G (Asn40Asp) polymorphism may not have a major effect on the development of alcohol use disorders at least in the Finnish population.
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http://dx.doi.org/10.1093/alcalc/agt050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296254PMC
April 2014

Mean-weekly alcohol questions are not recommended for clinical work.

Alcohol Alcohol 2013 May-Jun;48(3):308-11. Epub 2013 Mar 21.

School of Medicine, University of Tampere, Tampere FIN-33014 Finland.

Aims: The aim of this study was to evaluate middle-aged men's willingness to answer short, clinically feasible alcohol-related questions and to discuss changing their drinking habits.

Methods: All 45-year-old male inhabitants of the city of Tampere, Finland, were invited to a health screening. Of these, 664 (55.1%) agreed to participate and 615 drank alcohol. The mailed health questionnaire also included mean-weekly (M-W), quantity-frequency (Q-F) and structured frequency-quantity (AUDIT-FQ) questions based on the Alcohol Use Disorders Identification Test (AUDIT). Based on the Q-F, drinkers were classified as moderate, risky and heavy episodic drinkers.

Results: Q-F was answered by 90.2%, the AUDIT by 96.6% and the M-W by 45.5%. In all drinker categories, Q-F gave higher consumption levels compared with M-W and AUDIT-FQ. Willingness to discuss and change alcohol drinking was low in all drinker categories.

Conclusion: Choosing a method preferred by patients may increase their willingness to talk about alcohol. Also, a method giving high consumption values may be the most truthful, because patients often underestimate their drinking. This is why Q-F questions should be favoured over M-W and AUDIT-FQ in patient interviews.
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http://dx.doi.org/10.1093/alcalc/agt018DOI Listing
October 2013

Dose- and gender-dependent interactions between coffee consumption and serum GGT activity in alcohol consumers.

Alcohol Alcohol 2013 May-Jun;48(3):303-7. Epub 2013 Mar 14.

Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and University of Tampere, Hanneksenrinne 7, 60220 Seinäjoki, Finland.

Aims: Coffee consumption has been recently linked with decreased blood gamma-glutamyltransferase (GGT) activities and protection from alcoholic liver disease. To explore the relationship and dose response, we assessed the impacts of coffee and alcohol intake on serum GGT activity in apparently healthy men and women with varying levels of coffee and alcohol consumption.

Methods: Data on coffee, alcohol consumption and serum GGT activities were collected from 18,899 individuals (8807 men and 10,092 women), mean age 48 years, range 25-74 years, who participated in a large national cross-sectional health survey. Body mass index, smoking index and age were used as covariates in all analyses.

Results: Among the study population, 89.8% reported varying levels of coffee consumption; 6.9% were abstainers from alcohol, 86.1% moderate drinkers, 3.7% heavy drinkers and 3.3% former drinkers. In men, the elevation of GGT induced by heavy drinking (>280 g/week) was found to be significantly reduced by coffee consumption exceeding 4 cups per day. A similar trend was also observed among women, which however, did not reach statistical significance.

Conclusion: Coffee modulates the effect of ethanol on serum GGT activities in a dose- and gender-dependent manner. These observations should be implicated in studies on the possible hepatoprotective effects of coffee in alcohol consumers.
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http://dx.doi.org/10.1093/alcalc/agt017DOI Listing
October 2013

Effect of age and gender on the relationship between alcohol consumption and serum GGT: time to recalibrate goals for normal ranges.

Alcohol Alcohol 2012 Sep-Oct;47(5):558-62. Epub 2012 Jun 29.

Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, University of Tampere, Seinäjoki FIN-60220, Finland.

Aims: While serum gamma-glutamyltransferase (GGT) enzyme activity is a well established biomarker of excessive alcohol consumption and liver dysfunction, recent studies have also implicated it as a predictor of morbidity due to extrahepatic causes. Therefore, further information on the associations between ethanol intake and GGT activities in apparently healthy individuals appears warranted.

Methods: Data on alcohol consumption and serum GGT activities were collected from 18,899 individuals (8807 men, 10,092 women), mean age 48 years and range 25-74 years, who participated in a national cross-sectional health survey. Alcohol use was assessed by detailed questionnaires and the study population was subsequently divided into subgroups according to age and gender. Body mass index and smoking were used as covariates in all analyses.

Results: In men over 40 years, a reported regular consumption of 8 standard ethanol doses ('dose' = 12 g ethanol) or more per week was found to lead to a significant elevation in serum GGT activities, whereas those below 40 showed first significant changes not until the reported ethanol intake exceeded 14 doses per week. For women, the corresponding threshold levels were four and seven standard ethanol doses, respectively.

Conclusion: The data pertaining to the present population sample indicate that rather low levels of reported regular ethanol consumption lead to elevated levels of GGT and that age over 40 markedly enhances the impact of alcohol consumption on GGT activity. The present findings should form the basis for defining safe levels of ethanol consumption and in recalibrating goals for normal limits in the clinical use of GGT measurements.
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http://dx.doi.org/10.1093/alcalc/ags072DOI Listing
December 2012

Institutionalization of brief alcohol intervention in primary health care-the Finnish case.

Alcohol Clin Exp Res 2012 Aug 8;36(8):1456-61. Epub 2012 Mar 8.

Co-operation Area for Health Care Services in Jyväskylä, Finland.

Background: There have been several research and practical projects to promote alcohol brief interventions (BIs) in healthcare settings, but no reports of nationwide outcome have so far been published. In Finland, these activities started in the early 1990s, and in the past years, the focus has been mainly on primary and occupational health care. The aim of the present study was to ascertain whether the extensive and long-lasting implementation efforts have led to the institutionalization of this activity among primary healthcare physicians and to the identification of factors that may be associated with it.

Methods: The data were gathered by a questionnaire sent to all Finnish primary healthcare physicians in 2002 and 2007. In both years, the questionnaire contained questions on demographics, professional background and the physicians' own BI activity (regular, occasional, or none). In 2007, a question eliciting information about the change in BI activity during the past 5 years was added. The response rate was 67.1% (95% CI 65.4 to 68.8) (2,001/2,980) in 2002 and 50.9% (95% CI 49.2 to 52.6) (1,610/3,163) in 2007.

Results: The number of physicians offering BI had increased during the study years from 59.2 to 78.5%. Regular activity was reported in 2002 by 9.3% of physicians and in 2007 by 17.2% and occasional activity correspondingly by 49.9 and 61.3%. Of the physicians who offered BI in 2007, 52.4% reported increased activity and 42.6% similar activity to that reported 5 years earlier. Having a specialist's license in general practice or occupational health care or long experience as a primary healthcare physician predicted high activity.

Conclusions: The BI activity of Finnish primary healthcare physicians is reasonably high and rising. Training and motivating those with low BI activity remains future challenge.
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http://dx.doi.org/10.1111/j.1530-0277.2012.01755.xDOI Listing
August 2012

Depression and heavy drinking occasions: a cross-sectional general population study.

Addict Behav 2011 Apr 10;36(4):375-80. Epub 2010 Dec 10.

National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland.

The purpose of this study was to assess the association between depression and heavy drinking occasions in the Finnish general population. A subsample (2086/4020, response rate 51.9%) of the National FINRISK 2007 Study was used. Depression was assessed with a modified Beck Depression Inventory (short form) and alcohol problems with the Alcohol Use Disorders Identification Test. Total alcohol intake and number of heavy drinking occasions (≥7 drinks for men, ≥5 drinks for women) were evaluated using the Timeline Followback. Of the sample, 13.0% (123/946) of men and 17.4% (198/1140) of women were classified as being depressed. Further, 7.5% (71/946) of men and 3.5% (40/1140) of women reported having at least four heavy drinking occasions in the previous 28days. In an adjusted logistic regression model, these men had a 2.6-fold risk (95% C.I. 1.2-5.3) of depression, as compared to men with less than four heavy drinking occasions. The association was found irrespective of total alcohol consumption and alcohol problems. This association was not found in women.
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http://dx.doi.org/10.1016/j.addbeh.2010.12.015DOI Listing
April 2011

Effectiveness of buprenorphine maintenance treatment as compared to a syringe exchange program among buprenorphine misusing opioid-dependent patients.

Nord J Psychiatry 2011 Sep 3;65(4):238-43. Epub 2010 Nov 3.

Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.

Aims: To investigate the effectiveness of buprenorphine maintenance treatment (BMT) among opioid dependents who are mainly misusing buprenorphine intravenously.

Methods: The study was a prospective naturalistic follow-up with a non-randomized control group. In Finland, 30 opioid dependents reporting previous misuse of buprenorphine and participating in the outpatient BMT and 30 matched controls participating in a syringe exchange program (SEP) were followed. Based on the evidence for the superiority of maintenance treatment, randomization was not done. The effectiveness was evaluated by retention rate, European Addiction Severity Index (EuropASI) interviews, Beck Depression Inventory (BDI), visual analogue scale for quality of life (VAS) during the 2-year follow-up and mortality rates during the 3-year follow-up. Because of drop-outs in the SEP group, only the BMT group was interviewed at 24 months.

Results: At 3 months, the retention rate of the BMT group was 100% and of the SEP group 47%. At 12 months, the corresponding percentages were 83% and 37%. The total EuropASI composite score improved significantly only in the BMT group. In the BMT group, the BDI total score and VAS scales for quality of life improved significantly more than they did in the SEP group. During 3-year follow-up, four patients in the SEP died and none in the BMT.

Conclusions: BMT appears to be an effective treatment for opioid dependents using mainly buprenorphine intravenously. On the other hand, bare SEP appears to result in high drop-out, not significant improvements and deaths.
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http://dx.doi.org/10.3109/08039488.2010.531762DOI Listing
September 2011

AUDIT-C, AUDIT-3 and AUDIT-QF in screening risky drinking among Finnish occupational health-care patients.

Drug Alcohol Rev 2010 Sep;29(5):563-7

Department of Mental Health and Alcohol Research, National Institute for Health and Welfare (THL), Helsinki, Finland.

Introduction And Aims: Primary care physicians need a brief screening instrument to detect risky drinkers. In previous studies, the three first questions of the Alcohol Use Disorders Identification Test-C (AUDIT-C) and the third question on heavy episodic drinking alone (AUDIT-3) have been shown to be almost as effective as the whole AUDIT. Also, AUDIT-QF (the first two questions of AUDIT) can be a potential screening instrument. However, the validity of these short questionnaires has not been studied among the occupational health-care patients.

Design And Methods: Patients visiting their doctor in six occupational health clinics were asked to fill in a health questionnaire containing AUDIT. All together 759 patients participated in the study. Risky drinking was defined as having scored of≥10 for men or≥8 or more for women in the AUDIT questionnaire. Validity of AUDIT-C, AUDIT-3 and AUDIT-QF were compared against the whole AUDIT.

Results: Based on the whole AUDIT, 92 (24%) of the men and 33 (9%) of the women were risky drinkers. For men and women, area under the curve was relatively high for all tested questionnaires. For AUDIT-C, the best combination of sensitivity and specificity was yielded at cut-off point of 6 for men and 4 for women.

Discussion And Conclusion: Short questionnaires perform almost as well as the whole AUDIT screening risky drinking among men and women. This is why they can be recommended for clinical use in busy settings. The cut-off points, however, have to be tailored for gender and culture.
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http://dx.doi.org/10.1111/j.1465-3362.2010.00172.xDOI Listing
September 2010

The Alcohol Use Disorders Identification Test (AUDIT) and its derivatives in screening for heavy drinking among the elderly.

Int J Geriatr Psychiatry 2011 Sep 26;26(9):881-5. Epub 2010 Jul 26.

Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.

Objective: The performance of the Alcohol Use Disorders Identification Test (AUDIT) in screening for heavy drinking among the elderly has been unsatisfactory. The aim of the present study was to determine whether tailoring the cut point improves the performance of the AUDIT and its derivatives in this age group.

Methods: From a stratified random sample of 804 Finns aged 65-74 years, 517 subjects (64.3%) completed the AUDIT and the Timeline Follow-back (TLFB) interview regarding alcohol consumption. A subject was defined as a heavy drinker if consumption of ≥8 drinks (approx. 12 g) on average in a week or ≥4 drinks at least in 1 day during the prior 28 days was reported. Combinations in which both sensitivity and specificity are ≥0.8 were defined as optimal. The elderly specific AUDIT-3 is a modification in which the binge drinking threshold is ≥4 drinks.

Results: Based on the TLFB, 118 subjects (22.8%) were heavy drinkers. The areas under receiving operating characteristics curves (AUROCs) were equivalent (≥0.898) for all questionnaires. When using the standard cut point of ≥8 for the AUDIT, the sensitivity was 0.48. Lowering the cut point to ≥5 led to both a sensitivity and specificity over 0.85. The optimal cut point of the AUDIT-C was ≥4. The AUDIT-QF, AUDIT-3 and elderly specific AUDIT-3 did not provide optimal combinations of sensitivity and specificity with any cut point.

Conclusions: The AUDIT and AUDIT-C are accurate in screening for heavy drinking among the elderly if the cut points are tailored to this age group.
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http://dx.doi.org/10.1002/gps.2498DOI Listing
September 2011

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

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
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