Search

Hip fractures in the elderly are a worldwide epidemic, and aging of the populations is increasing the burden of these fractures on the health care systems. To improve the knowledge of whether the number of hip fractures is increasing even more rapidly than can be accounted for by the demographic changes only, all patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first hip fracture were selected from the National Hospital Discharge Register. There was a steady, average 7.7% annual increase in the total number of hip fractures in Finland during this period so that the number of fractures was 2239 in 1970 and 6071 in 1991. The proportion of patients aged 60 years or more increased steadily from 75% in 1970 to 91% in 1991. In 1991, 74% of the patients were women. Across the study period, the age-adjusted total incidence of hip fractures also increased in both women and men 50 years of age and over. This increase was more pronounced in men. Thus, the increasing incidence of hip fractures in Finland was not only due to the fact that the population was aging but also due to the increasing age-adjusted incidence. We conclude that the number of hip fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and this will seriously challenge the Finnish health care system in the future. [ABSTRACT FROM AUTHOR]

To cite this article: Int J Dent Hygiene 10, 2012; 46-53 DOI: 10.1111/j.1601-5037.2011.00517.x Arpalahti I, Järvinen M, Suni J, Pienihäkkinen K. Acceptance of oral health promotion programmes by dental hygienists and dental nurses in public dental service. Abstract: Objectives: The aim of this study was to analyse how dental hygienists and in-service trained dental nurses accepted new health promotion programmes, how did they experience them in practice, and how did these programmes affect their attitudes to work. Methods: The subjects were all the dental hygienists and in-service trained dental nurses ( n = 28) involved in health promotion of small children. Education and written instructions on two new programmes had been given to the professionals in two areas of Vantaa and those in the third area used the routine programme. The transtheoretical model (TTM) was selected as the theoretical framework for counselling. A structured questionnaire of 31-35 items was sent to all subjects. Independent samples Mann-Whitney U and Fisher's exact tests were used as statistical methods. Results: The response rate was 89%. All respondents felt that the work they had carried out had always been important during their working career. Twenty-one of 25 respondents reported that the instructions and education were suitable for oral health promotion. The respondents within the new programmes felt they had advanced more as health professionals ( P = 0.020) and acquired more confidence from the education ( P = 0.018) compared with the routine programme. Conclusions: The new programmes for small children were well accepted by the dental hygienists and the in-service trained dental nurses, and the majority of them gained some new practices for their work. [ABSTRACT FROM AUTHOR]

Inorganic nitrogen loading was simulated using two dynamic catchment scale models, Integrated Nutrients in Catchments-Nitrogen (INCA-N) and the Generalized Watershed Loading Functions (GWLF). The simulated N loading was compared to a standard method to calculate annual loading using measured discharge and discharge-weighted concentrations. The main aim of the study was to compare these three estimation approaches with regards to their performance in hydrologically variable years in a small headwater catchment in southern Finland. Inter-annual variability of INCA-N and GWLF was compared with measured inorganic N concentrations at the catchment outlet. In years where snow melt dominates the annual discharge pattern all methods gave concurrent annual loading estimates. However, the loading estimates differ between the studied methods in years where large rainfall events in late summer or autumn dominate the annual discharge pattern, or when the model was not able to reproduce the spring discharge maximum properly. The results suggest that both models can be useful tools in estimating dissolved inorganic nitrogen loading from a catchment under changing climate conditions, providing that the key influencing driver, hydrology, is well captured. [ABSTRACT FROM AUTHOR]

This prospective one-year follow-up study compared the risks of knee injuries in various commuting and lifestyle activities as well as in recreational and competitive sports in a 15 to 74-year-old Finnish population cohort. A cohort of 3657 persons was randomly selected from the nationwide population register of Finland. Ninety-two percent of them accepted to participate (n = 3363). The subjects were interviewed by telephone three times during the one-year follow-up. The recorded data included all physical activities that lasted 15 minutes or more, and all injuries that were sustained during these activities. Fifteen percent (n = 321) of all reported injuries affected the knee. The individual risk of knee injury per 1000 exposure hours was low in commuting activities (cycling, walking), 0.06 (95% Cl 0.04 to 0.09) and in lifestyle activities (gardening, hunting, fishing, home repair etc.), 0.04(0.03–0.06). In recreational and competitive sports, the knee injury risk was almost ten times higher, 0.44 (0.39–0.50). For commuting activities (p = 0.046) and for recreational and competitive sports (p < 0.001), there was a decreasing injury rate with age. In lifestyle activities (p = 0.038), in turn, there was an increasing trend of injuries with aging. In commuting activities (hazard ratio, HR 5.99, 95% Cl 1.40 to 25.6), the risk of knee injury was significantly higher in women than in men. In conclusion, the knee injury risk per exposure hours is almost ten times lower in commuting and lifestyle activities compared to recreational and competitive sports. The knee injury risk is especially high in the age group of 15 to 25 years, especially in various team sports and ball games. At population level, however, widely practiced low-to-moderate intensity activities with relatively low injury risk per exposure hours produce a large absolute number of knee injuries. [ABSTRACT FROM AUTHOR]

Studies temporal coherence in water chemistry and temperature under the ice of the boreal lakes of Finland. Key issues of interest; Analysis of pertinent topics and relevant issues; Implications on water research.

The representativeness of aquatic ecosystem monitoring and the precision of the assessment results are of high importance when implementing the EU's Water Framework Directive that aims to secure a good status of waterbodies in Europe. However, adapting monitoring designs to answer the objectives and allocating the sampling resources effectively are seldom practiced. Here, we present a practical solution how the sampling effort could be re-allocated without decreasing the precision and confidence of status class assignment. For demonstrating this, we used a large data set of 272 intensively monitored Finnish lake, coastal, and river waterbodies utilizing an existing framework for quantifying the uncertainties in the status class estimation. We estimated the temporal and spatial variance components, as well as the effect of sampling allocation to the precision and confidence of chlorophyll-a and total phosphorus. Our results suggest that almost 70% of the lake and coastal waterbodies, and 27% of the river waterbodies, were classified without sufficient confidence in these variables. On the other hand, many of the waterbodies produced unnecessary precise metric means. Thus, reallocation of sampling effort is needed. Our results show that, even though the studied variables are among the most monitored status metrics, the unexplained variation is still high. Combining multiple data sets and using fixed covariates would improve the modeling performance. Our study highlights that ongoing monitoring programs should be evaluated more systematically, and the information from the statistical uncertainty analysis should be brought concretely to the decision-making process.

Background: Falls and related injuries are a major public health concern in elderly people. Multifactorial interventions may result in significant reduction in falls but their effectiveness in prevention of fall-induced injuries at centre-based falls clinics is unclear. This study assessed the effectiveness of the multifactorial Chaos Clinic Falls Prevention Programme on rate of falls and related injuries of home-dwelling older adults., Methods: This study was a pragmatic, randomised controlled trial concentrating on high risk individuals and their individual risk factors of falling. Home-dwelling elderly people aged 70 years or more were recruited to the Chaos falls clinics in the cities of Lappeenranta and Tampere in Finland between January 2005 and June 2009. 1314 participants with high-risk for falling and fall-induced injuries and fractures were randomised into intervention group (n=661) and control group (n=653). A multifactorial, individualized 12-month falls prevention programme concentrating on strength and balance training, medical review and referrals, medication review, proper nutrition (calcium, vitamin D), and home hazard assessment and modification was carried out in the intervention group. The main outcome measures were rates of falls, fallers, and fall-induced injuries., Results: During the one-year follow-up, 608 falls occurred in the intervention group and 825 falls in the control group. The rate of falls was significantly lower in the intervention group (95 falls per 100 person-years) than in the controls (131 falls per 100 person-years), the incidence rate ratio (IRR) being 0.72 (95% confidence interval (CI) 0.61-0.86, p<0.001, NNT 3). In the intervention group 296 participants fell at least once. In the controls the corresponding number was 349. The hazard ratio (HR) of fallers in the intervention group compared with the control group was 0.78 (95% CI 0.67-0.91, p=0.001, NNT 6). The number of fall-induced injuries in the intervention group was 351 with the corresponding rate (per 100 person-years) of 55. In the control group, these figures were higher, 468 and 75. The IRR of fall-induced injuries in the intervention group compared with the control group was 0.74 (95% CI 0.61-0.89, p=0.002, NNT 5)., Conclusions: The multifactorial Chaos Clinic Falls Prevention Programme is effective in preventing falls of older adults. The programme reduces the rate of falls and related injuries by almost 30%., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

We summarize the patterns of ¹³⁷Cs activity concentrations and transfer into fish and other biota in four small forest lakes in southern Finland during a twenty-year period following the Chernobyl accident in April 1986. The results from summer 1986 showed fastest accumulation of ¹³⁷Cs into planktivorous fishes, i.e. along the shortest food chains. Since 1987, the highest annual mean values of ¹³⁷Cs have been recorded in fish occupying the highest trophic levels, for perch (Perca fluviatilis) 13,600 Bq/kg (ww) and for pike (Esox lucius) 20,700 Bq/kg (ww). At the same time, activity concentrations of ¹³⁷Cs in crustacean zooplankton and Asellus aquaticus have ranged between 1000 and 19,500 Bq/kg (dw). In 2006, 5-28% of the 1987 ¹³⁷Cs activity concentration levels were still present in perch and pike. Since 1989 their ¹³⁷Cs activity concentrations in oligohumic seepage lakes have remained significantly higher than in polyhumic drainage lakes due to the increased transfer of ¹³⁷Cs into fish in the seepage lakes with lower electrolyte concentrations, longer water retention times and lower sedimentation rate., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: Low-trauma fractures of older adults have been recognized as a major public health problem in developed societies with aging populations. However, nationwide information on recent fracture trends is rather scarce., Methods: We determined the trend in the number and incidence (per 100,000 persons) of low-trauma ankle fracture among elderly people in Finland by taking into account all persons 60 years of age or older who were admitted to our hospitals for primary treatment of such fracture in 1970-2006., Results: The number of low-trauma ankle fractures among 60-year-old or older Finnish persons increased steadily and sharply between 1970 (369 fractures) and 1997 (1668 fractures), but since then, the increase has leveled off (1670 fractures in 2006). The raw incidence of low-trauma ankle fracture, showing a clear rise from 57 fractures per 100,000 persons in 1970 to 169 fractures in 1997, somewhat decreased between 1997 and 2006 (to 144 fractures in 2006). Observations on the age-adjusted fracture incidence were similar. During 1970-1997, the age-adjusted incidence of low-trauma ankle fracture clearly rose in both women and men, but thereafter, the incidence declined; in women, from 199 in 1997 to 173 in 2006, and in men, from 123 in 1997 to 100 in 2006., Conclusions: The sharp increase in the incidence of low-trauma ankle fracture in Finnish older adults from early 1970s until late 1990s has been followed by stabilized, slightly declining fracture rates. Reasons for this are not known, but a cohort effect toward a healthier aging population with improved functional ability and reduced risk of injurious slips, trips and falls could partly explain the phenomenon.

Background: Although various low-trauma fractures among older adults are said to be a major public health concern in contemporary societies with aging populations, reliable epidemiologic information on their secular trends is scarce., Methods: We assessed the current trend in the number and incidence (per 100,000 persons) of low-trauma fractures of the calcaneus and foot of older adults in Finland, a European Union country with a well-defined white population of 5.2 million, by taking into account all persons 50 years old or older who were admitted to Finnish hospitals for primary treatment of such injury in 1970-2005., Results: The number and raw incidence of low-trauma fractures of the calcaneus and foot among Finns 50 years old or older rose considerably between the years 1970 and 2005, from 64 (number) and 5.6 (incidence) in 1970 to 294 and 15.2 in 2005. For the study period, the age-adjusted incidence of fracture was higher in men than women and showed a clear increase in both sexes in 1970-2005, from 7.3 to 17.4 in men (138% increase), and from 4.3 to 12.5 in women (191% increase). A similar finding was observed in the age-specific incidences. Assuming that the observed increase in the age-specific fracture incidence continues in the 50-year-old or older group and the size of this population increases as predicted, the annual number of low-trauma fractures of the calcaneus and foot in this population will be two times higher in the year 2030 (approximately 550 fractures annually) than it was during 2001-2005., Conclusions: In Finnish persons aged 50 years or older, the number of low-trauma fractures of the calcaneus and foot has risen considerably in 1970-2005 with a rate that cannot be explained merely by demographic changes. Further studies are needed to explore the exact reasons for the rise and possibilities for fracture prevention.

The purpose of this prospective study was to examine the incidence, nature, causes, and severity of injuries in female floorball. Three hundred and seventy-four licensed female floorball players from Finnish top leagues were observed prospectively for one season (6 months). The practice and game hours of floorball were recorded on an exercise diary. All injuries were registered with a structured questionnaire and verified by a physician. During the study period, 133 out of the 374 (35%) players sustained 172 injuries. The injury incidence was 1.8 per 1000 practice hours and 40.3 per 1000 game hours. Of all injuries, 70% were traumatic and 30% were from overuse. The most common injury type was joint sprain (27%). The most commonly injured sites were the knee (27%) and ankle (22%). Twenty-one of the knee injuries (46%) were serious including 10 anterior cruciate ligament (ACL) ruptures. Eight of ACL ruptures occurred during floorball games, giving an ACL rupture incidence of 3.6 per 1000 game hours. Eleven injuries (6%) needed hospital admission. The study attested that injury rate in floorball game is very high. Injury prevention strategies in female floorball should be targeted at injuries occurring at the knee and ankle.

The quadriceps and hamstring muscle strengths of 16 patients operated using a bone-patellar tendon-bone (BTB) autograft and 32 patients operated using a quadruple hamstring autograft for an arthroscopic anterior cruciate ligament (ACL) reconstruction were analyzed 4- to 7-years postoperatively. Standardized isokinetic testing, a clinical evaluation and instrumented assessment of knee laxity were done. The findings showed no significant strength deficits between the patients in the BTB and Hamstring groups and the deficits were, in general, small. The quadriceps and hamstring muscle strengths were better in patients with a longer than shorter follow-up and stable knees had less knee flexion torque deficit than unstable knees. Strength deficit was associated with lower Lysholm knee scores. The findings of this study showed that the muscle strengths of the operated limb had a positive association with the functional outcome of the knee in the long-term and support the use of active rehabilitation after ACL reconstruction.

Unlabelled: This epidemiologic study determined the trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, between 1970 and 2004. The results show that the alarming rise in the fracture incidence from early 1970s until late 1990s has been now followed by declining fracture rates. Reasons for this are largely unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns could partly explain the phenomenon., Introduction: Although osteoporotic fractures of older adults are said to be a major public health concern in modern societies with aging populations, fresh nationwide information on their secular trends is limited., Materials and Methods: This epidemiologic study determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, by taking into account all persons >or= 50 years of age who were admitted to our hospitals for primary treatment of such fracture in 1970-2004., Results: The number of hip fractures among >or= 50-year-old Finns rose very constantly between 1970 (1857 fractures) and 1997 (7122 fractures), but since then, the rise has leveled off (7083 fractures in 2004). After this and because of a continuous rise in population at risk, the crude incidence of hip fracture (showing a clear rise in 1970-1997) decreased between 1997 and 2004, from 438 (per 100,000 persons) in 1997 to 374 in 2004. Concerning the age-adjusted fracture incidence, findings were similar. Until 1997, the age-adjusted incidence of hip fracture clearly increased in both women and men, but thereafter, this incidence declined in both sexes: in women, from 494 in 1997 to 412 in 2004, and in men, from 238 in 1997 to 223 in 2004., Conclusions: The rise in the incidence of hip fracture in Finland from the early 1970s until the late 1990s has been followed by declining fracture rates. Exact reasons for this are unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns cannot be ruled out.

A sideways fall onto the hip is known to be a clear risk factor for hip fracture of elderly people, but it has remained unclear how severe injury such a fall can be. This retrospective patient file survey of young adults aged 15 to 49 years suggested that a fall onto the hip is indeed a serious high-impact injury possessing energy to fracture the proximal femur even in young healthy men. This being the case, it is evident that sideways falls can be very dangerous and thus a natural target for fracture prevention.

This study assessed the current secular trends in unintentional injury deaths among persons 15 years of age or older in Finland. For this purpose, we obtained from the Finnish Official Cause-of-Death Statistics (OCDS) the data for persons aged 15 years or older whose deaths occurred in 1971--2003 due to an unintentional injury. Among Finnish men, the most drastic change occurred in road traffic crashes. The age-standardised death rate (per 100,000 person-years) of men's road traffic crashes was 47 in 1971 but only 11 in 2003. In contrast, the rate of fall-induced deaths among Finnish men gradually rose, from 18 in 1971 to 24 in 2003, by which time falls became the leading category of men's unintentional injury death. Also alcohol poisonings seemed to bypass road traffic crashes as the cause of men's injury death. Among Finnish women, the age-standardised rate of fall-induced deaths decreased till 1975, after which the curve was rather flat. The death rate (per 100,000 person-years) of women's falls was 30 in 1971 and 18 in 2003. During the entire period of 1971--2003, traffic caused fewer deaths in women than men, but the declining trend in women's death rates was also clear, from 17 in 1971 to 5 in 2003. Other unintentional causes accounted for few deaths in women during 1971--2003, although it was of interest that the rate of women's deaths due to alcohol poisoning rose from 1 in 1971 to 4 in 2003. In conclusion, during 1971--2003 falls replaced road traffic crashes as the leading cause of unintentional injury death in adult Finns. The rise in men's fall-induced deaths occurred even with a rate that cannot be explained merely by demographic changes, and therefore, systematic fall prevention measures are needed to control the development. The rising incidence of women's deaths due to alcohol poisoning needs close follow-up.

The purpose of this study was to get reliable insight into injury risk in various commuting and lifestyle activities, as well as recreational and competitive sports. A cohort of 3 657 persons was randomly selected from the 15- to 74-year-old Finnish population. Ninety-two percent (n = 3 363) of the subjects accepted to participate the one-year follow-up, record all their physical activities that lasted 15 min or more, and register all acute and overuse injuries that occurred during these activities. To collect the information, the study subjects were interviewed by phone by the trained personnel of the Statistics Finland three times in four-month intervals. The individual injury risk per exposure time was relatively low, ranging from 0.19 to 1.5 per 1 000 hours of participation, in commuting and lifestyle activities including walking and cycling to work, gardening, home repair, hunting and fishing, and, in sports such as golf, dancing, swimming, walking, and rowing. The risk was clearly higher in squash, orienteering, and contact and team sports, such as judo, wrestling, karate, rinkball, floorball, basketball, soccer, ice hockey, volleyball, and Finnish baseball ranging from 6.6 to 18.3 per 1 000 hours of participation. However, the highest absolute number of injuries occurred in low-risk activities, such as gardening, walking, home-repair, and cycling, because they are performed so often. In conclusion, individual injury risk per exposure hours is relatively low in commuting and lifestyle activities compared to many recreational and competitive sports. However, at a population level, these low-to-moderate intensity activities are widely practised producing a rather high absolute number of injuries, and thus, preventive efforts are needed in these activities, too.

To increase knowledge about recent trends in the number and incidence of various low-trauma injuries among elderly people, we selected, from the National Hospital Discharge Register, all patients > or =60 years of age who were admitted to hospitals in Finland (5 million population) for primary treatment of a first low-trauma ankle fracture during 1970-2000. In each year of the study, the age-adjusted and age-specific incidence of fracture was expressed as the number of patients per 100,000 persons. The predicted numbers and incidence rates of fractures until the year 2030 were calculated using a regression model. For the study period, the number and incidence of low-trauma ankle fractures in Finnish persons > or =60 years of age rose substantially: the total number of fractures increased from 369 in 1970 to 1545 in 2000, a 319% increase, and the crude incidence increased from 57 to 150, a 163% increase. The age-adjusted incidence of these fractures also rose in both women (from 66 in 1970 to 174 in 2000, a 164% increase) and men (from 38 in 1970 to 114 in 2000, a 200% increase). The regression model indicates that, if this trend continues, there will be about three times more low-trauma ankle fractures in Finland in the year 2030 than there was in 2000. In conclusion, the number of low-trauma ankle fractures in elderly Finns is rising rapidly at a rate that cannot be explained simply by demographic changes and, therefore, potentially effective preventive measures, such as prevention of slippings, trippings, and falls in elderly people, and use of ankle supports, should be urgently studied., (Copyright 2002 Elsevier Science Inc.)

Low-trauma fractures of elderly people are a major public health burden worldwide, and as the number and mean age of older adults in the population continue to increase, the number of fractures is also likely to increase. Epidemiologically, however, an additional concern is that, for unknown reasons, the age-standardized incidence (average individual risk) of fracture has also risen in many populations during the recent decades. Possible reasons for this rise include a birth cohort effect, deterioration in the average bone strength by time, and increased average risk of (serious) falls. Literature provides evidence that the rise is not due to a birth cohort effect, whereas no study shows whether bone fragility has increased during this relatively short period of time. This osteoporosis hypothesis could, however, be tested if researchers would now repeat the population measurements of bone mass and density that were made in the late 1980s and the 1990s. If such studies proved that women's and men's age-standardized mean values of bone mass and density have declined over time, the osteoporosis hypothesis would receive scientific support. The third explanation is based on the hypothesis that the number and/or severity of falls has risen in elderly populations during the recent decades. Although no study has directly tested this hypothesis, a great deal of indirect epidemiologic evidence supports this contention. For example, the age-standardized incidence of fall-induced severe head injuries, bruises and contusions, and joint distortions and dislocations has increased among elderly people similarly to the low-trauma fractures. The fall hypothesis could also be tested in the coming years because the 1990s saw many research teams reporting age- and sex-specific incidences of falling for elderly populations, and the same could be done now to provide data comparing the current incidence rates of falls with the earlier ones.

We assessed the current trends in the number and incidence of osteoporotic knee fractures in Finland by collecting data from the National Hospital Discharge Register for all patients > or =60 years of age who were admitted to Finnish hospitals in 1970-1999 for primary treatment of such fractures. The knee fracture was defined "osteoporotic" if it was caused by a low-energy trauma only; that is, a fall from standing height or less. We also predicted fracture development until the year 2030 by a regression model, which took into account the predicted changes in the fracture incidences and population at risk. The number and incidence (per 100,000 persons) of osteoporotic knee fractures in Finnish women aged > or =60 years clearly rose during the study period, from 218 (number) and 55 (incidence) in 1970 to 685 and 113 in 1999. Even after age adjustment, the incidence of women's fractures showed a clear increase, from 59 in 1970 to 105 in 1999. If this trend continues, there will be about 2.5 times more osteoporotic knee fractures in Finnish women in the year 2030 than there were in 1999. In Finnish men aged > or =60 years, the annual number of fractures and its changes were clearly smaller (77 in 1970 vs. 138 in 1999), and the fracture incidence did not show consistent trend changes over time (30 in 1970 vs. 34 in 1999). We conclude that in elderly Finnish women the number of osteoporotic knee fractures shows a rise with a rate that cannot be explained merely by demographic changes and, therefore, vigorous preventive measures are needed to control this development.

Two hundred and ninety-five licensed floorball players from Finnish premier to fifth division were observed prospectively for one season to study the incidence, nature, causes and severity of floorball injuries. During the study period, 100 out of the 295 (34 %) players sustained 120 injuries. Thirty-seven percent (73/199) of the male players and 28 % (27/96) of the females suffered from an injury. The injury rate was 1.0 per 1000 practice hours for both sexes. The injury rates per 1000 game hours were 23.7 for men and 15.9 for women. One hundred injuries (83 %) were acute and the remaining 20 (17 %) were overuse injuries. Sprain was the most common type of injury in men while overuse injuries were the most frequent injury type in women. The lower extremity was involved in 62 %, spine or trunk in 19 % and upper extremity in 10 % of the injuries. The most commonly injured sites were the knee and ankle (22 % and 20 % of all injuries), followed by head and neck (8 %). In both sexes the majority of injuries were minor, level II, injuries. Ten of the knee injuries (38 %) were serious, level IV injuries, of which seven were ACL ruptures. In conclusion, the individual risk of injury in floorball is relatively low in game practice while rather high during the game itself. Before initiation of clinical trials on prevention of floorball injuries, an exact knowledge of the risk factors and mechanisms of floorball injuries are needed.

We determined the current trends in the number and incidence of osteoporotic fractures of the proximal humerus in Finland by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to Finnish hospitals in 1970-1998 for primary treatment of such fractures. The fracture was defined osteoporotic if it was caused by a low-energy trauma only, i.e., a fall from standing height or less. The number and incidence (per 10(5) persons) of fractures increased sharply from 208 (number) and 32 (incidence) in 1970 to 1,105 and 110 in 1998. Even after the age-adjustment, the incidence of fractures showed a clear increase: in women from 50 in 1970 to 133 in 1998, and in men from 14 in 1970 to 49 in 1998. If this trend continues, there will be three times more osteoporotic fractures of the proximal humerus in Finland in the year 2030 than there were in 1998.

We investigated the trends in age-standardized rates (per 100,000 persons-years) of unintentional injury deaths in adult Finns from 1971-1997. In 1971, the leading category of unintentional injury resulting in death among Finnish men was road traffic accidents (age-standardized death rate 47 per 100,000 person-years). This rate has declined sharply, reaching 13 per 100,000 person-years in 1997. Simultaneously, the rate of fall-induced death among men gradually increased from 17/100,000 person-years in 1971 to 21/100,000 person-years in 1997. In 1997 the death rate from falls in men was greater than that of any other category of injury. In 1971, traffic caused fewer deaths in women (rate 17/100,000 person-years) than men, and declined from there to a rate of 6/100,000 person-years in 1997. Concurrently the rate of fall-induced deaths in women also decreased, from 27/100,000 person-years in 1971 to 17/100,000 person-years in 1997. Falling, however, was the leading cause of injury-related death in 1997. Thus, in the period 1971-1997, falls replaced road traffic accidents as the leading cause of unintentional injury death in Finland.

Background: This study examined the recent nationwide trends for the absolute number and the age- and sex-specific incidence rates of the fatal and serious non-fatal injuries among 0-14 year old children in Finland in 1971-1995., Methods: We selected from Official Cause-of-Death Statistics and National Hospital Discharge Register children aged 0-14 years who died or required treatment at a hospital department because of an injury in 1971-1995. The number of Finnish children was 1.1 million in 1971, and 1.0 million in 1995., Results: During the entire study period injuries were the leading cause of death in children aged 1-14 years, but not in infants. However, in these years the incidence (per 100 000 people) of fatal injuries in Finnish children decreased considerably in all age groups and both sexes, in girls from 20.1 in 1971 to 4.6 in 1995, and in boys from 36.7 in 1971 to 9.3 in 1995. In 1995, 41% of all the injurious deaths among 0-14 year old Finnish children were motor vehicle accidents, 12% were drownings, and 24% intentional injuries. The overall number and incidence of serious non-fatal injuries among Finnish children showed no clear trend change in 1971-1995. The mean hospitalization time of injured children shortened between 1971 and 1995, from 7.4 days to 2.7 days., Conclusions: We conclude that the number and incidence of fatal childhood injuries have decreased dramatically in Finland between 1971 and 1995. The reasons for this positive development are multifactorial, but improved traffic safety and trauma care are probably very important. In children's serious non-fatal injuries the development has not been so encouraging and therefore children's injury prevention should receive continuous intense attention.

Background and Aims: The aim of this retrospective study was to compare the relative costs of treating simple and spiral wedge (requiring closed reduction under anaesthesia) tibial shaft fractures in a plaster cast or with intramedullary locking nail., Material and Methods: The material consisted of 26 fractures treated in a plaster cast and 51 fractures treated with an intramedullary locking nail. The costs caused by the direct costs (treatment, hospitalisation, and outpatient appointments) as well as indirect costs (lost productivity) were taken into account. Costs caused by complications were also included in the analysis., Results: Mean direct costs per patient were FIM 22920 and FIM 26952 and mean overall costs per patient were FIM 120486 and FIM 82224 in plaster cast and intramedullary locking nailing groups, respectively (FIM 1 = USD 0.19). The higher mean overall costs of the plaster cast group were attributable to the longer sick leave periods in this group (218 days in plaster cast group and 124 in intramedullary nailing group)., Conclusion: Plaster cast treatment of simple and spiral wedge tibial shaft fractures requiring closed reduction under anaesthesia is more expensive to society than operative treatment with intramedullary locking nail.

The purpose of our epidemiologic study was to determine the current trend in the number and incidence of osteoporotic pelvic fractures in Finland, a country with a Caucasian population of 5 million. Thus, all Finns 60 years of age or older who were admitted to hospitals in 1970-1997 for primary treatment of a first osteoporotic pelvic fracture were selected from The National Hospital Discharge Register. In each year of the study, the number and the age-specific and age-adjusted incidences of fractures were expressed as the number of. patients per 100,000 individuals. The total number of osteoporotic pelvic fractures increased considerably in Finland during the study period, from 128 in 1970 to 913 in 1997, an average increase of 23% a year. The corresponding fracture incidence (per 100,000 persons 60 years of age or older) was 20 in 1970 and 92 in 1997. The mean age of the patients also increased, from 74 years (1970) to 80 years (1997). Despite this, the age-adjusted incidence of osteoporotic pelvic fractures also showed a steady increase from 1970 to 1997: in women, from 31 to 103, and in men, from 13 to 38 (relative increases were 232% and 192%, respectively). If this trend continues, the current number of osteoporotic pelvic fractures in this country (about 900 fractures per year) may treble by the year 2030 (about 2,700 fractures per year). We conclude that the number of osteoporotic pelvic fractures in elderly Finns is increasing at a rate that cannot be explained simply by demographic changes and therefore effective preventive measures should be urgently initiated to control the increasing burden of these age-related fractures.

Context: Although various fall-induced injuries and deaths among older adults are increasing, little is known about the epidemiology of these events., Objective: To determine the trends in the number and incidence of fall-induced injuries and deaths of older adults in a well-defined white population., Design and Setting: Secular trend analysis of the population of Finland, using the Finnish National Hospital Discharge Register and the Official Cause-of-Death Statistics of Finland., Participants: All persons aged 50 years or older who were admitted to hospitals in Finland for primary treatment of a first fall-induced injury from the years of 1970 to 1995, and for comparison, all fall-induced deaths in the same age group from the years 1971 to 1995., Main Outcome Measure: The number and the age-specific and age-adjusted incidence rate (per 100000 persons) of fall-induced injuries and deaths in each year of the study., Results: For the study period, both the total and population-adjusted number (per 100000 persons) of Finns aged 50 years or older with fall-induced injury increased substantially. Total fall-induced injuries increased from 5622 in 1970 to 21 574 in 1995, a 284% increase, and the rate increased from 494 to 1398 per 100000 persons, a 183% increase. The age-adjusted incidence also increased in both women (from 648 in 1970 to 1469 in 1995, a 127% increase) and men (from 434 in 1970 to 972 in 1995, a 124% increase). Moreover, the number of deaths due to falls in the overall population increased from 441 in 1971 to 793 in 1995, an 80% increase, and the rate increased from 38 in 1971 to 51 in 1995, a 34% increase. However, after age adjustment the incidence of fall-induced death did not show a clear upward trend., Conclusions: In a well-defined white population, the number of older persons with fall-induced injuries is increasing at a rate that cannot be explained simply by demographic changes. Preventive measures should be adopted to control the increasing burden of these injuries. Fortunately, the age-adjusted incidence of the fall-induced deaths shows no increasing trend over time.

Background: Hip fractures in elderly people are common worldwide, and the predicted ageing of populations is increasing the burden of these fractures on health-care systems. However, prediction of the true increases in number of patients needing treatment requires exact knowledge of whether the number of hip fractures is rising more rapidly than can be accounted for by demographic changes alone. We aimed to make such a prediction for people aged 50 years or more in Finland., Methods: All patients aged 50 years or more, who were admitted to hospitals in Finland during 1970-97 for primary treatment of first hip fracture were selected from the National Hospital Discharge Register. The age-specific and age-adjusted fracture incidences were expressed as the number of patients per 100,000 individuals per year, and prediction of the number, and incidence of hip fractures in Finland (population 5 million) until the year 2030 was calculated with a regression model., Findings: The number of hip fractures in Finnish people aged 50 or more rose during the study period, from 1857 in 1970 to 7122 in 1997. The corresponding fracture incidence (per 100,000 people) increased from 163 to 438. The age-adjusted incidence of hip fractures also showed a steady increase from 1970 to 1997: in women, from 292 to 467, and in men, from 112 to 233. If this trend continues, the number of hip fractures in Finland will be almost three-fold higher in the year 2030 than in 1997., Interpretation: The number of hip fractures in elderly Finnish men and women is increasing at a rate that cannot be explained merely by demographic changes. The precise reasons for this are not known, but deterioration in age-adjusted bone-mineral density and strength, with accompanying increase in the age-adjusted incidence of injurious falls of the elderly, could partly account for the development.

To increase knowledge about recent trends in the number and incidence of various fall-induced injuries among older adults, the authors selected from the National Hospital Discharge Register all patients 60 years of age or older who were admitted to hospitals in Finland for primary treatment of a first fall-induced severe head injury during 1970-1995. Similar patients aged 30-39 years served as a reference group. For the study period, the number and incidence (per 100,000 persons) of fall-induced severe head injuries in Finnish persons 60 years of age or older increased considerably (554 and 85, respectively, in 1970 compared with 1,393 and 144, respectively, in 1995). The age-adjusted incidence of these injuries also increased in women, from 80 in 1970 to 125 in 1995, and in men, from 102 in 1970 to 147 in 1995. In the reference group (patients aged 30-39 years), the absolute numbers and incidences of similar injuries did not show consistent trend changes over time. We conclude that the number of fall-induced severe head injuries in elderly Finnish women and men is increasing at a rate that cannot be explained simply by demographic changes, and therefore vigorous preventive measures should be instituted at once to control the increasing burden of these devastating injuries.

To improve knowledge of the current trends in the number and incidence of age-related minor trauma knee fractures, we selected from the National Hospital Discharge Register all patients 60 years old or older who were admitted to Finnish hospitals in 1970-1972, 1974-1975, 1978-1980, 1983-1985, 1988-1989 and 1991-1994 for primary treatment of first knee fracture. The knee fracture was defined to be a "minor trauma" fracture if it had occurred as a result of a fall from standing height or less. We also predicted fracture development until the year 2020 by a regression model, which took into account the predicted changes in fracture incidences and population at risk. The number and incidence (per 100,000 persons) of minor trauma knee fractures in Finnish women aged 60 years or more clearly increased during the study period, from 219 (number) and 55 (incidence) in 1970 to 579 and 100 in 1994. Women's age-adjusted incidence of these fractures also showed an increase, from 58/100,000 in 1970 to 93/100,000 in 1994. If this trend continues, there will be about 2 times more minor trauma knee fractures in Finnish women in the year 2020 than there were in 1994. In Finnish men aged 60 years or more the absolute numbers and incidences of these fractures did not show consistent trend changes over time. We conclude that the number of minor trauma knee fractures in elderly Finnish women in increasing more rapidly than can be accounted for by the demographic changes alone and therefore effective preventive measures should urgently be adopted to control the increasing burden of these age-related fractures.

To improve the knowledge of the current trends in the number and incidence of osteoporosis-related pelvic fractures, patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first osteoporotic pelvic fracture were selected from the National Hospital Discharge Register. The overall incidence (per 100,000 inhabitants) of osteoporosis-related pelvic fractures (high energy traumas were excluded) in a population aged 60 years or more was 20 in 1970 and 63 in 1991. The increase was most pronounced in the older age groups (patients aged 80 years or more) and was observed in both sexes. The proportion of these osteoporotic pelvic fractures of all pelvic fractures increased from 18% in 1970 to 52% in 1991. Similarly, the proportion of patients over 60 years of age increased from 28% in 1970 to 62% in 1991. In 1991, 78% of the patients with an osteoporotic pelvic fracture were women. Across the study period, the age-adjusted total incidence of osteoporotic pelvic fractures also increased in both women and men 60 years of age and over. The proportional increase was more pronounced in men. We conclude that the number of osteoporotic pelvic fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and that effective preventive measures are urgently needed to control the increasing number of these age-related fractures.

Achilles paratenonitis and medial tibial syndrome are the most common specific overuse injuries among athletes in Finland, and they are a problem especially in endurance sports, such as long-distance running and jogging. Conservative treatment is often successful, but if it fails operative treatment is necessary. The surgical methods developed in Finland, which are widely used in the treatment of Achilles paratenonitis and medial tibial syndrome, are presented with clinical follow-up results in this paper. The patients operated on for Achilles paratenonitis were some years older than the patients operated on for retrocalcaneal bursitis (mean 38.4 versus 32.3 years). Results after operation were excellent or good in 92.4% of 291 patients operated on for Achilles paratenonitis, 84.2% of the 63 operated on for retrocalcaneal bursitis and 79% of the 47 operated on for medial tibial syndrome. All the patients treated operatively were patients in whom conservative treatment had failed. In conclusion, operative treatment of Achilles paratenonitis or medial tibial syndrome in athletes is indicated when these complaints do not respond to any type of conservative treatment.

All visits to physicians in the Orivesi Region Federation of Municipalities for Public Health Work in Finland paid due to symptomatic osteoarthrosis of the knee joint were prospectively recorded over a period of one year. Two hundred and thirty four visits were made, accounting for 0.63% of all visits. The prevalence of knee osteoarthrosis was 1.11% (men 0.45%, women 1.72%), and the incidence was 0.60%. The disease occurred almost twice as often in the right knee than in the left. The study provides basic information about patients needing medical help because of symptomatic knee osteoarthrosis. The results can be used as an aid to the planning of examination and treatment resources and in assessment of the need for such services.

A 30-month prospective follow-up study of children's overuse injuries at an outpatient sports clinic was carried out to determine the number, profile, and specific features of these injuries compared with those of young adults. During this period 74 athletically active boys (less than or equal to 15 years), 83 girls, 255 men (21-30 years), and 77 women visited the station because of an overuse sports injury of the musculoskeletal system. About one-third of the patients of each group did not seek medical help until more than 6 months after the onset of the symptoms. The injuries most commonly affected the lower extremities, with the knee joint involved in about one third of patients. In girls and women, the lower back (13%) was significantly more frequently affected than in boys and men (6%) (p less than 0.01). Thirty two percent of all boys' overuse problems were classified as exercise-induced growth disorders and osteochondritic pains (apophysitides, etc.), but in girls only 13% had a similar basis. The most common diagnosis among boys was Osgood-Schlatter's disease (13 patients, 18%); in girls it was nonspecific synovitis of the knee (9, 16%).

All visits to physicians paid due to knee injuries in the Orivesi Region Federation of Municipalities for Public Health Work in Finland were prospectively recorded over a period of one year. The visits totalled 360, which accounted for 1.0% of all visits. The number of patients was 148, and the total incidence rate of knee injuries was 1.1% corresponding to that during one year period every hundredth inhabitant sought medical treatment from a physician because of a knee injury. Forty-eight per cent of the knee injuries were sustained in sports activities. The injuries affected mostly knee ligaments and/or menisci. Every tenth visit led to a surgical consultation for assessment of the need for surgery, equalling three patients per 1000 inhabitants annually. The study provides basic information concerning the occurrence of knee injuries and the need for further care. The results can be used as an aid in the planning of arthroscopy as well as other examination and treatment resources of knee injuries as well as in the assessment of need for such services.