Browsing by Subject "INJURIES"

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  • Parekh, Utsav; Chariot, Patrick; Dang, Catherine; Stray-Pedersen, Arne; Druid, Henrik; Sajantila, Antti (2020)
    The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal duties, especially when those duties involve humans. The potential for contracting the virus from working in close contact with living sufferers is high, and we have yet to fully determine the risk of infection from the deceased. In an attempt to support the community, the Journal of Forensic & Legal Medicine has drawn together three articles which underline the importance of continued forensic medical practice during the pandemic and highlight some factors to consider in a Roadmap towards safe practice. Our Roadmap has intentionally taken an international perspective and supports other work we have published in the Journal on our collective response to the COVID-19 crisis.
  • Jokela, Aleksi; Stenroos, Antti; Kosola, Jussi; Valle, Xavier; Lempainen, Lasse (2022)
    Hamstring injuries are among the most common muscle injuries. They have been reported in many different sports, such as running, soccer, track and field, rugby, and waterskiing. However, they are also present among the general population. Most hamstring injuries are mild strains, but also moderate and severe injuries occur. Hamstring injuries usually occur in rapid movements involving eccentric demands of the posterior thigh. Sprinting has been found to mainly affect the isolated proximal biceps femoris, whereas stretching-type injuries most often involve an isolated proximal injury of the semimembranosus muscle. The main cause of severe 2- or 3-tendon avulsion is a rapid forceful hip flexion with the ipsilateral knee extended. Most hamstring injuries are treated non-surgically with good results. However, there are also clear indications for surgical treatment, such as severe 2- or 3-tendon avulsions. In athletes, more aggressive recommendations concerning surgical treatment can be found. For a professional athlete, a proximal isolated tendon avulsion with clear retraction should be treated operatively regardless of the injured tendon. Surgical treatment has been found to have good results in severe injuries, especially if the avulsion injury is repaired in acute phase. In chronic hamstring injuries and recurring ruptures, the anatomical apposition of the retracted muscles is more difficult to be achieved. This review article analyses the outcomes of surgical treatment of hamstring ruptures. The present study confirms the previous knowledge that surgical treatment of hamstring tendon injuries causes good results with high satisfaction rates, both in complete and partial avulsions. Early surgical repair leads to better functional results with lower complication rates, especially in complete avulsions. KEY MESSAGEs Surgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates. Both complete and partial hamstring tendon ruptures have better results after acute surgical repair, when compared to cases treated surgically later. Athletes with hamstring tendon ruptures should be treated more aggressively with operative methods.
  • GBD 2015 Eastern Mediterranean Reg; Mokdad, Ali H.; Weiderpass, Elisabete; Rahman, Shiri (2018)
    The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.
  • Palmu, Raimo; Partonen, Timo; Suominen, Kirsi; Vuola, Jyrki; Isometsä, Erkki (2018)
    Objective: We investigated alcohol use and smoking at time of burn and their relationships with severity of burn and presence of mental disorders. Methods: Consecutive acute burn patients (N = 107) admitted to the Helsinki Burn Center were assessed with the structured clinical interview for mental disorders (SCID) at baseline and after 6 months. Information regarding being under the influence of alcohol and having smoking-related activity at burn as well as about hazardous drinking (Alcohol Use Disorders Identification Test) and heavy smoking before the burn was recorded. Results: Around half (52%) of the acute burn patients were under the influence of alcohol and 19% had been both drinking and smoking at the time of the burn. Patients under the influence at the time of burn had significantly higher prevalence of lifetime mental disorders compared to those patients who were not under the influence of alcohol (73.2% vs. 45.1%, p = 0.003), especially alcohol dependence (55.4% vs. 13.7%, p <0.001) and anxiety disorders (28.6% vs. 9.8%, p = 0.015). Patients who had both alcohol use and smoking at burn had even more often at least one mental disorder (95.0% vs. 51.7%, p <0.001), in specific alcohol dependence (90.0% vs. 23.0%, p <0.001), or psychotic disorder (25.0% vs. 6.9%, p = 0.016). The main characteristics of the burns themselves did not differ significantly between these groups. Conclusion: Half of the burn patients were under the influence of alcohol at the time of the burn in this study. In almost all patients where alcohol and smoking contributed to the burn a diagnosable alcohol use disorder was present. Interventions for those with alcohol use disorders and the associated risk behaviors are important for the prevention of burns. (C) 2017 Published by Elsevier Ltd.
  • Ponkilainen, Ville T.; Tukiainen, Erkki J.; Uimonen, Mikko M.; Häkkinen, Arja H.; Repo, Jussi P. (2020)
    Background: The structural validity of the Lower extremity functional scale (LEFS), the Visual analogue scale foot and ankle (VAS-FA), and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) has not been compared earlier in patients after foot and ankle surgery. Methods: Altogether 165 previously operated patients completed the foot and ankle specific instruments, the 15D health-related quality of life (HRQoL) instrument, and general health (VAS). Results: The LEFS, the VAS-FA and the WOMAC had slight differences in their measurement properties. The VAS-FA had the best targeting and coverage. All three foot and ankle measures accounted for mobility and usual activities when compared to the different aspects of generic HRQoL. Conclusions: The LEFS, the VAS-FA and the WOMAC have relatively similar psychometric properties among foot and ankle patients, yet the VAS-FA provides the best targeting and coverage. (C) 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
  • Sormaala, Markus J.; Ruohola, Juha-Petri; Mattila, Ville M.; Koskinen, Seppo Kalervo; Pihlajamaki, Harri K. (2011)
  • Girka, Anastasiia; Kulmala, Juha-Pekka; Äyrämö, Sami (2020)
    Protruding impact peak is one of the features of vertical ground reaction force (GRF) that is related to injury risk while running. The present research is dedicated to predicting GRF impact peak appearance by setting a binary classification problem. Kinematic data, namely a number of raw signals in the sagittal plane, collected by the Vicon motion capture system (Oxford Metrics Group, UK) were employed as predictors. Therefore, the input data for the predictive model are presented as a multi-channel time series. Deep learning techniques, namely five convolutional neural network (CNN) models were applied to the binary classification analysis, based on a Multi-Layer Perceptron (MLP) classifier, support vector machine (SVM), logistic regression,k-nearest neighbors (kNN), and random forest algorithms. SVM, logistic regression, and random forest classifiers demonstrated performances that do not statistically significantly differ. The best classification accuracy achieved is 81.09% +/- 2.58%. Due to good performance of the models, this study serves as groundwork for further application of deep learning approaches to predicting kinetic information based on this kind of input data.
  • Marinescu-Gava, Magdalena; Suomalainen, Anni; Vehmas, Tapio; Ventä, Irja (2019)
    ObjectivesTo examine the role of cone beam computed tomography (CBCT) in preventing failures in implant treatment. We hypothesize that the number of malpractice claims related to dental implant treatment would decrease after the first CBCT device came available in 2002 in Finland.Material and methodsData concerning malpractice claims related to dental implant treatment during the years 1997-2011 were collected from the Finnish Patient Insurance Centre (N=330 subjects). We selected the cases that might have benefitted from the use of CBCT examination. These cases (n=131) led to financial compensation due to permanent inferior alveolar nerve injury, improper implant position, or insufficient amount of bone for the implant. The annual total number of inserted dental implants, CBCT devices, and CBCT examinations in Finland were drawn from the national registers and used to estimate the impact of CBCT in preventing treatment failures.ResultsThe most common reason for all failures (n=268 implants) was an improper implant position (46.3%). The most common area of malpractices was upper front teeth (34%). We have noticed a fall in the rate of compensable malpractice cases concerning implant failure, simultaneously with CBCT technology emerging on the market.ConclusionsThere may be an association between the increasing availability of CBCT equipment and the reducing frequency of compensable malpractice claims.Clinical relevanceIt is possible that the use of CBCT may result in fewer compensable malpractice claims.
  • Högberg, Ulf; Fellman, Vineta; Thiblin, Ingemar; Karlsson, Ruth; Wester, Knut (2020)
    Aim Specific birth-related fractures have been studied; underestimates might be a problem. We aimed to assess all fractures diagnosed as birth-related as well as other neonatal fractures. Methods A population-based study on all infants born in Sweden 1997-2014; data were retrieved from the Swedish Health Registers (10th version of International Classification of Diseases. Outcome measures were birth-related fractures (ICD-10 P-codes) and other neonatal fractures (ICD-10 S-codes). Results The overall fracture incidence was 2.9 per 1000 live birth (N = 5336); 92.6% had P-codes and 7.4% (S-codes). Some birth-related fractures were diagnosed beyond the neonatal period. Other neonatal fractures could have been birth-related. Clavicle fracture (88.8%) was associated with adverse maternal and infant anthropometrics and birth complications. The few neonates with rib fractures all had concomitant clavicle fracture. For skull fractures, a minor part was birth-related and most were associated with accidents. Half of the long bone fractures were associated with accidents. Birth-related femur fractures were associated with bone fragility risk factors. Five infants with abuse diagnoses had fractures: skull (4), long bone (2) and rib (1). Conclusion Birth-related and other neonatal fractures are rarely diagnosed. Difficult birth is the main contributor to birth-related fracture and accidents to other neonatal fractures.
  • Kosola, Silja; Salminen, Päivi; Kallio, Pentti (2016)
    Background and aims: In our previous study, the annual number of adolescents treated at Helsinki Children's Hospital and Toolo Trauma Centre for injuries from moped and scooter accidents increased five-fold between 2002 and 2007. In June 2011, the requirements for a moped/scooter license changed to include driver's education and a vehicle handling evaluation. The aim of this retrospective study was to assess the influence of legislative changes on moped and scooter related serious injuries in adolescents. Patients and methods: Data from 520 patients (age 15-16) treated for trauma from moped and scooter accidents at our institutions between January 2008 and December 2013 were included. Case numbers were compared with population data from national databases. Overall incidence, trauma mechanism, injury profile, and proportion of patients requiring hospital admission were calculated for time periods before and after the law amendment. Results: After the law change in 2011, the annual incidence of moped/scooter injuries among 15-year-olds in our area decreased from 0.8% in 2011 to 0.3% in 2013 (p <0.001), and estimated incidence of injuries per new moped/scooter license declined from 1.8% in 2011 to 1.0% in 2013 (p = 0.001). Simultaneously, proportions of patients injured in collisions, diagnosed with multiple trauma or requiring in-patient care reduced. Conclusions: A change in moped/scooter license requirements may have a causal relationship with both reduced number and severity of moped/scooter related injuries in adolescents. (C) 2015 Elsevier Ltd. All rights reserved.
  • Haagsma, Juanita A.; Olij, Branko F.; Majdan, Marek; van Beeck, Ed F.; Vos, Theo; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L. S.; Sylte, Dillon O.; Aremu, Olatunde; Baernighausen, Till Winfried; Borzi, Antonio M.; Briggs, Andrew M.; Carrero, Juan J.; Cooper, Cyrus; El-Khatib, Ziad; Ellingsen, Christian Lycke; Fereshtehnejad, Seyed-Mohammad; Filip, Irina; Fischer, Florian; Haro, Josep Maria; Jonas, Jost B.; Kiadaliri, Aliasghar A.; Koyanagi, Ai; Lunevicius, Raimundas; Meretoja, Tuomo J.; Mohammed, Shafiu; Pathak, Ashish; Radfar, Amir; Rawaf, Salman; Rawaf, David Laith; Riera, Lidia Sanchez; Shiue, Ivy; Vasankari, Tommi Juhani; James, Spencer L.; Polinder, Suzanne (2020)
    Introduction Falls in older aged adults are an important public health problem. Insight into differences in fall-related injury rates between countries can serve as important input for identifying and evaluating prevention strategies. The objectives of this study were to compare Global Burden of Disease (GBD) 2017 estimates on incidence, mortality and disability-adjusted life years (DALYs) due to fall-related injury in older adults across 22 countries in the Western European region and to examine changes over a 28-year period. Methods We performed a secondary database descriptive study using the GBD 2017 results on age-standardised fall-related injury in older adults aged 70 years and older in 22 countries from 1990 to 2017. Results In 2017, in the Western European region, 13 840 per 100 000 (uncertainty interval (UI) 11 837-16 113) older adults sought medical treatment for fall-related injury, ranging from 7594 per 100 000 (UI 6326-9032) in Greece to 19 796 per 100 000 (UI 15 536-24 233) in Norway. Since 1990, fall-related injury DALY rates showed little change for the whole region, but patterns varied widely between countries. Some countries (eg, Belgium and Netherlands) have lost their favourable positions due to an increasing fall-related injury burden of disease since 1990. Conclusions From 1990 to 2017, there was considerable variation in fall-related injury incidence, mortality, DALY rates and its composites in the 22 countries in the Western European region. It may be useful to assess which fall prevention measures have been taken in countries that showed continuous low or decreasing incidence, death and DALY rates despite ageing of the population.
  • RODEO Collab Grp; Sanders, Fay R. K.; Birnie, Merel F.; Dingemans, Siem A.; van den Bekerom, Michel P. J.; Parkkinen, Markus; van Veen, Ruben N.; Goslings, J. Carel; Schepers, Tim (2021)
    Aims The aim of this study was to investigate whether on-demand removal (ODR) is noninferior to routine removal (RR) of syndesmotic screws regarding functional outcome. Methods Adult patients (aged above 17 years) with traumatic syndesmotic injury, surgically treated within 14 days of trauma using one or two syndesmotic screws, were eligible (n = 490) for inclusion in this randomized controlled noninferiority trial. A total of 197 patients were randomized for either ODR (retaining the syndesmotic screw unless there were complaints warranting removal) or RR (screw removed at eight to 12 weeks after syndesmotic fixa- tion), of whom 152 completed the study. The primary outcome was functional outcome at 12 months after screw placement, measured by the Olerud-Molander Ankle Score (OMAS). Results There were 152 patients included in final analysis (RR = 73; ODR = 79). Of these, 59.2% were male (n = 90), and the mean age was 46.9 years (SD 14.6). Median OMAS at 12 months after syndesmotic fixation was 85 (interquartile range (IQR) 60 to 95) for RR and 80 (IQR 65 to 100) for ODR. The noninferiority test indicated that the observed effect size was significantly within the equivalent bounds of-10 and 10 scale points (p < 0.001) for both the intention to treat and per-protocol, meaning that ODR was not inferior to RR. There were significantly more complications in the RR group (12/73) than in the ODR group (1/79) (p = 0.007). Conclusion ODR of the syndesmotic screw is not inferior to routine removal when it comes to functional outcome. Combined with the high complication rate of screw removal, this offers a strong argument to adopt on demand removal as standard practice of care after syndesmotic screw fixation.
  • Crowe, Christopher Stephen; Massenburg, Benjamin Ballard; Morrison, Shane Douglas; Chang, James; Friedrich, Jeffrey Barton; Abady, Gdiom Gebreheat; Alahdab, Fares; Alipour, Vahid; Arabloo, Jalal; Asaad, Malke; Banach, Maciej; Bijani, Ali; Borzi, Antonio Maria; Briko, Nikolay Ivanovich; Castle, Chris D.; Cho, Daniel Youngwhan; Chung, Michael T.; Daryani, Ahmad; Demoz, Gebre Teklemariam; Dingels, Zachary; Hoa Thi Do; Fischer, Florian; Fox, Jack T.; Fukumoto, Takeshi; Gebre, Abadi Kahsu; Gebremichael, Berhe; Haagsma, Juanita A.; Haj-Mirzaian, Arvin; Handiso, Demelash Woldeyohannes; Hay, Simon; Chi Linh Hoang; Irvani, Seyed Sina Naghibi; Jozwiak, Jacek Jerzy; Kalhor, Rohollah; Kasaeian, Amir; Khader, Yousef Saleh; Khalilov, Rovshan; Khan, Ejaz Ahmad; Khundkar, Roba; Kisa, Sezer; Kisa, Adnan; Liu, Zichen; Majdan, Marek; Manafi, Navid; Manafi, Ali; Manda, Ana-Laura; Meretoja, Tuomo J.; Miller, Ted R.; Mohammadian-Hafshejani, Abdollah; Mohammadpourhodki, Reza; Bandpei, Mohammad A. Mohseni; Mokdad, Ali H.; Naimzada, Mukhammad David; Ndwandwe, Duduzile Edith; Cuong Tat Nguyen; Huong Lan Thi Nguyen; Olagunju, Andrew T.; Olagunju, Tinuke O.; Hai Quang Pham; Pribadi, Dimas Ria Angga; Rabiee, Navid; Ramezanzadeh, Kiana; Ranganathan, Kavitha; Roberts, Nicholas L. S.; Roever, Leonardo; Safari, Saeed; Samy, Abdallah M.; Riera, Lidia Sanchez; Shahabi, Saeed; Smarandache, Catalin-Gabriel; Sylte, Dillon O.; Tesfay, Berhe Etsay; Bach Xuan Tran; Ullah, Irfan; Vahedi, Parviz; Vahedian-Azimi, Amir; Theo Vos; Woldeyes, Dawit Habte; Wondmieneh, Adam Belay; Zhang, Zhi-Jiang; James, Spencer L. (2020)
    Background As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. Results The global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%. Conclusions Certain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.
  • Pihlajamaki, Harri K.; Parviainen, Mickael C.; Kautiainen, Hannu; Kiviranta, Ilkka (2017)
    Background: Musculoskeletal disorders and injuries are common causes of morbidity and loss of active, physically demanding training days in military populations. We evaluated the incidence, diagnosis, and risk factors of knee disorders and injuries in male Finnish military conscripts. Methods: The study population comprised 5 cohorts of 1000 men performing their military service, classified according to birth year (1969, 1974, 1979, 1984, and 1989). Follow-up time for each conscript was the individual conscript's full, completed military service period. Data for each man were collected from a standard pre-information questionnaire used by defense force healthcare officials and from all original medical reports of the garrison healthcare centers. Background variables for risk factor analysis included the conscripts' service data, i.e., service class (A, B), length of military service, age, height, weight, body mass index (BMI), underweight, overweight, obesity, smoking habit, education, diseases, injuries, and subjective symptoms. Results: Of the 4029 conscripts, 853 visited healthcare professionals for knee symptoms during their military service, and 103 of these had suffered a knee injury. Independent risk factors for the incidence of knee symptoms were: older age; service class A; overweight (BMI 25.0-29.9 kg/m(2)); smoking habit; comprehensive school education only; and self-reported previous symptoms of the musculoskeletal, respiratory, and gastrointestinal system. The majority of visits to garrison healthcare services due to knee symptoms occurred during the first few months of military service. Knee symptoms were negatively correlated with self-reported mental and behavioral disorders. Conclusions: The present study highlights the frequency of knee disorders and injuries in young men during physically demanding military training. One-fifth of the male conscripts visited defense force healthcare professionals due to knee symptoms during their service period. Independent risk factors for the incidence of knee symptoms during military service were age at military service; military service class A; overweight; smoking habit; comprehensive school education only; and self-reported previous symptoms of the musculoskeletal system, respiratory system, or gastrointestinal system. These risk factors should be considered when planning and implementing procedures to reduce knee disorders and injuries during compulsory military service.
  • Hanninen, Timo; Parkkari, Jari; Tuominen, Markku; Iverson, Grant L.; Ohman, Juha; Vartiainen, Matti; Luoto, Teemu M. (2017)
    Objectives: To examine test-retest reliability of the. SCAT3 for two consecutive seasons using a large sample of professional male ice hockey players, and to make recommendations for interpreting change on the test. Design: A cross-sectional descriptive study. Methods: Preseason baseline testing was administered in the beginning of the seasons 2013-2014 and 2014-2015 to 179 professional male hockey players in rink side settings. Results: The test-retest reliabilities of the SCAT3 components were uniformly low. However, the majority of athletes remained grossly within their own individual performance range when two pre-season SCAT3 baseline scores were compared to published normative reference values. Being tested by the same person or a different person did not influence the results. It was uncommon for the Symptom score to worsen by >= 3 points, the Symptom Severity score to worsen by >= 5 points, SAC total score to worsen by >= 3 points, M-BESS total error points to increase by >= 3, or the time to complete Tandem Gait to increase by >= 4s; each occurred in less than 10% of the sample. Conclusions: The SCAT3 has low test-retest reliability. Change scores should be interpreted with caution, and more research is needed to determine the clinical usefulness of the SCAT3 for diagnosing concussion and monitoring recovery. Careful examination of the natural distributions of difference scores provides clinicians with useful information on how to interpret change on the test. (C) 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
  • Ervasti, Jenni; Pentti, Jaana; Nyberg, Solja T.; Shipley, Martin J.; Leineweber, Constanze; Sorensen, Jeppe K.; Alfredsson, Lars; Bjorner, Jakob B.; Borritz, Marianne; Burr, Hermann; Knutsson, Anders; Madsen, Ida E. H.; Hanson, Linda L. Magnusson; Oksanen, Tuula; Pejtersen, Jan H.; Rugulies, Reiner; Suominen, Sakari; Theorell, Tores; Westerlund, Hugo; Vahtera, Jussi; Virtanen, Marianna; Batty, G. David; Kivimäki, Mika (2021)
    Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints. Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline assessed long working hours (>55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers. Findings: 2747 (4.6%) participants in the primary cohorts and 3027 (6.8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1.68; 95% confidence interval 1.08-2.61 in primary analysis and 1.52; 0.90-2.58 in replication analysis), infections (1.37; 1.13-1.67 and 1.45; 1.13-1.87), diabetes (1.18; 1.01-1.38 and 1.41; 0.98-2.02), injuries (1.22; 1.00-1.50 and 1.18; 0.98-1.18) and musculoskeletal disorders (1.15; 1.06-1.26 and 1.13; 1.00-1.27). Working long hours was not associated with all-cause mortality. Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality. (C) 2021 The Authors. Published by Elsevier Ltd.
  • Stickley, Andrew; Baburin, Aleksei; Jasilionis, Domantas; Krumins, Juris; Martikainen, Pekka; Kondo, Naoki; Leinsalu, Mall (2021)
    This study examined trends and inequalities in road traffic accident (RTA) mortality in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in relation to large-scale macroeconomic changes in the 2000s. Educational inequalities in RTA mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 among 30-74 year olds were examined using census-linked longitudinal mortality data and by estimating the relative and slope index of inequality. Overall RTA mortality decreased substantially between 2000-2003 and 2012-2015. From 2004-2007 to 2008-2011, the RTA mortality decline accelerated but was larger in the Baltic countries. Among men the RTA mortality decline was mostly driven by a larger fall among the high and middle educated. Among women, the changes in RTA mortality by educational level had no clear pattern. From 2000-2003 to 2012-2015 relative educational inequalities in RTA mortality increased among men, although more in the Baltic countries. Among women the pattern was mixed across countries. Absolute inequalities fell in all countries among both sexes. Educational inequalities in male RTA mortality may be growing because of increasingly less access to safer cars and a more hazardous driving culture among the lower educated.
  • Roitto, Hanna-Maria; Öhman, Hannareeta; Salminen, Karoliina; Kautiainen, Hannu; Laurila, Jouko; Pitkälä, Kaisu H. (2020)
    Objectives: Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association. Design: Longitudinal cohort study. Setting and Participants: In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland. Methods: NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0-3), low NPS burden (NPI 4-12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Results: Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P <.001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls. Conclusions and Implications: The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
  • Pihlajamäki, Harri; Parviainen, Mickael; Kyröläinen, Heikki; Kautiainen, Hannu; Kiviranta, Ilkka (2019)
    BackgroundBone stress fractures are overuse injuries commonly encountered in sports and military medicine. Some fatigue fractures lead to morbidity and loss of active, physically-demanding training days. We evaluated the incidence, anatomical location, risk factors, and preventive measures for fatigue fractures in young Finnish male conscripts.MethodsFive cohorts of 1000 men performing military service, classified according to birth year (1969, 1974, 1979, 1984, 1989), were analysed. Each conscript was followed for his full military service period (180days for conscripts with rank and file duties, 270days for those with special training, 362days for officers and highly trained conscripts). Data, including physical activity level, were collected from a standard pre-information questionnaire and from the garrisons' healthcare centre medical reports. Risk factor analysis included the conscripts' service class (A, B), length of military service, age, height, weight, body mass index, smoking, education, previous diseases, injuries, and subjective symptoms, as well as self-reports of physical activity before entering the service using a standard military questionnaire.ResultsFatigue fractures occurred in 44 (1.1%) of 4029 men, with an incidence of 1.27 (95% confidence interval: 0.92-1.70) per 1000 follow-up months, and mostly (33/44, 75%) occurred at the tibial shaft or metatarsals. Three patients experienced two simultaneous stress fractures in different bones. Most fatigue fractures occurred in the first 3months of military service. Conscripts with fatigue fractures lost a total of 1359 (range 10-77) active military training days due to exemptions from duty. Conscripts reporting regular (>2 times/week) physical activity before entering the military had significantly fewer (p=0.017) fatigue fractures. Regular physical activity before entering the service was the only strong explanatory, protective factor in the model [IRR=0.41 (95% CI: 0.20 to 0.85)]. The other measured parameters did not contribute significantly to the incidence of stress fractures.ConclusionRegular and recurrent high-intensity physical activity before entering military service seems to be an important preventive measure against developing fatigue fractures. Fatigue fractures should be considered in conscripts seeking medical advice for complaints of musculoskeletal pain, and taken into consideration in planning military and other physical training programs.
  • Radun, Igor; Radun, Jenni; Esmaeilikia, Mahsa; Lajunen, Timo (2018)
    Some researchers and many anti-helmet advocates often state that when cyclists wear a helmet they feel safer and take more risks. This hypothesis-risk compensation - if true, would reduce, annul or even reverse the assumed benefits of helmets in reducing head injuries. Consequently, this hypothesis is often used to oppose mandatory helmet laws. In this article, we illustrate how one of the few studies that attempted to experimentally test the hypothesis in relation to bicycle helmets arrives at a false conclusion. As a result it is often cited as evidence of risk compensation. Given the lack of experimental studies in this research area, the impact of a single study in shaping the opinions of the general public and of policy makers can be significant. (C) 2018 Elsevier Ltd. All rights reserved.