The aim of this study was to characterize the type and severeity of acute injuries occurring in Finnish orienteerers in 1987 to 1991. The study is based on the orienteering license insurance records accounting for 2189 orienteering injuries during 69268 person-years of exposure in active orienteerers. Of these orienteerers, 73.0% were male; 73.5% (N = 1608) of all injuries occurred in males, so the injury rate was similar in males and females. The rate was highest in orienteerers 20 to 24 years of age and lowest in children. Injuries occurred most commonly during May to September (78.9% or all injuries), the months which include the orienteering competition season, and were more common during competitions (59.8%) than during training. A high number of the injuries occurred during weekends (58.9% of injuries) including 68.1% of all competition injuries and 44.9% of all training injuries. The lower limbs were involved in 1611 (73.6%) of cases, the ankle (28.7%) and the knee (23.2%) being the two most common injury locations. Sprains, strains and contusions were the most common injuries. Wounds were proportionally more common in males than in females while ankle sprains were more common in females. Fractures, seven open and 94 closed, accounted for 4.6% of injuries; they were most common in the hand/wrist/forearm (N = 44) and ankle (N = 16), and were more frequent during competition (62.3%) than during training. The most important areas for preventive measures seem to be the ankle and the knee.
To determine the acute injury profile in each of six sports and compare the injury rates between the sports.
Analysis of national sports injury insurance registry data.
Finland during 1987-91.
621,691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate.
Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors.
54,186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability.
Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.
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To determine whether, from a healthcare perspective, a specific occupational health intervention is cost effective in reducing sickness absence when compared with usual care in occupational health in workers with high risk of sickness absence.
Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n = 209) or to usual care (n = 209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for 384 subjects and questionnaire data on healthcare costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct healthcare costs up to 12 months after randomisation. Cost effectiveness (CE) was expressed as an incremental CE ratio, CE plane and CE acceptability curve with both available direct total cost data and missing total cost data imputed.
After one year, the mean of sickness absence was 30 days in the usual care group (n = 192) and 11 days less (95% CI 1 to 20 days) in the intervention group (n = 192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost euro974 and euro1049 in the intervention group (n = 134) and in the usual care group (n = 138), respectively. The intervention turned out to be dominant-both cost saving and more effective than usual occupational health care. The saving was euro43 per sickness absence day avoided with available direct total cost data, and euro17 with missing total cost data imputed.
One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is a cost effective use of healthcare resources.
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The relationship between different sport activities and lumbar intervertebral disk degeneration (DD) is largely unknown. We evaluated whether adolescent participation in different sports is associated with lumbar DD in a population-based birth cohort of young adults. A total of 558 young adults (325 females and 233 males) underwent magnetic resonance imaging (MRI, 1.5-T scanner). A DD sum score, based on the Pfirrmann grading, was calculated for all lumbar levels. The sum score was categorized into no DD, 1, 2, or at least 3. Participation in different sport activities was self-reported by postal surveys at 16, 18, and 19 years, and three groups were formed based on participation frequency in 11 sports: (a) highly active (at least twice a week), (b) moderately active (2-4 times a month), and (c) inactive (maximum once a month). Cumulative odds ratios (COR) and their 95% confidence intervals (CI) were obtained for each sport by ordinal logistic regression, adjusting for gender, body mass index, age, socioeconomic status, smoking, and other sports. Highly active participation in jogging/running and swimming was associated with a higher DD sum score (COR: 3.0; 95% CI: 1.4-6.3 and 5.0; 1.7-15.2, respectively) compared to inactive participation, whereas highly active participation in skating showed low COR. In conclusion, running and swimming at least twice a week in early adulthood are potentially associated with lumbar DD. Follow-up studies with MRI are needed to show whether frequent exposure to running or swimming has further effect on the integrity of lumbar intervertebral disks.
Risk factors such as high serum cholesterol concentration measured in young adulthood predict premature coronary heart disease (CHD) in the middle-aged. The objective of this study was to analyze the associations between physical activity and CHD risk factors--body composition, blood pressure, serum lipids, apolipoproteins, and insulin--in children and young adults. The design was a cross-sectional study of atherosclerosis precursors in children and young adults using a cohort of children and young adults (N = 2,358) aged 9 to 24 years to determine indices of physical activity, measurements of anthropometric characteristics, blood pressure, serum lipids, apolipoproteins A-I and B, and insulin. The results show that a high level of physical activity was associated with high serum high density lipoprotein cholesterol (HDL-C) and HDL2-C concentrations, and low levels of serum triglycerides (TG), apolipoprotein B and insulin in males. However, in females, the influence of physical activity was evident only on TG level. In both genders, physical activity was inversely associated with obesity. In all these associations, a significant dose-related relationship was observed. We found no association between physical activity and blood pressure. In conclusion, physical activity is associated with a favorable serum lipid profile already during childhood and early adulthood in a dose-related manner, particularly in males. The promotion of physical activity is important in childhood in preventing obesity and premature cardiovascular disease.
Low educational level is associated with an increased risk of coronary heart disease. The aim of the present study was to examine the relationships between education and common cardiovascular risk factors in young adults.
Trends in conventional risk factors of young adults aged 21, 24, 27 and 30 years in 1992 (n = 443) were examined across the educational groups as part of a 12-year follow-up study, the Cardiovascular Risk in Young Finns Study. Education was determined as participants' own educational level and as parental years of schooling.
In males, subject's own education was related inversely and independently of parental school years to serum total and low density lipoprotein (LDL) cholesterol concentration, smoking and body mass index. In females, participant's own educational level associated inversely with smoking and physical inactivity. Parental school years was associated inversely and independently of one's own educational level with serum total and LDL cholesterol values and waist-hip ratio in females. In both genders, parental education was a stronger determinant of diet (butter use) than one's own educational level.
The least educated young adults have adopted a more adverse lifestyle than the more educated. The risk factor profile in young adulthood, especially in females, is still affected by parental education. The influences of one's own and parental educational level on vascular risk profile should be taken into consideration when planning public health campaigns among young adults.
To evaluate the effectiveness of two occupational health intervention programmes, both compared with usual care.
Based on a health survey, 1341 employees (88% males) in construction, service and maintenance work were classified into three groups: "low risk" (n = 386), "intermediate risk" (n = 537) and "high risk" (n = 418) of sickness absence. Two separate randomised trials were performed in the groups "high risk" and "intermediate risk", respectively. Those high risk subjects that were allocated to the intervention group (n = 209) were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Among the intermediate risk employees those in the intervention group (n = 268) were invited to call a phone advice centre. In both trials the control group received usual occupational health care. The primary outcome was sickness absence during a 12-month follow-up (register data).
The high risk group, representing 31% of the cohort, accounted for 62% of sickness absence days. In the trial for the high risk group the mean sickness absence was 30 days in the usual care group and 19 days in the intervention group; the mean difference was 11 days (95% CI 1 to 20 days). In the trial for the intermediate risk group the mean sickness absence was 7 days in both arms (95% CI of the mean difference -2.3 to 2.4 days).
The identification of high risk of work disability was successful. The occupational health intervention was effective in controlling work loss to a degree that is likely to be economically advantageous within the high risk group. The phone advice intervention for the intermediate risk group was not effective in controlling work loss primarily due to poor adherence.
In adults, the high-density lipoprotein cholesterol (HDL-C) level is higher among physically active subjects. However, the association of physical activity and HDL-C is less well studied in adolescents and young adults. Furthermore, it is not known whether the effect of physical activity on HDL-C levels is independent, or whether it is mediated by other physiological changes seen in exercise, such as weight loss or increased insulin sensitivity. In order to study the effects of leisure-time physical activity on the levels of serum HDL-C concentration, we analysed longitudinal data from a follow-up study of adolescents and young adults. The study subjects were participants of a large multicentre study of cardiovascular risk factors, aged 15-21 years at the beginning of the study (n = 714). HDL-C was measured from the serum supernatant after precipitation with dextran sulphate and MgCl2. A physical activity index was calculated on the basis of frequency, intensity, and duration of leisure-time activity assessed by a questionnaire. In males, an increase in the physical activity level predicted an increase in HDL-C concentration, and this association persisted after simultaneously controlling for changes in body mass index (kg/m2), subscapular skinfold thickness, serum insulin and triglyceride concentrations, and smoking. For example, an increase in the physical activity level corresponding to approximately 1 hour of intensive exercise weekly lead to an increase of 42 mumol/L in HDL-C as calculated from the regression equation. In conclusion, physical activity seems to have a direct effect on HDL-C levels among young male subjects within the usual range of physical activity levels.
The effect of physical activity on serum total and low-density lipoprotein cholesterol concentrations varies with apolipoprotein E phenotype in male children and young adults: The Cardiovascular Risk in Young Finns Study.
Apolipoprotein E (apo E) determines serum total (TC) and low-density lipoprotein (LDL-C) cholesterol concentrations and is thus associated with coronary heart disease (CHD) risk. We studied if the effect of physical activity (PA) on serum TC and LDL-C concentrations varies with apo E phenotype in a population-based sample of children and young adults with regular PA. The study cohort consisted of subjects aged 9, 12, 15, 18, 21, and 24 years in 1986 (N = 1,498) participating in a large multicenter study of cardiovascular risk factors in children and young adults. Serum lipid concentrations were determined enzymatically, and apo E phenotypes by isoelectric focusing and immunoblotting. The composition of the diet was determined by a 48-hour recall method, and a PA index was calculated on the basis of frequency, intensity, and duration of activity assessed by a questionnaire. LDL-C (P = .0082), TC (P = .014), and the high-density lipoprotein cholesterol (HDL-C)/TC ratio (P = .0004) responses to exercise varied with apo E phenotype. The effect of PA on LDL-C, TC, or HDL/TC was not found in apo E phenotype E4/4. A moderate inverse effect of PA on TC and LDL-C and a positive effect on HDL/TC was found in subjects with E4/3 and E3/3 phenotypes. Similar but stronger associations were found between these variables within the group of E3/2 males. The effect of PA on serum lipid levels was strongest within the phenotype E3/2. These associations were not explained by dietary habits. Apo E phenotype partly determines the effect of PA on serum TC and LDL-C in Finnish male children and young adults with regular PA.