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Biomedical subjects

J Parkkari

Publications and source records attributed to J Parkkari.

At least 37 records · Page 2Linked to original sources
PubMed2000

Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium.

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.

Aged↗
PubMed2000

Unintentional injury deaths in an adult Finnish population from 1971-1997.

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.

Adolescent↗
PubMed2000

Childhood deaths and injuries in Finland in 1971-1995.

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.

Accident Prevention↗
PubMed1999

Genetic factors and osteoporotic fractures in elderly people: prospective 25 year follow up of a nationwide cohort of elderly Finnish twins.

OBJECTIVE: To determine whether genetic factors partly explain variation in risk of osteoporotic fracture, the true end point of the osteoporosis problem. DESIGN: Prospective 25 year follow up of a nationwide cohort of elderly Finnish twins. SETTING: The Finnish twin cohort and the national hospital discharge register, covering the entire 5 million population of Finland. SUBJECTS: All same sex twin pairs born before 1946. The cohort contained 2308 monozygotic and 5241 dizygotic twin pairs (15 098 people) at the beginning of follow up. Main: outcome measure The number and concordance of osteoporotic fractures in the twin pairs, 1972-96. RESULTS: 786 cohort members sustained an osteoporotic fracture. In women, the pairwise concordance rate for fracture (that is, the relative number of twin pairs in whom the fracture affected both twins in a pair) was 9.5% (95% confidence interval 5.3% to 15.5%) in monozygotic pairs and 7.9% (5.2% to 11.4%) in dizygotic pairs. In men, the figures were 9.9% (4.4% to 18.5%) and 2.3% (0.6% to 5.7%). CONCLUSIONS: Susceptibility to osteoporotic fractures in elderly Finns is not strongly influenced by genetic factors, especially in elderly women. The traditional strategy for prevention of osteoporotic fractures-that is, increasing peak bone mass and preventing age related bone loss-should be changed to include new elements such as prevention of falls and protection of the critical anatomical sites of the body when a fall occurs.

Aged↗
PubMed1999

Fall-induced injuries and deaths among older adults.

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.

Accidental Falls↗
PubMed1999

Hip fractures in Finland between 1970 and 1997 and predictions for the future.

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.

Age Factors↗
PubMed1999

Increasing number and incidence of fall-induced severe head injuries in older adults: nationwide statistics in Finland in 1970-1995 and prediction for the future.

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.

Accidental Falls↗
PubMed1999

Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients.

The objectives of this study were to learn how hip fracture patients fall, and to compare the mechanics of their falls with those falls that did not result in hip fracture. In this way we sought to obtain reliable insight into the etiology and pathogenesis of hip fracture and fracture prevention. A total of 206 consecutive patients with fresh hip fracture and 100 controls were interviewed and examined between October 1994 and May 1996. The only inclusion criterion was that the fracture had occurred within 24 hours of hospital admittance. The control subjects were admitted from the same community after an accidental fall that did not result in hip fracture. The characteristics of the accident were determined by personal interview and examination of the patients within 24 hours of the event. In 98% of the hip fracture patients, the fracture was a result of a fall. The majority of the patients (76%) reported that they had fallen directly to the side. Forty-eight fracture cases had one or more eyewitnesses and their reports supported this observation. In 56% of the hip fracture patients, a fresh subcutaneous hematoma was seen on the greater trochanter of the proximal femur; such a hematoma was rare in the controls (6%) (P < 0. 001), and this gave evidence for the direct impact of the greater trochanter during the fall of the hip fracture subjects. Most of the elderly fallers who fractured a hip did not manage to break the fall, e.g., with an outstretched arm. In conclusion, our results suggest that a typical hip fracture is the result of a fall and a subsequent impact on the greater trochanter of the proximal femur. The clinical implication of this finding is that effective prevention of hip fractures could be achieved by the diminution of the number and severity of falls of the elderly. We suggest that the severity of the falls (impacts on the greater trochanter) could be decreased by an external hip protector.

Accidental Falls↗
PubMed1999

Comparison of force attenuation properties of four different hip protectors under simulated falling conditions in the elderly: an in vitro biomechanical study.

The purpose of this in vitro biomechanical study is to determine the force attenuation capacity of four different hip protectors (KPH1, KPH2, Safehip, and Safetypants) in falling simulations in elderly subjects (falls to the side). The simulated falling conditions were created by a biomechanical testing system, which consisted of an impact pendulum, surrogate pelvis and femur, and two load cells. Three series of impact experiments were conducted in an ascending order (low, moderate-, and high-force experiments), each exceeding the literature-provided average (+/- 1 SD) fracture threshold (3100 +/- 1200 N) of the proximal femur of elderly women with a mean age of 71 years. Using a low impact force of 4330 N, the trochanteric soft tissue (20-mm-thick polyethylene foam) attenuated the peak femoral impact force to 3740 N and, accordingly, the KPH1 protector to 590 N, KPH2 to 510 N, Safehip to 1080 N, and Safetypants to 790 N. Thus, in this low force experiment, all tested protectors could reduce the peak impact force entered into the proximal femur below the aforementioned average fracture threshold area (3100 +/-1200 N) of the proximal femur of elderly women. With a moderate impact force of 7230 N, the soft tissue attenuated the peak femoral impact force to 6130 N, and the protectors to 780 N, 760 N, 2240 N, and 2760 N, respectively. Thus, with this impact force, only the KPH hip protectors could reduce the impact force clearly below the fracture threshold area. In the final series of the experiment, the peak femoral impact force was set to be so high (10,840 N) that the protector, if effective, should prevent the hip fracture in almost all cases and situations. The trochanteric soft tissue attenuated this peak impact force to 9190 N, and the tested protectors to 1360 N, 1170 N, 4640 N, and 5770 N. Thus, with the KPH protectors the force received by the proximal femur remained below the average force required to fracture the proximal femur of elderly women, whereas with the two other protectors the impact force entered into the proximal femur clearly exceeded this threshold value. In conclusion, the test results showed that, of the four tested hip protectors, the anatomically designed energy-shunting and energy-absorbing KPH protectors can provide an effective impact force attenuation in a sideways-fall simulation in the elderly, whereas the force attenuation capacity of the two other protectors seems more limited. However, the true efficacy of any protector in the prevention of hip fractures can only be evaluated in randomized clinical trials.

Accidental Falls↗
PubMed1998

Epidemiology of minimal trauma rib fractures in the elderly.

We determined the secular trends in the number and incidence of the elderly's minimal trauma rib fractures (typically caused by a fall from standing height or less) in Finland in 1970-1994 by collecting from the National Hospital Discharge Register all patients aged 60 years or more who were treated in Finnish hospitals in 1970-72, 1974-75, 1978-80, 1983-85, 1988-89, and 1991-94 for first rib fracture. The age-adjusted incidence of fractures slightly increased in both sexes, from 36 (1970) to 40 (1994) in women, and from 63 to 71 in men; in younger patients (aged 20-49 years) this incidence decreased from 10 to 6. The age-specific incidences increased especially in women aged 85 years and over, from 108 (1970) to 251 (1994). If this trend continues, the total number of hospital-admitted, minimal trauma rib fractures in Finnish elderly will increase from 576 (1994) to almost 1000 in the year 2010. We conclude that the number of the elderly's minimal trauma rib fractures is increasing in Finland, largely due to the increasing number of elderly in the Finnish population. Therefore, effective preventive measures are needed to keep this problem under control.

Adult↗
PubMed1998

Secular trends in the osteoporotic fractures of the distal humerus in elderly women.

Osteoporosis, with its sequelae of fracture, is a major, continuously increasing threat to the health of the elderly, and therefore reliable epidemiological information is needed for assessment of the fracture development in the future and for effective fracture prevention. However, very little population-based information is available concerning the nationwide numbers, incidences and especially secular trends of osteoporotic fractures other than those occurring at the hip. We determined the current trends in the number and incidence of osteoporotic fractures of the distal humerus in Finnish women in 1970-1995 by collecting from the National Hospital Discharge Register all female patients aged 60 years or more who were admitted to our hospitals in 1970-1972, 1974-1975, 1978-1980, 1983-1985 and 1988-1995 for primary treatment of first osteoporotic fracture of the distal humerus. The fracture was defined as osteoporotic if it occurred on individuals aged 60 years or more as a consequence of a moderate or minimal trauma only (a fall from standing height or less). We also predicted the fracture development till the year 2030 by a regression model, a model that took into account the predicted changes in the fracture incidences and population at risk. The number and incidence (per 100,000 women) of osteoporotic fractures of the distal humerus in Finnish women aged 60 years or more increased from 42 (number) and 11 (incidence) in 1970 to 175 and 30 in 1995. The age-adjusted incidence of osteoporotic fractures of the distal humerus also increased, from 12/100,000 women in 1970 to 28/100,000 women in 1995. If this trend continues, the number of these fractures in Finnish women will be almost three-fold in the year 2030 compared with that in 1995. We conclude that the number of osteoporotic fractures of the distal humerus in elderly Finnish women is increasing more rapidly than can be accounted for by the demographic changes alone and therefore effective preventive measures are imperative to keep this problem in control.

Age Factors↗
PubMed1998

Acceptability and compliance with wearing energy-shunting hip protectors: a 6-month prospective follow-up in a Finnish nursing home.

OBJECTIVES: To assess the acceptability and compliance with use of an energy-shunting hip protector in institutionalized elderly people. DESIGN AND SETTING: A 6 month prospective follow-up in a Finnish nursing home. PARTICIPANTS: 19 ambulatory nursing home residents with a high risk of hip fracture. MAIN OUTCOME MEASURES: The proportion of the residents who were willing to use the device, the number of hours of wearing the protector and the attitudes of the study subjects and the caregivers towards the appearance, comfort, fit, efficacy and laundering of the protector. RESULTS: 12 of the 19 ambulatory residents (63%) agreed to use the protector. During the study period, these subjects wore the protector on average for more than 90% of their active days, i.e. the days they were mobile. Two subjects wore the protectors at night time; the rest only during waking hours. Mean wearing time during waking hours exceeded 90%. CONCLUSION: External hip joint protectors are a feasible strategy to prevent hip fractures in institutionalized elderly people. The attitude, education and motivation of the staff may be a factor in achieving good user compliance. Further community-based studies on acceptability and compliance in wearing external hip joint protectors are needed for verification of benefits to the general population of older people.

Accidental Falls↗
PubMed1997

The number and incidence of minor trauma knee fractures are increasing in elderly women but not in elderly men.

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.

Age Distribution↗
PubMed1997

Impact experiments of an external hip protector in young volunteers.

This study represents the first measures and experiences of using an external hip protector in humans under forces that could, without the protector, fracture the proximal femur of some of the elderly persons. In other words, we wanted to know if it is possible, using the hip protector, to hit the proximal femur of young volunteers with forces that have the power to fracture some individuals' proximal femur, and if so, how intense is the pain reaction under the impacted area? Four of the researchers (JP, AH, HS, and PK) volunteered to be the study subjects. In the impact experiments, we wore the protector on both sides of the pelvis (greater trochanter), and the pendulum, with an effective mass of 40 kg, was impacted on the protector. The descent height was gradually increased and the highest impact energy used was 115 J. With a load cell mounted on the head of the pendulum we ensured that the external forces used were high enough to fracture the proximal femur of some of the elderly people. Using the external hip protector we tolerated the impacts well although after the high energy impacts every subject reported mild tenderness on the skin area under the contact surface of the protector. Repeated examinations of the impacted area of the study subjects did not reveal hematoma or swelling. In conclusion, our test results suggested that, when wearing an anatomically designed energy-shunting and energy-absorbing hip protector, the fall-induced peak impact forces do not cause undue pain to the impacted hip region, and, in all probability, the forces entering into the proximal femur remain below the range of force capable of fracturing the proximal femur of the elderly. The protector was found to be comfortable to wear and it did not move (slip away) during the experiment. We feel that our protector is now ready for a feasibility study and then for a randomized clinical trial.

Accidental Falls↗
PubMed1996

Epidemiology of osteoporotic ankle fractures in elderly persons in Finland.

BACKGROUND: Although osteoporotic or minimal trauma fractures among elderly persons are a major public health problem worldwide, epidemiologic information on these fractures is limited. OBJECTIVE: To determine the current trend in the number and incidence of osteoporotic ankle fractures in the elderly. A fracture was defined as osteoporotic only if it occurred as a result of minimal trauma in a person 60 years of age or older. DESIGN: National hospital discharge register. SETTING: Finland, a country with approximately 5 million inhabitants. PARTICIPANTS: All patients 60 years of age or older who were admitted to hospitals in Finland for primary treatment of first osteoporotic ankle fracture in 1970 to 1972, 1974, 1975, 1978 to 1980, 1983 to 1985, 1988 to 1989, and 1991 to 1994. MEASUREMENTS: The number and the age-specific and age-adjusted incidence of osteoporotic ankle fractures in each year of the study. RESULTS: For the study period, the number and incidence (per 100,000 persons) of osteoporosis-related ankle fractures in Finnish persons 60 years of age or older increased considerably (370 and 57, respectively, in 1970 compared with 1243 and 130, respectively, in 1994). The age-adjusted incidence of these fractures also increased in women, from 66 in 1970 to 162 in 1994, and in men, from 38 in 1970 to 82 in 1994. CONCLUSION: The number of osteoporotic ankle fractures in Finland is increasing at a rate that cannot be explained simply by demographic changes. Vigorous preventive measures are needed to control the increasing burden of this type of fracture.

Aged↗