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Notes: Regular exercise in cold, dry air is believed to be a predisposing factor for exercise-induced bronchospasm (EIB). The aim of this study was to compare the occurrence of EIB among previously healthy elite cross country skiers and their non-athletic control subjects.Twenty healthy elite cross country skiers and 18 non-asthmatic controls were challenged by a standardized free exercise test. Thereafter, subjects' respiratory function was followed by flow-volume spirometry up to 30 min. EIB was defined in the post-exercise spirometry as at least one of the following: a ≥10% decrease in forced expiratory volume in 1 s (FEV1), a ≥20% decrease in mean maximal expiratory flow (MMEF) or a ≥25% decrease in peak expiratory flow rate (PEF).EIB was found in two skiers and one control according to FEV1, for seven skiers and two controls according to MMEF. Two skiers and one control had exercise-induced asthma (EIA) according to both parameters. The largest decrease in PEF was 13%, that did not result in additional diagnoses. All nine of the subjects with a positive test result reported asthma-like symptoms (dyspnea, cough or increased mucus excretion) after the exercise challenge. Accordingly, seven previously healthy skiers (35%) and two controls (11%) were diagnosed as having EIB. In addition, three skiers of the original cohort were excluded because of an earlier asthma diagnosis, making the total asthma prevalence 10/23 (42%) among the elite skiers.It was concluded that EIB is more common in elite cross country skiers than in non-athletic controls. The bronchoconstriction induced by exercise is usually mild or moderate, and flow-volume spirometry with sensitive flow parameters is needed for it to be diagnosed. Even a mild asthma decreases minute ventilation and maximal performance of winter sport athletes. Therefore, skiers with long-term respiratory symptoms or decreased performance should be studied for EIA and treated adequately.

Notes: The basic response to injury at the tissue level is well known and consists of acute inflammatory phase, proliferative phase, and maturation and remodeling phase. Knowing these phases, the treatment and rehabilitation program of athletes' acute musculoskeletal injuries should use a short period of immobilization followed by controlled and progressive mobilization. Both experimental and clinical trials have given systematic and convincing evidence that this program is superior to immobilization – a good example where basic science and clinical studies do coincide – and therefore active approach is needed in the treatment of these injuries.

Notes: Abstract. 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.

Notes: Abstract 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 58/100000 in 1970 to 93/100000 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 is 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.

Notes: Abstract: 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 2700 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.

Notes: Abstract: The risk factors for falls in older adults are well known but knowledge on the direct injury mechanisms that result in various osteoporotic fractures has been very sparse. The purpose of this study was therefore to clarify the injury mechanisms of osteoporotic upper extremity fractures of older adults and to compare these mechanisms with those of the control fallers, and in this way to obtain reliable insight into the etiology and pathogenesis of upper extremity fractures and thus to enable fracture prevention. One hundred and twelve patients with a fresh fracture of the proximal humerus, 65 patients with an elbow fracture, 110 patients with a wrist fracture and 108 controls (no fracture, or a fracture other than the case fracture) were interviewed and examined between September 1995 and December 1997. The inclusion criteria of the subjects were that the patient was 50 years of age or older at the time of the accident, and that the fracture/injury had occurred as a result of low-energy trauma (typically a fall from standing height or less) within a week before the interview and examination. In 97% of patients with a proximal humerus or elbow fracture, and in all patients (100%) with a wrist fracture, the fracture was a result of a fall. In the control group this figure was 93%. In a polychotomous logistic regression analysis the intergroup differences in the fall directions (adjusted by gender, age and functional capacity) were statistically highly significant (χ2= 43.6, d.f. = 15, p〈0.001). Most of the patients with a proximal humerus fracture or elbow fracture reported that they had fallen “obliquely forward” (43% and 38%) or “to the side” (29% and 26%), whereas in the wrist fracture group the main fall direction was also “obliquely forward” (34%) but the other fall directions (i.e., “forward”, “to the side”, “obliquely backward” and “backward”) were quite equally represented (13–19%). The odds ratio (OR) for an obliquely forward fall resulting in a proximal humerus fracture was 3.5 [95% confidence interval (CI) 1.4–9.2), as compared with the fall directions of the controls and the “obliquely backward” fall direction. In a logistic regression analysis the patients with a wrist fracture managed to break their fall (e.g., with an outstretched arm) more frequently than the patients in the other groups (OR 3.9; 95% CI 2.0–7.3). The patients with a proximal humerus fracture, in turn, managed to break their fall less frequently than the controls (OR 0.33; 95% CI 0.14–0.80). The same was true of the patients with an elbow fracture, although the difference was not significant (OR 0.49%; 95% CI 0.19–1.3). As objective evidence for a direct fall-induced impact on the fracture site, 68% of patients with a proximal humerus fracture revealed a fresh subcutaneous hematoma on the shoulder/upper arm, while such a hematoma was rare in the controls (2%) (p〈0.001). Correspondingly, 62% of patients with an elbow fracture showed a similar hematoma on the elbow area, while this was seen in none of the controls (p〈0.001). In patients with a wrist fracture a hand/wrist hematoma was seen in 58% of the victims, as compared with 18% of the controls (p〈0.001). The study shows that the most typical osteoporotic upper extremity fractures of older adults have their specific injury mechanisms. A great majority of these fractures occur as a result of a fall and a subsequent direct impact of the fractured site. Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced impact force with injury site protection.

Notes: Abstract. 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.

Notes: Abstract 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 repidly 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.

Notes: Abstract. 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.

Notes: Abstract 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.