Acute and overuse injuries among sports club members and non-members: the Finnish Health Promoting Sports Club (FHPSC) study.

BACKGROUND: Physical activity in adolescence is promoted for its multi-dimensional health benefits. However, too intensive sports participation is associated with an increased injury risk. Our aim was to compare the occurrence of acute and overuse injuries in Finnish sports club members and non-members and to report training and competing habits associated with a higher injury risk in sports club members. METHODS: In this cross-sectional survey targeted at 14-16-year-old adolescents, a structured questionnaire was completed by 1077 sports club members and 812 non-members. The main outcome measures were self-reported acute and overuse injuries, their location and type. RESULTS: At least one acute injury in the past year was reported by 44.0% of sports club members and 19.8% of non-members (P < 0.001). The sex-adjusted odds ratio (OR) for acute injury in sports club members compared to non-members was 3.13 (95% confidence interval (95% CI) 2.54-3.87). Thirty-five percent of sports club members and 17.4% of non-members (P < 0.001) reported at least one overuse injury during the past year. The overuse injury OR for sports club members was 2.61 (95% CI 2.09-3.26). Sports club members who trained 7-14 h per week during training (OR 1.61, 95% CI 1.21-2.12, P = 0.001) or competition season (OR 1.55, 95% CI 1.18-2.06, P = 0.002) were more likely to report an injury compared to members who trained 3-6 h per week. Those sports club members who participated in forty competitions or more compared to 7-19 competitions per year were more likely to report an acute injury (OR 1.55, 95% CI 1.05-2.08, P = 0.028) or for an overuse injury (OR 1.53, 95% CI 1.02-2.30, P = 0.038). CONCLUSIONS: Both acute and overuse injuries are common among youth sports club members, and the number increases along with increasing amounts of training and competitions. More effective injury prevention is needed both for adolescents engaging in sports club activities and for other adolescents.

Changes from 1986 to 2006 in reasons for liking leisure-time physical activity among adolescents.

Reasons for participating in physical activity (PA) may have changed in accordance with the general modernization of society. The aim is to examine changes in self-reported reasons for liking leisure-time physical activity (LTPA) and their association with self-reported LTPA over a 20-year period. Data were collected among nationally representative samples of 13-year-olds in Finland, Norway, and Wales in 1986 and 2006 (N = 9252) as part of the WHO cross-national Health Behaviour in School-aged Children (HBSC) study. Univariate ANOVAs to establish differences according to gender, year, and country were conducted. In all countries, 13-year-olds in 2006 tended to report higher importance in terms of achievement and social reasons than their counterparts in 1986, while changes in health reasons were minor. These reasons were associated with LTPA in a similar way at both time points. Health reasons for liking LTPA were considered most important, and were the strongest predictor of LTPA. The findings seem robust as they were consistent across countries and genders. Health education constitutes the most viable strategy for promoting adolescents' motivation for PA, and interventions and educational efforts could be improved by an increased focus on LTPA and sport as a social activity.

Low back and neck and shoulder pain in members and non-members of adolescents' sports clubs: the Finnish Health Promoting Sports Club (FHPSC) study.

BACKGROUND: The objective of this study was to investigate the prevalence of self-reported low back pain (LBP) and neck and shoulder pain (NSP), and the related factors in members and non-members of adolescents' sports clubs. METHODS: This cross-sectional study was based on surveys of 14-16-year-olds as a part of the Finnish Health Promoting Sports Club (FHPSC) Study. The surveys on self-reported health behaviours, injuries, and musculoskeletal health were conducted among sports club members (n = 962) and non-members (n = 675). Binary logistic regression analysis was applied to study the associations between dependent variables of LBP and NSP, and the independent factors. RESULTS: The prevalence of LBP during the preceding 3 months was 35.0 % in girls and 24.5 % in boys (p < 0.05 for sex difference). The prevalence of NSP was 55.9 % in girls and 27.3 % in boys (p < 0.001 for sex difference). Being a sports club member increased the odds for LBP in boys (odds ratio [OR] 2.35, 95 % CI 1.48-3.72). On the other hand, sports club participation was associated with lower odds of frequent NSP in girls (OR 0.52, 95 % CI 0.33-0.82). No associations were found between other leisure-time physical activity and LBP or NSP. Higher screen time (computer games, TV/DVD, phone, Internet) during leisure-time increased the odds of NSP in boys and LBP in boys and girls. CONCLUSIONS: In this study, self-reported LBP and NSP were already relatively common among adolescents. Girls have a higher risk for reporting LBP and NSP. Measures that are more effective in the prevention of LBP in male sports club members are needed. Excessive screen time is weakly associated with LBP and NSP, which should be taken into account in health promotion among adolescents.

Oral hygiene habits of 11-year-old schoolchildren in 22 European countries and Canada in 1993/1994.

This study is part of the Cross-National Survey on Health Behaviour in School-aged Children--a WHO Collaborative Study, which started in 1982. The aim of the study was to describe the oral hygiene habits (toothbrushing and flossing) of 11-year-old schoolchildren in 22 European countries (Austria, Belgium, the Czech Republic, Denmark, Estonia, FInland, France, Germany, Greenland, Hungary, Israel, Latvia, Lithuania, Northern Ireland, Norway, Poland, Russia, Scotland, the Slovak Republic, Spain, Sweden, and Wales) and Canada. The data were collected from standardized anonymous questionnaires in school classrooms during the 1993-1994 school year. At least 1300 school children, representing the whole country, participated in the study in each country. Oral hygiene habits were analyzed according to gender, age, country, school performance, and family economy. The children brushed most favorably in Sweden, Denmark, German, Austria, and Norway (83-73% brushed twice a day). More-than-once-a-day toothbrushing was especially uncommon (from 26 to 33%) among boys in Finland, Lithuania, Russia, Estonia, and Latvia. Toothbrushing frequency differed significantly according to school performance in Canada, the Czech Republic, Scotland, Poland, Northern Ireland, and Wales and between different socio-economic groups in Northern Ireland, Wales, the Czech Republic, Scotland, Poland, and Russia. Use of dental floss was rare. In general, flossing was less frequent among boys than among girls. Daily flossing was most common among Canadian adolescents (25%). In conclusion, there are considerable differences in toothbrushing frequency among children in European countries.

Self reported physical activity, public health, and perceived environment: results from a comparative European study.

STUDY OBJECTIVE: The focus of physical activity promotion is moving from methods for increasing health enhancing physical activity on the individual level to higher level strategies including environmental and policy approaches. Scientific inquiry, traditionally related to individual-based strategies, requires adaptation and refinement when environmental and policy changes become more relevant. The objective of this study is to investigate the significance for behaviour and health of community-based environments that encourage physical activity. DESIGN AND SETTING: The article presents data and results from a cross sectional comparative survey of the general population in six European countries (Belgium, Finland, Germany (East and West), Netherlands, Spain, Switzerland). Specifically, the relation between perceived community-based opportunities for physical activity, self reported physical activity, and self rated health status is investigated. PARTICIPANTS: Representative samples of general populations (adults 18 years or older). Overall response rate: 53.5%. Sample sizes realised: Belgium: n = 389; Finland: n = 400; Germany (East): n = 913; Germany (West): n = 489; Netherlands: n = 366; Spain: n = 380; Switzerland: n =406. MAIN RESULTS: Analyses show that best opportunities are reported by people who are lightly to moderately physically active. People's self rated health is moderately, but significantly associated with both perceived opportunities, and physical activity itself. These predictors interact in that especially for women, the health impact of physical activity is more pronounced in case of good opportunities. CONCLUSIONS: The paper shows the potential of opportunities within residential and community environments with regard to physical activity, both for behaviour and health. Opportunities may enable the population, especially women, to develop an active lifestyle, and thus improve their health. Future studies with objective indicators for physical activity related environments should test the findings that are based on perceptions.

The importance of the social environment for physically active lifestyle--results from an international study.

Physically active lifestyles are regularly associated with improved health and quality of life. Differences in lifestyles in society can partly be understood through the differences in the social and physical environment. This study examines the relationships between reported physical activity, and the extent of perceived support for physical activity in the physical and policy environment (e.g. facilities, programmes and other opportunities), and in the social environment. The data for the study come from a cross-cultural health policy study called MAREPS. In total, 3342 adults, 18 years or older, from six countries (Belgium, Finland, Germany, The Netherlands, Spain, Switzerland) were interviewed via telephone. Respondents were categorised as active or inactive according to self-reported physical activity. Social environmental factors and physical and policy environmental factors were also assessed. The analysis of the data was informed by social cognitive theory, although the study was not originally designed for this purpose. Sixty-eight percent of females and 70% of males were active. The proportions of active and inactive varied by countries to a great extent. The strongest independent predictor of being physically active was social environment. Those who perceived low social support from their personal environment (i.e. family, friends, school and workplace) were more than twice as likely to be sedentary compared to those who reported high social support from their personal environment. Specific knowledge of the programmes and actions for physical activity and sport was also a strong predictor of being active. A supportive physical and policy environment was not associated with participation in physical activity as strongly as had been anticipated. The variation between countries was stronger predictor of being active than the physical and policy environment variables. This study generates the hypotheses and raises the questions that in a preliminary way, there appears to be some relationships between aspects of physical and social environment and physical activity participation. However, future research is needed to refine and clarify this.

How is oral health education conducted in Finnish health centers?

The oral health education (OHE) given in Finnish health centers is mostly implemented by dental assistants and hygienists. However, there is no exact information concerning the distribution of OHE work and the working methods among individual health educators. The aims of this study were to assess 1) the time used for OHE by the dental professionals who bear most of the responsibility for OHE in health centers, and to evaluate 2) the collaboration between OH-educators and the parents of schoolchildren, school personnel and the other health care personnel and 3) the sources of the OHE knowledge and skills of these OH-educators and their methods according to their work load. The data for this study were collected from 323 OH-educators. About one fourth (28%) of the OH-educators used 40% or more of their working time for group OHE and one third (33%) used 40% or more of their time for individual OHE. These workers were considered to be full-time OH-educators. The mean age of the OH-educators was 36 yr. The mean length of the OHE career was 8 yr. The most common OHE methods were a usual type of school lesson or a lesson in which the audience was questioned. Slides, models, transparencies and leaflets were the most general visual aids used.

Oral health habits of schoolchildren in 11 European countries.

This study is part of the Cross-National Survey on Health Behaviour in Schoolchildren--A WHO Collaborative Study, which started in 1982. The aim of the study was to describe the oral health habits (oral hygiene habits, use of sugar snacks and use of fluorides) in schoolchildren in 11 countries. The data were gathered during the 1985-86 school year, and the age groups studied were 11-, 13- and 15-year olds from Austria, Belgium, Finland, Hungary, Israel, Norway, Scotland, Spain, Sweden, Switzerland and Wales. The data are nationally representative for the age groups concerned. Exact results are presented for toothbrushing frequency and use of dental floss, toothpicks, sweets, soft drinks, fluoride toothpaste, fluoride rinses and fluoride tablets. Toothbrushing was consistently less frequent among boys than among girls. Use of dental floss is still very rare. Efforts must be continued to reduce the consumption of sweets and soft drinks. These findings should be taken into consideration when attempts are made to improve oral health education.

Frequent use of sugar products by schoolchildren in 20 European countries, Israel and Canada in 1993/1994.

The aim of this study was to describe the daily use of certain between-meal sugar products (soft drinks and sweets) of schoolchildren in 20 European countries, Israel and Canada as a part of the Cross-National Survey on Health Behaviour in School-Aged Children--a WHO Collaborative Study. The data were collected using standardised anonymous questionnaires in school classrooms during the 1993/1994 school year. In each country nationally or regionally representative samples of about 1,300 schoolchildren (450 in Greenland) were targeted. Use of sugar products was analysed according to sex, age, country, self-reported school performance and self-reported family economy. One third to one half of the children (30-48 per cent) drank coke or other soft drinks more than once a day in Israel, Northern Ireland, Scotland, the Slovak Republic and Flemish-speaking Belgium. Use of soft drinks was very uncommon in Finland, Sweden, Norway, Denmark, Latvia and Estonia. The strongest association (odds ratios) was between the use of soft drinks and good family economy; in Russia (20.3), in Lithuania (11.3), in Latvia (10.0), in Poland (8.5) and in Estonia (8.0). In Israel, Scotland, Northern Ireland, Russia and French-speaking Belgium 41-29 per cent of the children ate sweets more than once a day. Boys drank soft drinks and ate sweets slightly more often than girls did. In conclusion, large differences were found between the different countries in the frequency of use of soft drinks and sweets. This should be considered when developing the content of oral health promotion programmes.

Dental health habits in Austria, England, Finland and Norway.

Individually, people can prevent dental caries by sugar restriction and periodontal disease by toothbrushing. The aim of this study was to determine the toothbrushing frequency and consumption of sweets and soft drinks in some European countries. The data were obtained during the winter of 1983-84 from schoolchildren aged 11.5, 13.5 and 15.5 in Austria, England, Finland and Norway. Except for England, the samples were nationally representative. The questionnaires were completed at school. Dental health habits apparently were best in Norway, as the toothbrushing frequency was highest and the consumption of sweets and soft drinks was lowest. The toothbrushing frequency of boys was lowest in Finland. The consumption of sweets and soft drinks was very high in Austria and England. Such international comparisons should be used when evaluating and directing national programmes of preventive dentistry.

[Health promotion by sports and physical activity: politics, behavior and infrastructures in a European comparison]. / Gesundheitsförderung durch Sport und körperliche Aktivität: Politik, Verhalten und Infrastrukturen im europäischen Vergleich.

OBJECTIVES: The focus of physical activity promotion is moving from measures to increase health-enhancing physical activity on the individual level to higher-level strategies including policy and environmental approaches. Scientific evidence, traditionally related to individual-based strategies, calls for adaptation and refinement when environmental and policy changes become more relevant. METHODS: This paper investigates differences in physical activity promotion and public policy among six European countries. Data from a European study on public health promotion policy and health behaviours (MAREPS) is analysed to study behaviour, community-based opportunities for physical activity, and populations' perception of the effectiveness of their national policies in promoting physical activity. RESULTS: Analyses show significant differences in both involvement in and perceived opportunities for physical activity among the investigated countries. Populations in Finland, Switzerland, and The Netherlands show comparably higher participation and, at the same time, perceive better opportunities for physical activity within the residential environment than people in East Germany, Belgium, and Spain. Moreover, respondents from the former group of nations report considerably greater contribution of health policy in their country to the promotion of physical activity than respondents from the latter group. CONCLUSIONS: In conclusion, the results provide empirical support for the significance of environmental and policy approaches with regard to physical activity. Opportunities created by implementing such approaches may enable populations to develop more active lifestyles conducive to health. Further research employing longitudinal designs could be especially helpful to explore the causalities of the relationship between policy, environment and physical activity.

Food consumption and nutrient intakes with a special focus on milk product consumption in early pubertal girls in Central Finland.

OBJECTIVE: To evaluate the current status of dietary intakes in early pubertal girls with a special focus on milk products. DESIGN: Cross-sectional data using 3-day food records. SUBJECTS: Eight hundred and sixty girls, aged 10-12 years, at Tanner maturation stage I-III. RESULTS: The mean consumption of milk products (620 g day(-1)) was similar to that of a Finnish study in the 1980s, while the consumption of non-milk drinks (403 g day(-1)) had increased. Twelve per cent of the girls had a dairy-restricted diet and consumed significantly less milk products than girls with a non-restricted diet (465 vs. 644 g day(-1), P<0.001). Girls with low milk product consumption had the highest non-milk drinks consumption (P<0.001). The mean energy intake was 7.1 MJ day(-1). No major changes were found in the sources of nutrients. The shares of energy for nutrients were close to recommendations except for saturated fat (13.9 vs. 10% of energy) and carbohydrates (51.5 vs. 55-60% of energy). The mean calcium intake (1117 mg day(-1)) was above the recommendation, while the vitamin D intake (3.1 microg day(-1)) of 88% of the girls was below the recommendation. CONCLUSIONS: The diet quality of early pubertal girls is close to the recommendations and has improved with respect to fat compared with the 1980s. Consumption of milk products is high although the consumption of non-milk drinks has increased. We found a subgroup of girls who compensate their low milk product consumption with a higher consumption of non-milk drinks. Following a dairy-restricted diet is the main reason for low consumption of milk products.

Role and development of smoking prevention programmes in school.

In health education the primary issue lies very often in the so-called delayed learning: the effects of stimuli do not appear immediately after they have been given, they can appear after a long period of time, even years. If learning is understood as a life-long process, which is characterized by underpredictability of a certain level and by the fact that things learned cannot always be indicated by present research methods, the discussion on teaching and learning in school might change to a fairly great extent.

How young Europeans sleep.

This study investigated sleeping habits, difficulties in being able to fall asleep and their connections to self-reported health conditions, as well as other selected health behaviours and use of leisure time, among 11-16 year old Europeans from 11 countries. The study was part of a larger, comparative, WHO coordinated project on the health and life-style of school children (Health Behaviour of School Age Children--A WHO Cross-National Survey, The HBSC Study). In most of the countries, research data were collected from samples representative of the whole country. Using a standardized survey questionnaire, the data were collected anonymously in schools. Altogether 40,202 students responded to the survey. Sleeping habits and an inability to fall asleep varied significantly between countries as well as between age groups but only slightly between the sexes. Finnish school children experienced the most difficulty in being able to fall asleep. After the Israeli youth, the Finnish school children had the shortest night's sleep. At least a fifth of Finnish and Norwegian school children also reported that they felt tired almost every morning, the corresponding figure being smaller in other countries. A frequent use of psychoactive substances (alcohol and tobacco), lack of physical activity, excessive watching of TV/videos together with numerous evenings spent outside the home were all connected with going to bed late as well as with frequent difficulty in not being able to fall asleep. The results of the study offer an important challenge to health promotion and health education. Much more attention must be paid to this essential and exciting health habit!

Perceived tiredness among adolescents and its association with sleep habits and use of psychoactive substances.

This study investigated the variation in perceived tiredness among 11, 13 and 15-year-old Finnish adolescents (n = 4187). Additionally interrelationships between sleep habits, use of psychoactive substances (alcohol, tobacco and coffee) and perceived tiredness among 15-year-olds were examined. This study is part of an international, WHO-coordinated survey of school children's health and lifestyle (the HBSC Study). In Finland, research data represented the whole country. The data were collected in March-May 1994. Pupils responded anonymously to a standardized questionnaire during a class period. Subjective tiredness was very common and increased with age among adolescents. Perceived tiredness on at least four school mornings a week increased from 24 to 35% among boys and from 16 to 34% among girls. Feeling tired more often than once a week increased from 20 to 37% in girls and from 24 to 50% in boys. Structural equation models showed that interrelationships between three factors--sleep habits, use of psychoactive substances and perceived tiredness--were statistically significant. For these three factors the two remaining factors explained 24% of the variance of perceived tiredness among boys and 20% among girls, and the two remaining factors explained 42% (16%) of the variation in sleep habits. For the variance of the use of psychoactive substances sleep habits and perceived tiredness explained 26% (12%). Subjective tiredness is strongly age related; this together with the use of psychoactive substances and sleep habits regulate adolescents' daily life and well-being.

Use of xylitol chewing gum among Finnish schoolchildren.

The preventive, and partly the remineralizing, effect of xylitol was shown in Finland in the Turku Sugar Studies in 1971-73. Since then, several clinical trials in many countries have confirmed these results. In Finland, oral health personnel have recommended daily use of xylitol chewing gum in their dental health education. Moreover, commercial companies have advertised xylitol, emphasizing in particular its caries preventive effects. All Nordic dental associations have given their recommendations for xylitol use. The aim of this study was to describe how this health habit has been adopted by Finnish schoolchildren. The study was part of the comprehensive cross-national survey on Health Behavior in School-aged Children (HBSC Study)--a WHO Collaborative Study. The data were collected using standardized questionnaires to which pupils in grades 5 (11 years), 7 (13 years) and 9 (15 years) responded anonymously in school classrooms during the spring term 1998. The response rate varied between 87% (15-year-old boys) and 94% (11- and 13-year-old girls). Among boys, the percentages of daily users of xylitol chewing gum were 47% (11 years), 46% (13 years), and 44% (15 years), and among girls, 57% (11 years), 65% (13 years), and 69% (15 years), respectively. Use of sugar-sweetened chewing gum was very rare (1%), as also was use of chewing gum with other artificial sweeteners (1%). It may be concluded that since 1991 the use of xylitol chewing gum has further increased in Finland and currently more than a half of all schoolchildren benefit from it.

Minority status and perceived health: a comparative study of Finnish- and Swedish-speaking schoolchildren in Finland.

Results of earlier studies suggest that the health of the Swedish-speaking minority in Finland is better than that of the sociodemographically similar Finnish-speaking population. The causes of differences are unknown. The main aim of the study referred was to investigate whether differences in perceived health according to linguistic group were present in a nation-wide representative sample (n=5,230) of schoolchildren aged 11, 13 and 15 years. A further aim was to determine whether differences could be attributed to socioeconomic background, social relationships or health behaviour. The study is part of the international Health Behaviour in School-aged children (HBSC) survey. The perceived health of Swedish-speaking children (n=1,699) proved to be better than that of Finnish-speaking children (n=3,531). In multivariate logistic regression models the differences could not be attributed to underlying associations with any variable studied. The health advantage of Swedish-speaking children essentially could not be related to known risk factors.

Oral mucosal diseases investigated by patch testing with a dental screening series.

The rôle of contact allergies in oral mucosal diseases was studied. The subjects were 24 patients out of 479 tested, who had oral mucosal symptoms and positive patch test reactions in a dental series during 1987-1994 at the Department of Dermatology, Helsinki University Hospital. The clinical diagnoses were oral lichen planus (LPO, 13 patients), leukoplakia (2), glossodynia, i.e., 'burning mouth syndrome' (4), stomatitis (3) and recurrent angioedema (2). Only 1 patient had symptoms in relation to dental care. All but 2 patients had allergic reactions to mercury (Hg) (12 patients), gold sodium thiosulfate (Au) (13 patients) or both. A clinical connection between oral symptoms and contact allergy was seen in 10 patients. 9 patients (7 LPO, 2 leukoplakia) had Hg allergy. In these cases, the oral lesions disappeared after the amalgam fillings had been removed. 1 patient had recurrent stomatitis and perioral eczema after dental care and 2,2-bis(4-(2-hydroxy-3-methacryloxypropoxy)phenyl)propane (BIS-GMA) allergy. Her symptoms were caused by drilling of acrylic fillings. In addition, a connection between localized stomatitis and contact allergy was considered probable in 2 cases. 1 patient had stomatitis from contact with an orthodontic device and nickel allergy. The other had stomatitis from contact with a dental gold crown and gold allergy. No clinical connection was found between gold allergy and the oral symptoms of other patients.