Health Promotion Interventions: Lessons from the Transfer of Good Practices in CHRODIS-PLUS.

Health promotion and disease prevention often take the form of population- and individual-based interventions that aim to reduce the burden of disease and associated risk factors. There is a wealth of programs, policies, and procedures that have been proven to work in a specific context with potential to improve the lives and quality of life for many people. However, the challenge facing health promotion is how to transfer recognized good practices from one context to another. We present findings from the use of the implementation framework developed in the Joint Action project CHRODIS-PLUS to support the transfer of health promotion interventions for children's health and older adults identified previously as good practices. We explore the contextual success factors and barriers in the use of an implementation framework in local contexts and the protocol for supporting the implementation. The paper concludes by discussing the key learning points and the development of the next steps for successful transfer of health promotion interventions.

School environment and school injuries.

BACKGROUND: Although injuries at school are an important issue in public health, environmental factors in schools and school yards have seldom been the focus of school injury research. The goal of our investigation was to examine the effect of environmental factors on school injuries. METHODS: Nine comprehensive Finnish schools registered school injuries over a period of two school years. Injuries were classified as being associated with environmental factors, suspected environmental factors, and others. The consensus between two independent classifiers was 81%. RESULTS: A total of 722 injuries were classified. In 11.6% of these injuries, the physical environment factor was evident, and in 28.1% of the injuries, physical environment was suspected of being a contributory risk factor. Thus the physical environment of the school was a contributing factor in over a third (39.7%) of injuries occurring in the school, on the school yard or during the journey to, or from school. In this study, conducted in Finland, ice on the ground was mentioned most frequently as an environmental risk factor. CONCLUSION: In Finland, the Nordic weather conditions are not taken into account in the school yard and playground plans as they ought to from the safety point of view. An initiative has been launched on a mandatory wintertime master plan for every school yard.

Fire-related injuries with inpatient care in Finland: a 10-year nationwide study.

The aim of this study was to examine fire-related injuries leading to inpatient care in Finland. The Finnish National Hospital Discharge Register (2000-2009) and a sample of 222 patients from the Helsinki Burn Centre who sustained flame burns was used. During the 10-years study period, the incidence of fire-related injuries with inpatient care was approximately 5.6 per 100000 persons-years (n=295; males 74%, females 26%). Approximately three quarters involved burns and the remaining cases were mostly combustion gas poisonings. Burns declined from 5.4 in 2000 to 4.0 per 100000 person-years in 2009. The decline was accounted for by young people primarily. Socio-economic features and smoking habits differ between the injured and general population. House fire victims were mainly middle aged and older, while injures involving flammable substances, campfires, etc., were mostly associated with young people. House fires caused the worst damage in terms of Total Body Surface Area burned and inhalation burns. Significantly more people die on the scene of the incident than during the hospital care. Targeting preventive measures in particular at older people and those with a tendency for alcohol abuse and smoking could potentially reduce the burden of the most severe flame burns.

Underreporting of external cause codes in the Finnish Hospital Discharge Register.

BACKGROUND: Hospital discharge data (HDD) represent one of the most valuable information sources for injury prevention and control. OBJECTIVES: To investigate external code of injury (E-code) underreporting in the Finnish National Hospital Discharge Register from 1 January 1987 to 31 December 2004. MATERIAL AND METHODS: HDD for discharges with an injury as the main diagnosis were extracted from the FNHDR. The selection was made using codes for nature of injury (1987-1995, ICD-9; 1996-2004, ICD-10). The proportion of injury discharges with a missing E-code was examined by sex, age, hospital districts, type of hospital, duration of hospitalization, and nature of injury. RESULTS: In 432,549 (23.1%) of the recorded 1,868,519 discharges, an E-code was missing. The proportion of the discharges with a missing E-code varied among the above variables. During the period 1987-2004, the overall E-code underreporting decreased from 18.0% to 12.8%. The introduction of the ICD-10 in 1996 was followed by a dramatic increase (up to 57.5% of all discharges) in E-code underreporting. CONCLUSIONS: More attention ought to be dedicated to teaching and periodic training on the use of E-codes. Educational activities should specifically target the medical doctors, who, in Finland, are responsible for assigning the E-codes.

Gender and injury in Finnish comprehensive schools.

The aim of this study is to analyze the gender differences in injuries at Finnish comprehensive schools. Nine schools reported a total of 1135 injuries to the injury register over two school years. Boys (56%) were injured more often than girls, their injuries happened more often during breaks at school yard, whereas girls hurt themselves during sport lectures in the gymnastic halls. The proportion of boys' injuries also increased with age. More often, boys' injuries were caused by intentional actions by other pupils. Girls injured their lower extremities more often, whereas boys injured their faces and head. Boys also suffered concussion more often than girls, and were also referred for further care to health care centres or hospitals more often than girls. The higher injury frequency among boys at school corresponds to the higher injury rate of males in general, which is true for work, traffic, and leisure-time injuries. Increased adult supervisor control especially during breaks can prevent most of school injuries.

Surveillance of injury-related deaths: medicolegal autopsy rates and trends in Finland.

Medicolegal autopsies are a vital tool for obtaining reliable injury mortality data. In Finland, medicolegal autopsies have increased from 13.6% of all deaths in 1970 to 23.8% in 2004. In fact, medicolegal autopsies are performed in 87.2% of all unintentional injury deaths, 98.3% of homicides and 99.5% of suicides. Finland has exceedingly high medicolegal autopsy rates compared with other countries. Autopsy rates should be appropriately considered when performing international comparisons of injury-related deaths.