Anne Lounamaa

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.

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.

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.

FIRE SAFETY PRACTICES IN INSTITUTIONAL, RESIDENTIAL AND HOME CARE IN FINLAND

Background The rescue act 2011 in Finland stresses that the responsibility of fire safety is on building owners and service providers. The regulation is justifiable, because people in vulnerable positions, for example elderly and disabled, have an increased risk being fire victims. The aim of this study was to investigate the implementation of rescue service act among service providers in residential, institutional and home care facilities and to monitor changes from 2013 to 2015. Methods Online surveys on fire hazard assessment and risk management practices were done in 2013 and 2015. Respondents were managers of residential, institutional and home care facilities for the vulnerable people. Information of the facilities was obtained from the nationwide Register of Institutions in Social Welfare and Health Care. The study sample was systematically selected (every other) and it consisted 1605 organisations. Results In 2013 93% of institutional and 95% residential units had written guidelines to ensure fire safety. In 2015 the proportion has decreased to 84 in institutional and 88% in residential units. At home care written guidelines had less than 50%. The accident prevention guidelines had increased in institutional units from 66% to 74% and in residential units from 66% to 77%. At home care the guidelines had 50%. Safety guidelines in general e.g. crime prevention has also decreased and was now less than 50%, at home care only 22%. Patient and residential safety guidelines were increased only at home care from 55% to 60%. Conclusions The organisations have increased their preparedness for fire risk with sprinklers. But at the same time they made less written guidelines to prevent to fire. Fire risk assessment and management practices have improved only in home care. In IR-units the situation seems to be weaker than in 2013. The situation is not acceptable and the reasons should be diagnosed.

BURDEN OF FIRE-RELATED INJURIES IN FINLAND

Background The aim of this research was to examine the burden of (severe) fire-related injuries in Finland. Methods All together twelve separate data sets were gathered for conducting the study. Finnish Hospital Discharge register (FHDR) was the core data in which the injured persons could be identified. The Causes of Death register was the data to identify fire-related deaths. Criteria of inclusion for further study were that a person had been to inpatient care or died. Data on sickness allowances, different kinds of rehabilitation funding, (disability) pensions were obtained from the Social Insurance Institution of Finland. Other types of disability allowances or pensions were obtained from the Finnish Centre for Pensions. Causes of Death data supplemented with socioeconomic data were obtained from Statistics Finland. A data from Statutory Accident Insurance was obtained to cover work-related accidents. A five-year sample of patients with fire-related burn was obtained from the Helsinki Burn Centre. The Finnish Hospital Discharge Register was available at the National Institute for Health and Welfare, Finland. The whole study consisted of five sub-studies published in scientific journals. Results Quality, usability and some methodological issues of using the FHDR were resolved. A descriptive epidemiological study on the injuries nationwide was conducted. Inpatient care costs were approximated nationwide. Indirect burden of fire-related deaths was reported. Finally, indirect costs and benefits of fire-related injuries were studied. Conclusions Conducting an incidence-based cost of illness study requires detailed person-level data. Due to multiple sources and raw data being administrative on nature makes the research burdensome. Annually on average direct and indirect costs exceed EUR 40 million (population 5.4 million). Majority of the costs are indirect.

798 Fire safety practices in assisted living and home care in Finland

Background People in vulnerable positions, e.g. elderly or disabled people, substance abuser or mental health patients have an increased risk of becoming fire victims. To avoid this risk fire safety knowledge and good practices are needed for professionals working in the field. The social and health policy in Finland prioritise assisted living and home care. At the same time the rescue service act stresses that the responsibility of fire safety is on building owners and service providers. Therefore, care professionals are in a novel situation as they are working at clients home and required to take into consideration diverse environment and self-determination of an individual. The aim of this study was to investigate the fire risk and good practices in assisted living and home care. Methods The data is from six group interviews done during 2014–2015. Each group included the whole care service chain: the client and one of his/her relatives, care-giver, service provider and planner representatives and fire safety officer. Each group interviewed represented different type of clients and assisted living facilities and service. Interviews took place in various regions in Finland. Results Each agent at the service chain had ambition to improve fire safety. However, the knowledge among professionals what requires to be done and what others belonging to the same service chain are doing was inadequate. Some safety tools were used but oftentimes the user did not understand enough about their function. Overall, most were interested in safety information and to improve the safety, but the will to invest on safety was low. Conclusions The care service chain has overall good motivation to improve the safety and fire safety of vulnerable people. However requirements of rescue service act did not materialise in assisted living as well as possible. There is apparent need of knowledge and vocational education material.

MONITORING REGIONAL ACCIDENTAL INJURY SITUATION IN FINLAND

Background Official Statistics of Finland (OSF) are a wide collection of statistics describing society’s development and state and must have common quality criteria, which are compatible with European Statistical System quality criteria. However, there is no OSF statistics focused solely on injuries, nor a database on the subject. The National Institute for Health and Welfare (THL) produces information on Finland’s injury statistics. For monitoring regional injury situation, THL produces national injury reports, published since 2009, divided into rescue regions and health care districts. National injury reports are released once a year and are intended to improve regional and local safety planning. Methods Data is collected from the THL Injury Database which contains all deaths and hospital care periods for injuries and external causes of mortality from 1996 to 2013 (ICD-10 codes S00-T983 and V00-Y98). THL Injury Database’s data originates from Finland’s National Hospital Discharge register and Statistics Finland’s Causes of Death register. Standardised mortality/morbidity rate based on indirect age- and gender standardisation is used for comparing regional accidental injury deaths, hospital care periods, number of patients and hospital care days. Results Injuries leading to hospital care periods happens more often in Northern and Eastern Finland than in Southern and Western Finland. Most injuries occur in leisure and free time. Falls are the most common cause of death and reason for hospital care periods in the whole country. Regional differences are explained among other things by varying alcohol consumption, local care practices and population structure. Conclusions Regional national injury reports provide up-to-date information on municipalities’ injury situation. Injury reports guide local officials involved in safety planning to the right direction.

415 Evidence-based fire safety education and training material for social and healthcare service providers

Background Fire safety in institutional care of vulnerable people in Finland is at a good level. However, in assisted living, residential and home care fatal fires still occur. Risk assessment, as well as knowledge of good procedures is therefore needed. Information of fire safety is included in vocational education of social and health care sector but for formal, non-formal and in-formal education material to improve care practices and identify the fire hazards at clients home is lacking. Objective The aim of the project was to produce evidence-based educational material about fire safety for social and health care professionals. To produce this material, data gathered by National Institute for Health and Welfare, literature and good practices from social and health care and rescue services were utilised. The project took place 2012–2016 and was sponsored by Fire Protection Fund. Results Fire safety education material for social and health care professionals, students and planners was first published in 2014. The web-based material includes information about background, legislation, fatal fire cases, principles of risk management and learning from accidents. In addition, there are statistic, special knowledge about fire sensitive fabrics, electrical equipment and chemicals and also good practices to improve fire safety. Additional compact educational package for craft teachers is available. The material can be used also in voluntary work and for example for people taking care of their relatives. Conclusions Web-based material is freely available at https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/step-hanke/stepin-koulutusaineisto. The material is available in Finnish and Swedish. English version is under consideration as there is urgent need of fire safety training also for increasing number of foreigners and immigrants in Finland.