Glancing at the Content of Substantive Rules Under the Jurisdiction-Selecting Approach

Antalet individer med funktionsnedsättning ökar, dels beroende på att numera kan sjukdomar botas som tidigare inte kunde botas och dels beroende på att allt fler för tidigt födda barn kan räddas. Den orala hälsan är ofta negativt påverkad hos personer med funktionsnedsättning och det föreligger risk att dessa personer, trots ett större tandvårdsbehov än andra, erhåller mindre tandvård. Anledningen till detta är inte helt känd. Syftet med våra studier var därför att fördjupa kunskapen om hur personer med funktionsnedsättning och deras anhöriga prioriterar och tänker om oral hälsa. Syftet med studierna var också att fördjupa kunskapen om hur hälso- och sjukvårdspersonal samt tandvårdspersonal tänker om behov avseende bemötande och oral hälsa hos personer med funktionsnedsättning. Den kvalitativa forskningsmetoden grounded theory har valts då den är speciellt lämplig på områden där teorier är sparsamt förekommande eller saknas. Öppna kvalitativa intervjuer har genomförts med 65 informanter. Studierna visade att föräldrar till barn med funktionsnedsättning samt vuxna personer med kognitiva och/eller fysiska funktionsnedsättningar inte prioriterade den orala hälsan på grund av att andra mer akuta problem upplevdes som viktigare. Många personer med funktionsnedsättning vårdas kortare eller längre tid på vårdinrättningar, men kunskapen om oral hälsa var låg och inte prioriterad av personal inom hälso- och sjukvården. Personer med funktionsnedsättning återfinns inom såväl allmäntandvård som specialisttandvård och kunskapen om dessa patienters vårdbehov och bemötande av dem varierade mycket mellan olika kliniker, allmän- och specialisttandvård och mellan olika tandvårdspersonal. Sammantaget utgör dessa resultat en möjlig förklaring till varför personer med funktionsnedsättning löper ökad risk för oral ohälsa. Detta innebär också att en prioriterad, god oral hälsa och ett adekvat bemötande av personer med funktionsnedsättningar snarare kan handla om tur än om en jämlik rättighet

Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam

<p>Abstract</p> <p>Background</p> <p>High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam.</p> <p>Method</p> <p>The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis.</p> <p>Result</p> <p>Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment.</p> <p>Conclusion</p> <p>Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.</p

Oral hälsa hos barn i socialt utsatta områden – en utmaning

Alla som arbetar med barn ska känna till FNs Barnkonvention som bland annat anger att alla barn ska ha samma rätt till bästa möjliga hälsa. Trots god munhälsa i de nordiska länderna visar studier att barn som lever i social utsatthet har en starkt ökad risk för sämre munhälsa, att de inte nås av tandvårdens förebyggande arbete och inte kommer till tandvården på besök och behandling som andra barn. Därför behövs även särskilt riktade insatser i tillägg till det allmänna tandhälsoarbetet som riktas till alla barn. Det anses viktigt att promotions- och preventionsinsatserna börjar redan från tidig ålder. Det finns stora kunskapsluckor beträffande effekten av olika preventions- och behandlingsstrategier och det saknas ofta hälsoekonomiska analyser. Det är en särskild utmaning att på ett systematiskt sätt dokumentera och utvärdera de munhälsoinsatser som riktas till barn i socialt utsatta miljöer för att möjliggöra forskning. Här behövs tvärvetenskaplig forskning där även kliniker inkluderas. Visionen måste vara jämlik hälsa och att både hälsofrämjande och förebyggande åtgärder bidrar till att utjämna ojämlikheter i munhälsa mellan sociala grupper.publishedVersio

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. // Methods: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. // Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. // Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care

Updated clinical practice recommendations for managing adults with 22q11.2 deletion syndrome

This review aimed to update the clinical practice guidelines for managing adults with 22q11.2 deletion syndrome (22q11.2DS). The 22q11.2 Society recruited expert clinicians worldwide to revise the original clinical practice guidelines for adults in a stepwise process according to best practices: (1) a systematic literature search (1992-2021), (2) study selection and synthesis by clinical experts from 8 countries, covering 24 subspecialties, and (3) formulation of consensus recommendations based on the literature and further shaped by patient advocate survey results. Of 2441 22q11.2DS-relevant publications initially identified, 2344 received full-text review, with 2318 meeting inclusion criteria (clinical care relevance to 22q11.2DS) including 894 with potential relevance to adults. The evidence base remains limited. Thus multidisciplinary recommendations represent statements of current best practice for this evolving field, informed by the available literature. These recommendations provide guidance for the recognition, evaluation, surveillance, and management of the many emerging and chronic 22q11.2DS-associated multisystem morbidities relevant to adults. The recommendations also address key genetic counseling and psychosocial considerations for the increasing numbers of adults with this complex condition

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e‐Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. Methods: Following a registered protocol, a modified e‐Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care

Updated clinical practice recommendations for managing children with 22q11.2 deletion syndrome

This review aimed to update the clinical practice guidelines for managing children and adolescents with 22q11.2 deletion syndrome (22q11.2DS). The 22q11.2 Society, the international scientific organization studying chromosome 22q11.2 differences and related conditions, recruited expert clinicians worldwide to revise the original 2011 pediatric clinical practice guidelines in a stepwise process: (1) a systematic literature search (1992-2021), (2) study selection and data extraction by clinical experts from 9 different countries, covering 24 subspecialties, and (3) creation of a draft consensus document based on the literature and expert opinion, which was further shaped by survey results from family support organizations regarding perceived needs. Of 2441 22q11.2DS-relevant publications initially identified, 2344 received full-text reviews, including 1545 meeting criteria for potential relevance to clinical care of children and adolescents. Informed by the available literature, recommendations were formulated. Given evidence base limitations, multidisciplinary recommendations represent consensus statements of good practice for this evolving field. These recommendations provide contemporary guidance for evaluation, surveillance, and management of the many 22q11.2DS-associated physical, cognitive, behavioral, and psychiatric morbidities while addressing important genetic counseling and psychosocial issues

Summary of pain: Pain behaviour and distress in children during two sequential dental visits : comparing a computerised anaesthesia delivery system and a traditional syringe

Objective To compare the pain and distress response of children receiving a local anesthesia injection using a computerised device (Wand((R))) or a traditional syringe over two consecutive treatment sessions and to study whether the response to the two injection techniques was different for high or low dentally anxious children.Design Randomised controlled trial.Setting Secondary dental care practice specialised in treating children.Subjects and Methods Children were selected and randomly allocated to the Wand((R)) or traditional injection condition. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-ds). Based on video recordings of the injections, for each 15 seconds, the occurrence of five pain related behaviours was registered and a score was given on the Venham distress scale. Children rated their pain after each injection.Intervention Over two consecutive treatment sessions one group received two local anaesthesia injections with the traditional syringe and the other group received two injections with the Wand((R)).Outcome measures The mean number of pain related behaviours, the mean distress scores and the self-reported pain scores were compared. Based on the CFSS-ds subjects were split into highly and low dentally anxious children.Results One hundred and forty-seven subjects participated in the study: aged 4-11 years, 71 girls. Based on the behaviour displayed during the local anaesthesia injection and the self-reported pain after the injection, no difference could be found between an injection with the traditional syringe or the Wand((R)) over the first or second treatment session. However, on the first treatment session, highly anxious children reported more pain (p = 0.001), displayed more pain related behaviour (p = 0.002) and more distress (p <0.001) than low anxious children in reaction to the local anaesthesia injection.Conclusion No clear difference in the response of referred children could be found between an injection with the Wand((R)) or the traditional syringe. Level of dental anxiety was found to be an important factor in the response of children to a local anaesthesia injection