Psychosocial well-being of orthognathic patients

Hampaiden oikomishoitoa ja leikkaushoitoa yhdistävä, ns. ortognaattinen hoito tähtää vakavien leukojen välisten ja hammaskaarten välisten epäsuhtien korjaamiseen ja potilaiden elämänlaadun kohentamiseen. Vakavat leukojen ja hammaskaarten väliset epäsuhdat vaikuttavat potilaiden suun terveyteen ja toimintaan sekä psykososiaaliseen hyvinvointiin. Tämän väitöskirjatutkimuksen tarkoituksena oli analysoida prospektiivisella tutkimusasetelmalla potilaiden psykososiaalista hyvinvointia ennen hoitoa, hoidon aikana ja hoidon jälkeen. Ortognaattisten potilaiden hoitoon hakeutumisen syistä, psykososiaalisesta hyvinvoinnista ja tyytyväisyydestä hoidon lopputulokseen tehtiin systemaattinen kirjallisuuskatsaus. Tutkimukseen mukaan otettujen artikkelien (n=35) mukaan tärkeimmät tekijät hoitoon hakeutumiselle olivat purennan toiminnan, itseluottamuksen ja ulkonäön parantuminen. Psykososiaalista hyvinvointia arvioitiin tutkimuksissa vaihtelevilla menetelmillä ja mittausaikatauluilla. Kokonaisuutena ortognaattiset potilaat eivät kokeneet muita enempää psykiatrisia oireita. Enemmistö potilaista oli tyytyväisiä hoidon lopputulokseen. Tulevien ortognaattisten potilaiden psykososiaalista hyvinvointia verrattiin tätä hoitoa tarvitsemattomien nuorten aikuisten psykososiaaliseen hyvinvointiin. Tutkimusaineisto kerättiin kyselylomakkeilla, jotka arvioivat psykiatrisia oireita (Symptom Checklist 90), itsetuntoa (Rosenberg Self-Esteem Scale), psykologista joustavuutta (Acceptance and Action Questionnaire II), terveydentilaspesifiä elämänlaatua (Orthognathic Quality of Life Questionnaire), ja kehonkuvaa. Lisaksi potilaat arvioivat päivittäisiä tunteitaan strukturoidun päiväkirjan avulla ja arvioivat hampaistonsa ulkonäköä asteikolla yhdestä kymmeneen. Aineisto kerättiin ennen hoidon alkua. Suurin osa potilaista selviytyi hyvin leukojen epäsuhdan kanssa, vaikka se aiheutti vaikeuksia esimerkiksi haukatessa ja pureskellessa. Elämänlaatu ja kehonkuva olivat verrokeita heikompia niillä potilailla, jotka arvioivat hampaistonsa ulkonäön huonommaksi. Itsetunto ja psykologinen joustavuus eivät eronneet potilaiden ja verrokeiden välillä. Potilaiden psykososiaalista hyvinvointia arvioitiin hoidon kuudessa vaiheessa: ennen hoitoa (T0), ensimmäisen ortodonttisen tarkastuksen jälkeen (T1), kun kiinteät oikomiskojeet olivat olleet suussa 6 viikkoa -2 kuukautta (T2), 3-4 viikkoa ennen ortognaattista leikkausta (T3), 6 viikkoa leikkauksen jälkeen (T4), ja vuosi leikkauksen jälkeen (T5). Verrokeiden aineisto kerättiin potilaiden aineistonkeruuhetkiä T0, T4 ja T5 vastaavina ajankohtina. Tulokset viittasivat siihen, että hoidon seurauksena potilaiden terveydentilaspesifi elämänlaatu ja kehonkuva paranivat ja psykiatriset oireet vähenivät. Kokonaisuutena potilaiden psykososiaalinen hyvinvointi näyttäytyi yhtä hyvänä tai jopa parempana kuin verrokeiden. Hoidon pitkäkestoisten vaikutusten ymmärtämiseksi tulevaisuudessa tarvitaan lisää prospektiivisia tutkimuksia, joissa hyödynnetään sekä psyykkistä hyvinvointia laajemmin arvioivia menetelmiä että terveydentilaspesifejä menetelmiä. Lisaksi strukturoitujen päiväkirjojen hyödyntäminen täydentävänä tutkimusmenetelmänä lisää ymmärrystä niistä tunteista, joita potilaat kokevat jokapäiväisessä elämässään.Orthognathic treatment combining orthodontics and surgery aims at correcting severe dentofacial discrepancies and improving patients' quality of life. Several factors motivate patients to seek this treatment as severe dentofacial discrepancies affect patients' oral health and function, and psychosocial well-being. This thesis aimed at analyzing patients' psychosocial well-being before, during, and after orthognathic treatment using a prospective study design. A systematic literature review on orthognathic patients' motivation for treatment, psychosocial well-being, and satisfaction with treatment outcome was conducted. According to the included studies (n=35), the main motives for treatment were improvements in the stomatognathic system, self-confidence, and appearance. Psychosocial well-being was evaluated using a range of questionnaires, and with varying data collection points. Overall, orthognathic patients did not experience psychiatric symptoms to a greater degree than others. The vast majority of patients were satisfied with treatment outcome. Prospective orthognathic patients' psychosocial well-being was compared to that of young adults without orthognathic treatment need. Data was collected with questionnaires evaluating psychiatric symptoms (Symptom Checklist-90), self- esteem (Rosenberg Self-Esteem Scale), psychological flexibility (Acceptance and Action Questionnaire II), condition-specific quality of life (Orthognathic Quality of Life Questionnaire), and body image (body image questionnaire). Also, patients' assessed their daily emotions with a structured diary, and graded their own dental appearance on a scale from 1 to 10 -esthetic Component of the Index of Orthodontic Treatment Need). Data was collected before beginning treatment. Most of the patients coped well with their dentofacial deformities despite experiencing evident masticatory problems. Among the patients who graded their dental appearance as worse, quality of life and body image were lower than among controls. Self-esteem and psychological flexibility did not differ between patients and controls. Orthognathic patients' psychosocial well-being was evaluated in 6 treatment phases: before treatment (T0), after first orthodontic examination (T1), from 6 weeks to 2 months after placement of fixed orthodontic appliances (T2), 3-4 weeks before orthognathic surgery (T3), 6 weeks after surgery (T4), and 1 year after surgery (T5). Control group data was collected at time points corresponding to patients' T0, T4, and T5. The results indicated that treatment produced improvements in patients' psychosocial well-being with regard to condition-specific quality of life, body image, and psychiatric symptoms. The results regarding patients' psychosocial well-being were equal to or even better than for controls 1 year after surgery. In the future, prospective studies with both general measures of psychological well-being and condition-specific measures are needed to better understand the long- term effects of treatment. Furthermore, in addition to questionnaires, also structured diaries would bring new information about patients' emotions in their daily lives

Writing Otherwise than Seeing : Writing and Exteriority in Maurice Blanchot

Maurice Blanchot (1907-2003), the French writer and novelist, is one of the most important figures in post-war French literature and philosophy. The main intention of this study is to figure out his position and originality in the field of phenomenology. Since this thesis concentrates on the notion of vision in Blanchot s work, its primary context is the post-war discussion of the relation between seeing and thinking in France, and particularly the discussion of the conditions of non-violent vision and language. The focus will be on the philosophical conversation between Blanchot and his contemporary philosophers. The central premise is the following: Blanchot relates the criticism of vision to the criticism of the representative model of language. In this thesis, Blanchot s definition of literary language as the refusal to reveal anything is read as a reference pointing in two directions. First, to Hegel s idea of naming as negativity which reveals Being incrementally to man, and second, to Heidegger s idea of poetry as the simultaneity of revealing and withdrawal; the aim is to prove that eventually Blanchot opposes both Hegel s idea of naming as a gradual revelation of the totality of being and Heidegger s conception of poetry as a way of revealing the truth of Being. My other central hypothesis is that for Blanchot, the criticism of the privilege of vision is always related to the problematic of the exteriority. The principal intention is to trace how Blanchot s idea of language as infinity and exteriority challenges both the Hegelian idea of naming as conceptualizing things and Heidegger s concept of language as a way to truth (as aletheia). The intention is to show how Blanchot, with his concepts of fascination, resemblance and image, both affirms and challenges the central points of Heidegger s thinking on language. Blanchot s originality in, and contribution to, the discussion about the violence of vision and language is found in his answer to the question of how to approach the other by avoiding the worst violence . I claim that by criticizing the idea of language as naming both in Hegel and Heidegger, Blanchot generates an account of language which, since it neither negates nor creates Being, is beyond the metaphysical opposition between Being and non-Being.Maurice Blanchot (1907-2003) on eräs merkittävimmistä ranskalaisista sodanjälkeisistä kirjailijoista ja esseisteistä. Tutkimuksessa tarkastellaan Blanchot'n 1940-60-lukujen tuotantoa pohtimalla sen suhdetta ajankohdan fenomenologisen filosofian kenttään. Keskityn katseen käsitteen merkitykseen Blanchot'n tuotannossa. Tutkimuksen keskiössä on Blanchot'n ja hänen aikalaistensa välinen keskustelu siitä, mikä on kielen, ajattelun ja näkemisen välinen suhde, ja onko ns. ei-representoiva (ei-väkivaltainen, ei-objektivoiva) kieli mahdollista

Mediapoliitikko avaa silmät politiikan muutokselle

Pekka Isotalus: Mediapoliitikko. Gaudeamus 2017

Association between quality of life and severity of profile deviation in prospective orthognathic patients

Aimto evaluate whether severity of skeletal facial profile deviation assessed by professionals associates with quality of life and psychosocial factors in patients with dentofacial deformities and prospective orthognathic treatment.Materials and methodThe study consisted of 55 patients admitted to orthognathic treatment. Skeletal profile was assessed from lateral head films using cephalometric analysis. The following angles were used to assess the sagittal position of upper and lower jaw and profile: Sella-Nasion-A-point-angle, Sella-Nasion-B-point-angle, and A-point-Nasion-B-point-angle (ANB). For vertical assessment, gonial angle and the angle between Sella-Nasion and mandibular plane were used. Merrifield’s Z-angle was used to assess soft-tissue profile. Severity of skeletal facial profile deviation was assessed with deviation in ANB angle. Orthognathic quality of life (OQoL) and psychosocial factors were defined with four questionnaires: Orthognathic Quality of Life Questionnaire, Symptom Checklist-90, Rosenberg Self-Esteem Scale, and a body image questionnaire.ResultsIncrease in ANB deviation was associated with increased awareness of dentofacial deformity [Orthognathic Quality of Life Questionnaire subscale awareness of dentofacial deformity (OQLQ-AoDD), r = 0.319, P = 0.017). OQOL-AoDD was not found to be equal when ANB angle was divided into three different categories (χ 2 = 6.78, P = 0.034): G1. ANB = 0–4 degrees; G2. ANB 4 degrees. Furthermore, categories G1 and G2 differed significantly (U = 50.5, P = 0.017). Increase in ANB angle was also associated with a more positive body image (r = 0.342, P = .023). There were no significant correlations between other cephalometric variables, quality of life, and psychosocial factors.ConclusionSkeletal facial profile seems to associate with some aspects of orthognathic quality of life. Professional cephalometric analysis of the severity of facial profile deviation correlates with patients’ awareness of their own facial and dental appearance. Patients with more deviating skeletal profile are more aware of their dentofacial deformities compared to patients with normal values.</div

Reading and math abilities of Finnish school beginners born very preterm or with very low birth weight

Reading and math skills of preterm born (birth weight 1500 g or gestational age:532 weeks) children and full term (FT) children were compared during the first weeks of grade 1. The participants were 194 preterm born and 175 FT children born between 2001 and 2006. There were more precocious readers among FT than among preterm students, but even the latter performed close to the national norm. FT and preterm group differences among non-readers were minor with only rapid naming showing a robust difference. Math performance showed a stable difference in favor of FT students and the difference was sustained in the full-scale IQcontrol. Major brain pathology increased the likelihood of poor scholastic skills, but lower birth weight relative to gestational age did not. Somewhat surprisingly, maternal education was not associated with school readiness skills. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

A longitudinal study of changes in psychosocial well-being during orthognathic treatment

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n = 22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n = 22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2–T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.</p

Does orthognathic treatment improve patients' psychosocial well-being?

Objective: To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed. Materials and methods: Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test. Results: OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function. Conclusions: Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.</p

Integrins are not essential for entry of coxsackievirus A9 into SW480 human colon adenocarcinoma cells

Background: Coxsackievirus A9 (CV-A9) is a pathogenic enterovirus type within the family Picornaviridae. CV-A9 infects A549 human epithelial lung carcinoma cells by attaching to the alpha V beta 6 integrin receptor through a highly conserved Arg-Gly-Asp (RGD) motif, which is located at the exposed carboxy-terminus of the capsid protein VP1 detected in all studied clinical isolates. However, genetically-modified CV-A9 that lacks the RGD motif (CV-A9-RGDdel) has been shown to be infectious in some cell lines but not in A549, suggesting that RGD-mediated integrin binding is not always essential for efficient entry of CV-A9. Methods: Two cell lines, A549 and SW480, were used in the study. SW480 was the study object for the integrin-independent entry and A549 was used as the control for integrin-dependent entry. Receptor levels were quantitated by cell sorting and quantitative PCR. Antibody blocking assay and siRNA silencing of receptor-encoding genes were used to block virus infection. Peptide phage display library was used to identify peptide binders to CV-A9. Immunofluorescence and confocal microscopy were used to visualize the virus infection in the cells. Results: We investigated the receptor use and early stages of CV-A9 internalization to SW480 human epithelial colon adenocarcinoma cells. Contrary to A549 infection, we showed that both CV-A9 and CV-A9-RGDdel internalized into SW480 cells and that function-blocking anti-alpha V integrin antibodies had no effect on the binding and entry of CV-A9. Whereas siRNA silencing of beta 6 integrin subunit had no influence on virus infection in SW480, silencing of beta 2-microglobulin (beta 2M) inhibited the virus infection in both cell lines. By using a peptide phage display screening, the virus-binding peptide identical to the N-terminal sequence of HSPA5 protein was identified and shown to block the virus infection in both A549 and SW480 cell lines. HSPA5 was also found to co-localize with CV-A9 at the SW480 cell periphery during the early stages of infection by confocal microscopy. Conclusions: The data suggest that while alpha V beta 6 integrin is essential for CV-A9 in A549 cell line, it is not required in SW480 cell line in which beta 2M and HSPA5 alone are sufficient for CV-A9 infection. This suggests that the choice of CV-A9 receptor(s) is dependent on the tissue/cellular environment.Peer reviewe

Introduction and assessment of orthognathic information clinic

Orthognathic treatment is routine practice to rehabilitate severe malocclusions and dentofacial deformities. Because orthognathic treatment is elective, patient's involvement in deciding whether to proceed with treatment is vital. Interaction and communication between patient and treating team plays a key role in achieving post-treatment satisfaction. To achieve satisfaction, an orthognathic 'information clinic' for prospective orthognathic patients was established at Oral and Maxillofacial Unit, Tampere University Hospital, Finland. 'Information clinic' includes short talks with power-point presentation given by orthodontist, oral hygienist, oral and maxillofacial surgeon, psychologist, and previous patient. Aim of the study was to set up an 'information clinic' and, more specifically, 1. to assess patients' opinions on the 'clinic' during pilot phase (2013-14) and 2. to analyse general statistics during the first 3 years (2013-16). During the pilot phase, patient opinions, based on voluntary questionnaire, were obtained from 85 people. General data were collected for the clinics run in 2013-16. Seventy-two per cent of respondents reported the information provided to help in their decision-making to proceed/not proceed with treatment. Majority considered the information about the surgical aspects and meeting patient who had undergone orthognathic treatment to be the most important part of the clinic. Between March 2013 and 2016, 290 prospective orthognathic patients were invited to 29 'information clinics'. One hundred and ninety-four patients attended, of whom 137 were female and 57 male (age range 15-67 years). The questionnaire and verbal feedback from the patients was positive; hence, the 'information clinic' is now offered as a routine process to all prospective orthognathic patients in our clinic. Background/Objectives Methods Results Conclusion