Varför uteblir unga yrkesverksamma vuxna från tandvården?

Syfte: Projektets syfte är att undersöka tänkbara faktorer till varför unga yrkesverksamma vuxna utan akademisk utbildning uteblir från tandvård efter att deras fria tandvård har upphört. Material & metod: Denna kvalitativa intervjustudie utfördes med hjälp av semistrukturerade intervjuer. Ljudupptagningarna skedde med digital inspelningsutrustning och därefter gjordes transkribering av materialet. Detta tolkades sedan, delades in i olika kategorier med gemensamma ämnesområden och analyserades. Resultat: En majoritet av intervjupersonerna hade mist kontinuiteten med tandvården på grund av de hade flyttat eller gjort en längre resa, alltså på något sätt förflyttat sig bort från den ort där de tidigare fått tandvård. Kostnaderna var inte den huvudsakliga anledningen till uteblivande. För de flesta hade sedan i huvudsak avsaknad av symptom och initiativkraft varit andra stora orsaker till att de inte fortsatt. Ytterligare faktorer spelade också in i intervjupersonernas agerande, så som exempelvis rädsla. Den slutliga kategoriindelningen resulterade i följande ämnesområden: rädsla, prioritering av tid, kontakt med tandvården, ekonomi, tandhälsa, kunskap om tandvård och brist på initiativkraft. Slutsats: Flera faktorer uppdagades till varför unga yrkesverksamma vuxna utan akademisk utbildning uteblir från tandvården. Det framkom att flera av faktorerna samverkar till uteblivande. Svaret på frågeställningen om anledningar till uteblivande är därmed komplex och svårigheter finns att endast ange enskilda faktorer till varför unga vuxna uteblir. Studien visar på att det kanske inte är nödvändigt med ekonomiska incitament, utan snarare att underlätta kallelse då kontakten har brutits. Mer information och kunskap behövs för att dessa personer ska uppsöka tandvården.Aim: The aim of this project is to explore possible reasons as to why young employed adults without academic education refrain from dental care after their free dental care has expired. Method: This qualitative interview study was carried out using semi-structured interviews. The recordings were obtained using digital recording equipment and were thereafter transcribed, divided into classes with common topics and thereafter interpreted and analyzed. Results: A majority of the interviewed had lost the continuity with the dental care due to moving or taking a trip away from the location where they previously were treated. Cost was not the main reason for refraining from dental care. An absence of symptoms and lack of initiative had for the majority been significant causes for not continuing. Additional reasons such as fear also contributed to their behavior. The final classes resulted in the following categories: fear, prioritation of time, contact with dental care, economy, dental health, knowledge regarding dental care and lack of initiative. Conclusion: Several reasons why young employed adults without academic education refrain from dental care were discovered and many reasons were discovered to interact. The answer as to why young employed adults refrain from dental care is therefore complex and there are difficulties in finding distinct reasons. The study shows that it might not be necessary with economical incentives but rather to facilitate contact. More information and knowledge is needed to find out how to motivate these individuals to contact the dental care system

Development of a collision avoidance system for a videoconferencing robot.

The work presented in this paper is about the development of a collision avoidance systemfor a mobile telepresence robot developed by the company Gira technologies AB.The robot is designed to extend the length of time elderly can stay in their homes beforerequiring full-time staed care. The collision avoidance system is needed to help the userto avoid running in to objects or down a stairway. The design must be capable of beingimplemented at low cost, and should not look overtly "robotic" as this would not resultin an appealing industrial design. Herein, dierent techniques are presented and analyzed to nd the best suitable solutionfor the robot. In particular a lot of work is done in taking measurements to nd theright characteristics for the sensors according dierent mounting angles, dierent objectsand distances. A solution is chosen and calculations are made to nd the best positionsto place the sensors to get the best results. A complete solution is presented and implemented in the current system and testedto work as expected

Long-term Outcome of Antiretroviral Treatment in Patients With and Without Concomitant Tuberculosis Receiving Health Center-Based Care-Results From a Prospective Cohort Study

Background: In order to increase treatment coverage, antiretroviral treatment (ART) is provided through primary health care in low-income high-burden countries, where tuberculosis (TB) co-infection is common. We investigated the long-term outcome of health center-based ART, with regard to concomitant TB.Methods: ART-naïve adults were included in a prospective cohort at Ethiopian health centers and followed for up to 4 years after starting ART. All participants were investigated for active TB at inclusion. The primary study outcomes were the impact of concomitant TB on all-cause mortality, loss to follow-up (LTFU), and lack of virological suppression (VS). Kaplan-Meier survival estimates and Cox proportional hazards models with multivariate adjustments were used.Results: In total, 141/729 (19%) subjects had concomitant TB, 85% with bacteriological confirmation (median CD4 count TB, 169 cells/mm3; IQR, 99-265; non-TB, 194 cells/mm3; IQR, 122-275). During follow-up (median, 2.5 years), 60 (8%) died and 58 (8%) were LTFU. After ≥6 months of ART, 131/630 (21%) had lack of VS. Concomitant TB did not influence the rates of death, LTFU, or VS. Male gender and malnutrition were associated with higher risk of adverse outcomes. Regardless of TB co-infection status, even after 3 years of ART, two-thirds of participants had CD4 counts below 500 cells/mm3.Conclusions: Concomitant TB did not impact treatment outcomes in adults investigated for active TB before starting ART at Ethiopian health centers. However, one-third of patients had unsatisfactory long-term treatment outcomes and immunologic recovery was slow, illustrating the need for new interventions to optimize ART programs

Brief Report : Interferon-γ-Inducible Protein 10-A Potential Marker for Targeted Viral Load Monitoring of Antiretroviral Treatment?

BACKGROUND: The use of surrogate markers for targeting viral load (VL) testing could be an alternative to universal VL testing during antiretroviral treatment (ART) and would allow for more effective resource allocation. We investigated the correlation between levels of HIV RNA and interferon-γ-inducible protein 10 (IP-10) in Ethiopian adults at 12 months after ART initiation. In addition, we specifically investigated differences in IP-10 levels between patients with and without virological suppression.SETTING: Cohort of HIV-positive adults receiving ART at Ethiopian health centers.METHODS: Using a nested case-control design, individuals without virological suppression (HIV RNA ≥ 150 copies/mL) at 12 months after ART initiation were gender-matched with virologically suppressed controls (1:2 ratio). IP-10 levels were correlated with HIV RNA, and the distribution of IP-10 was compared for 3 VL strata: <150 copies/mL (VL < 150), 150-999 copies/mL (VL150-999), and ≥1000 copies/mL (VL ≥ 1000).RESULTS: At 12 months after ART initiation, the following VL distribution was found among 192 individuals (50% women): VL < 150, 122/192 (63.5%); VL150-999, 23/192 (12.0%); and VL ≥ 1000 47/192 (24.5%). IP-10 and HIV RNA levels were positively correlated (r = 0.481; P < 0.0001). Median IP-10 levels for the VL strata were VL < 150: 159 pg/mL [interquartile range (IQR) 121-246], VL150-999: 174 pg/mL (IQR 131-276), and VL ≥ 1000: 343 pg/mL (IQR 190-529), respectively. These differences were statistically significant for VL ≥ 1000 versus VL < 150 (adjusted P < 0.001) and VL150-999 (adjusted P = 0.004), respectively.CONCLUSIONS: IP-10 and HIV RNA levels during ART showed significant correlations, with significantly higher IP-10 concentration in ART recipients with VL ≥ 1000 copies/mL compared to those with suppressed or undetectable VL

Comorbidities in hereditary angioedema-A population-based cohort study

Background: In hereditary angioedema (HAE), low levels (type 1) or defect in function (type 2) of the serine-protease inhibitor C1 Inhibitor protein results in activation of the classical pathway of the complement system as well as the contact system. Here, we investigated the risk of comorbidities in HAE. Methods: Individuals with HAE (n = 239; identified through a physician made diagnosis) and a control cohort from the general population (n = 2383; matched for age, gender, and county of residence) were compared with the Swedish inpatient, cause of death, cancer, and prescription registers. Conditional logistic regression was used to analyze the data. Results: Increased risk of cardiovascular disease (odds ratio [OR] 1.83; 95% confidence interval [CI] 1.32-2.54), including arterial (OR 6.74; 95% CI 1.89-24.06) and venous thromboembolic disease (OR 4.20; 95% CI 2.42-7.23) as well as hypertension (OR 1.64; 95% CI 1.12-2.39) was seen in HAE. There was also an increased number of individuals diagnosed with hyperlipidemia (OR 2.01; 95% CI 1.16-3.50) among HAE patients. Furthermore, the risk of autoimmune disease was increased (OR 1.65; 95% CI 1.15-2.35) being particularly pronounced for systemic lupus erythematosus (OR 71.87; 95% CI 8.80-586.7). The risk of having two or more autoimmune diseases was also higher among HAE patients (p = 0.017). In contrast, the risk of cancer was not increased. Data from the prescription register revealed higher prescription rates of drugs against hypertension, hypothyroidism, and hyperlipidemia among HAE patients. Conclusions: The results warrant for awareness and prevention of comorbid conditions, in particular, thromboembolic and autoimmune diseases in HAE. Future prophylactic interventions may modify these risks

Development of an algorithm for determination of the likelihood of virological failure in HIV-positive adults receiving antiretroviral therapy in decentralized care

Background: Early identification of virological failure (VF) limits occurrence and spread of drug-resistant viruses in patients receiving antiretroviral treatment (ART). Viral load (VL) monitoring is therefore recommended, but capacities to comply with this are insufficient in many low-income countries. Clinical algorithms might identify persons at higher likelihood of VF to allocate VL resources. Objectives: We aimed to construct a VF algorithm (the Viral Load Testing Criteria; VLTC) and compare its performance to the 2013 WHO treatment failure criteria. Methods: Subjects with VL results available 1 year after ART start (n = 494) were identified from a cohort of ART-naïve adults (n = 812), prospectively recruited and followed 2011-2015 at Ethiopian health centres. VF was defined as VL≥1000 copies/mL. Variables recorded at the time of sampling, with potential association with VF, were used to construct the algorithm based on multivariate logistic regression. Results: Fifty-seven individuals (12%) had VF, which was independently associated with CD4 count <350 cells/mm3, previous ART interruption, and short mid-upper arm circumference (<24cm and <23cm, for men and women, respectively). These variables were included in the VLTC. In derivation, the VLTC identified 52/57 with VF; sensitivity 91%, specificity 43%, positive predictive value (PPV) 17%, negative predictive value (NPV) 97%. In comparison, the WHO criteria identified 38/57 with VF (sensitivity 67%, specificity 74%, PPV 25%, NPV 94%). Conclusions: The VLTC identified subjects at greater likelihood of VF, with higher sensitivity and NPV than the WHO criteria. If external validation confirms this performance, these criteria could be used to allocate limited VL resources. Due to its limited specificity, it cannot be used to determine treatment failure in the absence of a confirmatory viral load

The demand-what-you-want strategy to service recovery : Achieving high customer satisfaction with low service failure compensation using anchoring and precision effects

Purpose Previous research suggests that the compensation offered to customers after a service failure has to be substantial to make customer satisfaction surpass that of an error-free service. However, with the right service recovery strategy, it might be possible to reduce compensation size while maintaining happy customers. The aim of the current study is to test whether an anchoring technique can be used to achieve this goal. Design/methodology/approach After experiencing a service failure, participants were told that there is a standard size of the compensation for service failures. The size of this standard was different depending on condition. Thereafter, participants were asked how much they would demand to be satisfied with their customer experience. Findings The compensation demand was relatively high on average (1,000–1,400 SEK, ≈ $120). However, telling the participants that customers typically receive 200 SEK as compensation reduced their demand to about 800 SEK (Experiment 1)—an anchoring effect. Moreover, a precise anchoring point (a typical compensation of 247 SEK) generated a lower demand than rounded anchoring points, even when the rounded anchoring point was lower (200 SEK) than the precise counterpart (Experiment 2)—a precision effect. Implications/value Setting a low compensation standard—yet allowing customers to actually receive compensations above the standard—can make customers more satisfied while also saving resources in demand-what-you-want service recovery situations, in particular when the compensation standard is a precise value

Performance of Galectin-9 for Identification of HIV Viremia in Adults Receiving Antiretroviral Therapy in a Resource-Limited Setting

Background: Targeted viral load (VL) testing has been proposed for antiretroviral treatment (ART) monitoring in resource-limited settings. In this study, we have investigated the performance of the host biomarker galectin-9 (Gal-9), alone and in combination with interferon-γ-inducible protein 10 (IP-10), in identifying individuals at increased likelihood of viremia during ART.Setting:Cohort of HIV-positive adults receiving ART at Ethiopian health centers.Methods:We included participants with detectable viremia (VL ≥150 copies/mL) 12 months after starting ART and sex-matched nonviremic controls. Performance to identify individuals with VL ≥1000 copies/mL was determined for Gal-9 and the Gal-9/IP-10 combination, respectively, using receiver operating characteristic (ROC) analysis.Results:Among 191 participants (50.3% women), 46 (24.1%) had VL ≥1000 copies/mL, 23 (12.0%) had 150-999 copies/mL, and 122 (63.9%) had <150 copies/mL. Gal-9 and VL were positively correlated (rs= 0.451, P < 0.001). Sensitivity and specificity for Gal-9 to identify individuals with VL ≥1000 copies/mL were 91.3% (95% CI: 79.2-97.6) and 54.5% (95% CI: 46.0-62.8), respectively. The area under the ROC curve for Gal-9 was 0.810 (95% CI: 0.745-0.875), which was similar to that of the combination of Gal-9 and IP-10 [0.849 (95% CI: 0.792-0.905)]. Assuming 10% prevalence of VL ≥1000 copies/mL, using Gal-9 for targeted VL testing instead of universal VL testing would reduce the number of VL tests from 10 to 5 to identify 1 viremic individual, with misclassification of 1 in 10 viremic individuals.Conclusions:Gal-9 is a potential screening marker for targeted VL monitoring in ART recipients. Further studies are needed to determine optimal threshold levels