Changes in Institutionalized Older People's Dentition Status in Helsinki, 2003-2017

Non peer reviewe

Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study

Background A growing number of older adults have natural teeth and are at high risk of oral diseases, which are induced by oral bacterial accumulation and proceed unnoticed and quietly. Our aim was (1) to examine the association of oral disease burden (ODB) with health and functioning among dentate long-term care residents, and (2) to find easily detectable signs for nurses to identify residents' poor oral health. Methods In this cross-sectional observational study dentists examined 209 residents' oral status, and nurses assessed residents for their functioning and nutrition in long-term care facilities in Helsinki, Finland. ODB was defined by asymptotic dental score (ADS). Six clinical signs of residents' poor oral health were considered as potentially easy for nurses to detect: lesions on lips, teeth with increased mobility, lesions on oral mucosa, eating soft or pureed food, unclear speech, and needing assistance in eating. The association of these was tested with high ODB as outcome. Results Participants were grouped according to their ADS scores: low (n = 39), moderate (n = 96) and high ODB (n = 74). ODB was linearly associated with coronary artery disease and poor cognitive and physical functioning: needing assistance in eating, poor ability to make contact, and unclear speech but not with other diseases including dementia or demographic characteristics. Furthermore, ODB was linearly associated with eating soft or pureed food. Of the six selected, easily detectable signs, having at least two positive signs gave 89% sensitivity to detecting high ODB. Conclusion Poor oral health was common and ODB accumulated among residents with poor functioning. Nurses may use a few easily detectable signs to screen residents' oral health when considering a resident's need for consultation with an oral health professional.Peer reviewe

Burden of Oral Symptoms and Health-Related Quality of Life in Long-Term Care Settings in Helsinki, Finland

Objectives Poor oral health may complicate eating and deteriorate nutritional status. However, little is known about how the burden of oral symptoms (OS) is associated with the health-related quality of life (HRQoL) of vulnerable older people in institutional settings. This study explores how the burden of certain OS (chewing problems, swallowing difficulties, dry mouth) is associated with functioning, morbidity, nutritional status and eating habits. It also examines the association between the OS burden and HRQoL. Design A cross-sectional study in 2017. Setting All long-term care wards in Helsinki, Finland. Participants 2401 older residents (74% females, mean age 83.9). Measurements Nurses assessed the residents and completed questionnaires on the participants' demographics, functional status, diagnoses, OS and eating habits. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and HRQoL with a 15-dimensional instrument (15D). Results Of the residents, 25.4% had one OS and 16.6% two or three OS. OS burden was associated linearly with poorer cognitive and physical functioning and a higher number of comorbidities, edentulousness without dentures, and less frequent teeth brushing/denture cleaning. OS burden was also associated with malnutrition, lower BMI and eating less during main meals. In the multivariate analyses adjusted for various confounding factors, a higher number of OS was associated with lower HRQoL. OS burden correlated with nearly all dimensions of HRQoL. Conclusion Oral symptoms are associated with generic HRQoL. Therefore, OS should be regularly assessed and managed in daily care.Peer reviewe

Relationship between Fried's frailty phenotype and oral frailty in long-term care residents

Background: oral frailty (OFr) may be called a syndrome lacking a consensus on its definition. Objective: the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care. Design: the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition. Setting: participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs). Subjects: the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland. Methods: frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination. Results: a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties. Conclusions: OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.Peer reviewe

Oral hygiene and health-related quality of life in institutionalized older people

Purpose We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored. Methods This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants' background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden. Results Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender. Conclusions Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents' oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups. Key summary pointsAim We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities. Findings Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL. Message Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.Peer reviewe

Musiikinopettajien käsityksiä musiikillisesta improvisaatiosta ja sille suotuisasta sosiaalisesta oppimisympäristöstä

Tiivistelmä. Tämän tutkielman tarkoitus on selvittää musiikinopettajien käsityksiä musiikillisesta improvisaatiosta ja musiikilliselle improvisaatiolle suotuisasta sosiaalisesta oppimisympäristöstä sekä sen rakentamisesta. Tutkielman tavoitteena on lisätä musiikinopettajien tietoisuutta sosiaalisen oppimisympäristön merkityksestä musiikillisen improvisaation kannalta. Teoreettisessa viitekehyksessä avataan sosiaaliseen toimintaan vaikuttavia rakenteellisia tekijöitä: sosiaalisen kehityksen, sosiaalisen oppimisympäristön ja ryhmän kehityksen sekä ryhmädynamiikan käsitteitä. Lisäksi esitellään Engeströmin toiminnan teoria, joka havainnollistaa ihmisen toiminnan kehittymisen prosessia. Tässä tutkielmassa toiminnan teoria on sijoitettu musiikillisen improvisaation sosiaaliseen oppimisympäristöön. Musiikillista improvisaatiota avataan luovuuden ja ryhmäimprovisaation näkökulmista. Luovuuden näkökulmasta musiikillinen improvisaatio rinnastuu säveltämiseen. Ryhmäimprovisaation näkökulmassa korostuu opettajan rooli improvisaation ohjaajana. Tämä tutkimus on kvalitatiivinen eli laadullinen kuvaileva tutkimus. Tutkimuksen metodologisena lähtökohtana on fenomenografinen tutkimus, jonka aineisto on kerätty teemahaastattelulla. Haastateltavina oli neljä (N=4) musiikinopettajaa, jotka käyttävät työssään musiikillista improvisaatiota ryhmäkontekstissa, kaksi heistä oli lukion ja kaksi vapaan sivistystyön musiikinopettajia. Haastateltavia yhdisti musiikillisen improvisaation käyttö musiikinopetuksen työvälineenä. Aineistoa on käsitelty sisällön analyysin metodein. Tutkimuskysymysten kannalta olennaiset vastaukset pelkistettiin ja edelleen luokiteltiin alaluokiksi, yläluokiksi ja lopuksi yhdistäviksi luokiksi. Yhdistävät luokat syntyivät prosessin aikana tehtyjen analyysien perusteella ja tulkittiin tutkielman tuloksiksi. Tutkielman tuloksina selvisi, että osallistujien käsitysten mukaan musiikillinen improvisaatio toimintana voi olla konkreettista tekemistä tai työskentelyn tapa. Ajattelutapana improvisaatio on toimintaa ohjaava myös muualla arjessa. Musiikillisen improvisaation kannalta suotuisa oppimisympäristö on turvallinen, salliva ja hyväksyvä. Opettajan pedagoginen toiminta ja didaktinen osaaminen ohjaavat opettajaa musiikillisen improvisaation kannalta suotuisan oppimisympäristön rakentamisessa. Opettajan tasapuolisuus, positiivinen palaute ja työrauhasta huolehtiminen ovat olennaisia ilmapiirin sallivuuden ja turvallisuuden näkökulmasta. Lisäksi selvisi, että oppimisympäristö rakentuu improvisoivan ryhmän jäsenten välisen vuorovaikutuksen ja kommunikaation kautta. Tällä tutkielmalla toimme näkyväksi musiikillisessa ryhmäimprovisaatiossa kommunikaation ja positiivisen vuorovaikutuksen erityisen suuren merkityksen

Dietary fat intake and quality in long-term care residents in two cohorts assessed 10 years apart

Purpose To describe and compare detailed dietary fat intake, fat quality and associative factors between two measuring points 10 years apart of residents living in long-term care facilities, and to reflect how fat composition and fat quality corresponds to current nutrition recommendations. Methods In 2007 long-term care residents (n = 374) of 25 assisted-living facilities and nursing homes and in 2017-18 long-term care residents (n = 486) of 17 respective facilities in Helsinki metropolitan area were recruited for this study. Information on the residents' heights, demographic information and use of calcium and vitamin D supplementation were retrieved from medical records. Residents' clinical assessment included Clinical Dementia Rating (CDR), the Mini Nutritional Assessment (MNA) and questionnaire related to nutrition care. Participants' energy and fat intake were determined from 1--2-day food diaries kept by the ward nurses, and fat quality indicators calculated. Results Age, gender distribution, MNA score or body mass index did not differ between the two cohorts. Residents' cognitive status, subjective health and mobility were poorer in 2017 compared to 2007. Total fat and saturated fatty acid (SFA) intakes were higher and fat quality indicators lower in the 2017 cohort residents than in the 2007 cohort residents. Sugar intake, male gender, eating independently, eating larger amounts and not having dry mouth predicted higher SFA intake in the 2017 cohort. Conclusions The fat quality in long-term care residents in our study worsened in spite of official recommendations between the two measurement points.Peer reviewe

Concentration Dependence of the Effective Mass of He-3 Atoms in He-3/He-4 Mixtures

Recent measurements by Yorozu et al. (S. Yorozu, H. Fukuyama, and H. Ishimoto, Phys. Rev. B 48, 9660 (1993)) as well as by Simons and Mueller (R. Simons and R. M. Mueller, Czhechoslowak Journal of Physics Suppl. 46, 201 (1976)) have determined the effective mass of He-3 atoms in a He-3/He-4 mixture with great accuracy. We here report theoretical calculations for the dependence of that effective mass on the He-3 concentration. Using correlated basis functions perturbation theory to infinite order to compute effective interactions in the appropriate channels, we obtain good agreement between theory and experiment.Comment: 4 pages, 1 figur

Efficient implementation of mining waste regulations and future tailings related qualifications

Tailings dams are usually operated by mining companies or consultancies with experience of tailings facilities and remain under the supervision of state mining authorities. However, the safety of tailings dams is often not the priority of mining safety legislation and may often not be considered in any great detail. Legislation applicable to tailings management facilities varies in the different EU Member States and it usually includes environmental protection legislation, waste legislation, water legislation, and construction laws. The relatively recent mining related accidents, Baia Mare/Romania in 2000 and Aznalcóllar/Spain in 1998 and the pollution they caused have attracted the attention of the public to the environmental and safety hazards of mining activities. As a response to these accidents the European Commission launched a proposal for a new directive "on the management of waste from the extractive industries" on 2.6.2003. It is believed that a common set of rules at EU level will establish a level playing field in terms of minimum administrative control and supervision in the extractive industry sector. The purpose of this paper is to present some ideas and suggestions as to how new mining regulations could be implemented and maintained

Single Particle and Fermi Liquid Properties of He-3/--He-4 Mixtures: A Microscopic Analysis

We calculate microscopically the properties of the dilute He-3 component in a He-3/--He-4 mixture. These depend on both, the dominant interaction between the impurity atom and the background, and the Fermi liquid contribution due to the interaction between the constituents of the He-3 component. We first calculate the dynamic structure function of a He-3 impurity atom moving in He-3. From that we obtain the excitation spectrum and the momentum dependent effective mass. The pole strength of this excitation mode is strongly reduced from the free particle value in agreement with experiments; part of the strength is distributed over high frequency excitations. Above k > 1.7$\AA$^{-1}$ the motion of the impurity is damped due to the decay into a roton and a low energy impurity mode. Next we determine the Fermi--Liquid interaction between He-4 atoms and calculate the pressure-- and concentration dependence of the effective mass, magnetic susceptibility, and the He-3--He-3 scattering phase shifts. The calculations are based on a dynamic theory that uses, as input, effective interactions provided by the Fermi hypernetted--chain theory. The relationship between both theories is discussed. Our theoretical effective masses agree well with recent measurements by Yorozu et al. (Phys. Rev. B 48, 9660 (1993)) as well as those by R. Simons and R. M. Mueller (Czekoslowak Journal of Physics Suppl. 46, 201 (1996)), but our analysis suggests a new extrapolation to the zero-concentration limit. With that effective mass we also find a good agreement with the measured Landau parameter F_0^a.Comment: 47 pages, 15 figure