Dental utilisation by young adults before and after subsidisation reform in Finland

Dental care was never fully integrated into the welfare state in Finland, but in 1986 it was decided to improve access to both publicly and privately provided dental care by reducing the price paid by patients. Since this would have been rather expensive to do for the whole population, it was decided to introduce it gradually, starting with the young adult population (those under 21 already had free publicly provided dental care). The so-called “Subsidisation Reform” (SR) was based on the assumption that the seeking of care would increase, as would the amount of care actually provided, and this increase would be spread across both the public and the private sectors. This study investigates the short-term effects of this reform. The seeking of care did increase, but the amount of care actually provided decreased and the changes were not evenly spread between the two sectors. The reasons for these changes are explored, and some of the inherent difficulties in evaluating health care reforms are set out, since they are likely to be of wider significance than this particular reform in Finland.reform, dental care

Morbidity and Causes of Death in Patients with Cutaneous T-cell Lymphoma in Finland

Cutaneous T-cell lymphomas (CTCL), especially mycosis fungoides, can be considered as a state of longstanding low-grade systemic inflammation. Many studies have focused on secondary cancers with CTCL, but information about comorbidities is limited. A total of 144 patients with CTCL at Helsinki University Central Hospital during 2005 to 2015 were studied to determine associated comorbidities and causes of death in this cohort. Compared with an age-standardized control population, the prevalence of type 2 diabetes mellitus was increased among patients with CTCL with no link to obesity. Patients with CTCL had a lower prevalence of hypertension, myocardial infarction and stroke than the control group. The 3 most common causes of death were CTCL, coronary artery disease and lung cancer. The increased risk of myocardial infarction or stroke reported previously was not detected in this patient group.Peer reviewe

CAPMH health-related quality of life among adolescent psychiatric outpatients : a 12-month follow-up study among 12-14-year-old Finnish boys and girls

BackgroundLittle is known about adolescents' perceptions about their health-related quality of life (HRQoL) in the course of routine adolescent psychiatric treatment. The aim of this 1-year follow-up study was to investigate HRQoL and changes in it among youths receiving adolescent psychiatric outpatient treatment.MethodsThe study comprised 158 girls and 82 boys aged 12-14years from 10 psychiatric outpatient clinics in one Finnish hospital district. Same-aged population controls (210 girls and 162 boys) were randomly collected from comprehensive schools. HRQoL was measured using the 16D instrument. The questionnaire was self-administered when the adolescents entered the polyclinics (=baseline), after a treatment period of 6months, and after 12months.ResultsThe mean age of respondents was 13.8years (SD 0.63). At baseline, the mean HRQoL score of both female and male outpatients was significantly lower than that of population controls (pPeer reviewe

Costs of sialendoscopy and impact on health-related quality of life

PurposeTo analyse costs related to the diagnosis and treatment of patients with sialolithiasis and sialadenitis managed with sialendoscopy, and to prospectively evaluate the impact of sialendoscopy on health-related quality of life (HRQoL) in a longitudinal follow-up study.MethodsAll patients undergoing sialendoscopy or sialendoscopy-assisted surgery at a tertiary care university hospital between January 2014 and May 2016 were identified from a surgical database, and the direct hospital costs were retrospectively evaluated from 1year before to 1year after the sialendoscopy. The 15D HRQoL questionnaire and a questionnaire exploring the use of health care services during the preceding 3months were mailed to the patients before sialendoscopy as well as at 3 and 12months after the operation.ResultsA total of 260 patients were identified. Mean total hospital costs, costs related to the sialendoscopy, and complications were significantly higher in sialolithiasis patients than in patients with other diagnoses. 74 patients returned the baseline 15D questionnaire, and 51 patients all three 15D questionnaires. At baseline, the dimensions discomfort and symptoms and distress were lower in patients than in age- and gender-standardised general population, but the total 15D score did not differ significantly. The dimension discomfort and symptoms improved significantly at 3 and 12months postoperatively, and the mean total HRQoL score improved in patients with sialolithiasis at 3months postoperatively.ConclusionsThe costs related to sialendoscopy are substantial and the cost-effectiveness of sialendoscopy warrants further studies. However, sialendoscopy seems to reduce patients' discomfort and ailments and to improve HRQoL at least in patients with sialolithiasis.Peer reviewe

Health-related quality of life of patients with zygomatic fracture

Background: The objective was to evaluate health-related quality of life (HRQoL) before and after surgical treatment of zygomatic complex fracture and assess patients’ perceptions of the aesthetic and functional outcomes of surgery. Material and Methods: A prospective study of 79 adult patients before and after surgery for zygomatic complex fracture was conducted. HRQoL was measured using the generic 15-dimensional (15D) instrument, and patient satisfaction was assessed by an additional questionnaire. Results: The mean preoperative 15D score for patients was lower than for general population that was matched for age and gender (p=0.011). The mean 15D score was lowest on the first postoperative day (p<0.001) when patients were worse off for 6 of the 15 dimensions of the HRQoL instrument and better off for three dimensions. However, patients achieved, and even exceeded, the mean 15D score of the general population during the first month following surgery. Infraorbital sensory loss at the end of the six-month follow-up appeared to be the single most important factor that plagued the patients. Conclusions: HRQoL is significantly reduced after trauma but improves a few weeks after surgery. Infraorbital nerve sensory loss is a notable long-term factor that affects patients after zygomatic complex fracture. Key words:Zygomatic fracture, maxillofacial trauma, health-related quality of life, disturbance of infraorbital nerve, facial sensation

Resilience and health-related quality of life in patients with pulmonary diseases receiving ambulatory oxygen therapy

Background: Pulmonary diseases affect health-related quality of life (HRQoL), but there are few data on patients' adaptation to a serious illness. This study assessed resilience and its associations with HRQoL, life satisfaction, anxiety and depression in patients with pulmonary diseases receiving ambulatory oxygen therapy. Methods: In this prospective cohort study, we enrolled 42 patients with pulmonary diseases receiving ambulatory oxygen therapy. The patients completed the following questionnaires at baseline and after one and three months; the Resilience Scale-25, the Life Satisfaction Scale-4, the 15D instrument of HRQoL, the Hospital Anxiety and Depression Scale (HADS) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). To compare HRQoL, we recruited age- and gender-matched controls from the general population (n = 3574). The primary outcome was the proportion of patients with low resilience. Results: Half (42-48%) of the patients had low resilience, which was correlated with low HRQoL, low levels of life satisfaction and higher levels of anxiety and depression. Patients had very low HRQoL compared to controls. Dissatisfaction with life increased during the 3-months follow-up, but only a few patients had anxiety or depression. Patient satisfaction with assistive technology was high; the median QUEST 2.0 score (scale 1-5) was 4.00 at baseline, 3.92 at one month and 3.88 at three months. Conclusions: Resilience was low in half of the patients with pulmonary diseases receiving ambulatory oxygen therapy. Higher resilience was positively correlated with HRQoL and life satisfaction and negatively correlated with anxiety and depression.Peer reviewe

Good mid-term outcome of the rotating hinge knee in primary total knee arthroplasty - Results of a single center cohort of 106 knees with a median follow-up of 6.3 years

Background: The prognosis of complex primary total knee arthroplasty (TKA) with severe deformity and ligament deficiency is not clear. There is a paucity of evidence in the current literature on treatment outcomes of the rotating hinge knee implants in primary TKA. The aim of this study was to determine the mid-term clinical, radiographic, and health-related quality of life (HRQoL) outcomes in patients who had undergone complex primary TKA using single hinged knee replacement. Methods: In total, 106 complex primary TKAs (101 patients) were performed using the single rotating hinged knee (RHK) implant design at our institution between January 2004 and December 2013. We conducted a retrospective analysis of prospectively collected outcome data of these patients, obtaining also information on all possible revision surgeries from the Finnish Arthroplasty Register, and conducted a prospective follow-up study of all living patients. Results: The 10-year Kaplan-Meier survival rate of the RHK knees was 91.6% (95% CI 86.0% to 97.2%) with revision for any reason as the endpoint. Overall, eight knees (7.5 %) underwent revision surgery during the follow-up. None of the unrevised RHK knees were radio-graphically loose. The majority of patients evinced good clinical outcome and quality of life as measured with patient reported outcome measures. Conclusion: The hinge knee replacement which was assessed current study can be regarded as a suitable option in complex primary TKA, provided adequate attention is paid to the correct indications and patient selection. (C) 2020 Elsevier B.V. All rights reserved.Peer reviewe