| 1. |
- Johansson, Veronica, et al.
(författare)
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Contract and fee-for-service care - regression modelling of oral health-related quality of life
- 2007
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, implemented contract care alongside the traditional patient financial system of fee-for-service care. In contract care, the patient pays a fixed sum annually for dental care and then receives basic dental care without additional costs. Aim The aim was to study the relation between patient financial system and oral health-related quality of life (OHRQoL). Methods In 2003, a questionnaire was sent to 2,400 consecutively selected patients in the PDHS in Värmland, 1,200 from each patient financial system. The questionnaire was answered by 1,324 participants (57% of those who could be reached). The questionnaire contained questions about willingness to pay for dental care, how much one had paid for dental care the previous year, OHRQoL (measured with the OHIP-14), dental anxiety, humanism of caregiver, general health (measured with the SF-36), multidimensional health locus of control, sense of coherence, self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The data were analysed with a block method of multiple linear regression, adding blocks of variables in six steps: financial system, economic factors, individual factors, social factors, psychological factors and health factors. The threshold for statistical significance was set at p≤0.05. Results OHRQoL was affected by the financial system of the respondent: those in fee-for-service care had a worse OHRQoL than those in contract care. OHRQoL was also affected by health, sense of coherence and to some extent by psychological and economical factors. Of the social variables, only being foreign born had a significant effect on OHRQoL. Conclusions OHRQoL was found to be affected by patient financial system. Acknowledgements The study was financed by the Swedish Research Council.
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| 2. |
- Johansson, Veronica, et al.
(författare)
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Financial systems' impact on dental care : a review of fee-for-service and capitation systems
- 2007
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Ingår i: Community Dental Health. - 0265-539X. ; 24:1, s. 12-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective This review covers the impact of financial systems on dental care. Background Remuneration in fee-for-service (FFS) is done per service provided and in capitation (CAP) per patient enrolled. It may be expected that dentists’ incentive in CAP is to keep the number of services provided at a minimum, while in FFS it is to keep the number of services at a maximum. This should lead to a different impact on care, with the dentists in CAP focusing more on prevention and dentists in FFS more on restorative treatment. Six questions were put: Does CAP increase or decrease caries incidence? Does CAP increase or decrease restorative treatments? Does CAP increase preventive care? Does CAP increase or decrease productivity? Does CAP increase or decrease the dentist’s satisfaction with his/her work? Does CAP increase or decrease the patients’ satisfaction with the oral care provided? Methods Literature was obtained through searches in databases. A format was developed to define the literature of interest. Results CAP decreases restorative treatment and there is a tendency of decreased caries incidence. “Supervised neglect” cannot be established. CAP increases preventive care. A conclusion regarding productivity was not possible. The results on dentist’s satisfaction with work were inconclusive, as were the results regarding patient satisfaction. Conclusions CAP has a different impact on provided care than FFS. More research is needed in this area and focus on efficiency is of importance. This review was funded by the Swedish Research Council.
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| 3. |
- Johansson, Veronica, et al.
(författare)
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Multivariate analyses of patient financial systems and oral health-related quality of life
- 2010
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Ingår i: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 38:5, s. 436-444
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Since 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, has two co-existing patient financial systems, i.e. ways for the patient to pay for dental care services. Alongside the traditional system of fee-for-service payment, i.e. paying afterwards for provided services, a new system of contract care is offered. In this system, dental care is covered by a contractual agreement, for which the patient pays an annual fee and receives care covered by the contract without additional costs. The aim of this article was to study whether patient financial system was associated with oral health-related quality of life (OHRQoL). Methods: A questionnaire was answered by 1324 randomly selected patients, 52% from contract care and 48% from fee-for-service. The questionnaire contained questions about how much one was prepared to pay for dental care, how much one paid for dental care the previous year, OHIP-14 (measured OHRQoL), dental anxiety, humanism of caregiver, SF-36 (measured general health), multidimensional health locus of control, sense of coherence (SOC), self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The material was analysed with a hierarchical block method of multiple regression analysis. Results: When controlling for all other variables, patient financial system was one of the strongest associations with OHRQoL: patients in fee-for-service had worse OHRQoL than those in contract care. OHRQoL was also associated with general health, SOC and to some extent also with psychological and economic factors. Of the social variables, only being foreign born was significant: it was associated with worse OHRQoL. Conclusions: Patient financial system was associated with OHRQoL when controlling for confounding factors: patients in contract care had better OHRQoL than those in fee-for-service care.
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| 4. |
- Johansson, Veronica, et al.
(författare)
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Patients' health in contract and fee-for-service care : I. A descriptive comparison
- 2007
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Ingår i: Swedish Dental Journal. - : Swedish dental association. - 0347-9994. ; 31:1, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- Fee-for-service care, paying afterwards for services provided, is the traditional adult patient financial system in dentistry in Sweden. The public dental health service (PDHS) in the county of Värmland has since 1999 also an alternative system, contract care. There, a fixed sum of money is paid annually for dental care, which then is received without additional costs. This study compares the demographics, general health and oral health-related quality of life (OHRQoL) in the patient financial systems fee-for-service and contract care in the PDHS in Värmland. A questionnaire was answered by 1,324 patients, response rate 57%. A non-response analysis was undertaken. The non-response analysis showed that the likelihood for answering the questionnaire was higher for women, for respondents in contract care and for increasing age. Further analyses revealed that the non-respondents were healthier than the respondents and that experience of pain in the mouth was the only variable increasing the likelihood of response. General health was studied with the SF-36 and OHRQoL with the OHIP-14. The demographics studied were gender, age, birth country, marital status, education and social network. The results showed that there were differences in patients' health between the patient financial systems. Respondents in contract care had better OHRQoL than those in fee-for-service care. They also had better general health in four of the dimensions of SF-36, were younger, better educated, born in Sweden and were married/living with somebody to a larger extent than fee-for-service care respondents. Fee-for-service care respondents experienced higher social affinity with their housing area. In conclusion, patients in contract care had better general health and OHRQoL than patients in fee-for-service care. There were social differences in choice of financial system and biased non-response.
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| 5. |
- Sondell, Björn, et al.
(författare)
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Altered walking pattern in a virtual environment
- 2005
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Ingår i: Presence - Teleoperators and Virtual Environments. - Cambridge : MIT Press. - 1054-7460 .- 1531-3263. ; 14:2, s. 191-197
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Tidskriftsartikel (refereegranskat)abstract
- Falls and fractures among elderly persons constitute a major health problem. Many falls occur while walking and falls that occur during turning often result in a fracture. Methods aimed at understanding the complex mechanisms involved in walking should therefore assess tested individuals during walks and turns. In order to identify persons at risk and take the correct preventive measures, it is important to find methods that quantify movements as the tested persons are processing multisensory input. In a clinical setting this is sometimes difficult to achieve in a controlled manner, since tests are difficult to set exactly the same from one time to another. Using a virtual environment (VE) and a tracker system, conditions such as light, sound, events, body movements, and room size can be controlled and measured. Tests in VE can therefore be identically reproduced over and over again to evaluate if a person can withstand changing outer demands at any given moment. In order to perform quantitative measures 8 persons (21-74 years) were tested in immersive virtual reality. The VE was a corridor in which expected and unexpected events could be produced. Events studied were doors swinging open in front of the subjects during a walk and a virtual tilting of the environment. Trackers were used for collecting and analyzing the movement data. Our results show that the system was well tolerated among the subjects and that there was a clear tendency that the system could generate fall tendency among the subjects. There was also a difference among the subjects regarding walking strategies when subjected to the various events.
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| 6. |
- Backman, Anders, et al.
(författare)
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easyADL – Wearable Support System for Independent Life despite Dementia
- 2006
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Ingår i: ACM CHI 2006 Workshop onDesigning Technology for People with Cognitive Impairments.
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Konferensbidrag (refereegranskat)abstract
- This position paper outlines the easyADL project, a two-year project investigating the possibility of using wearable technology to assist people suffering the dementia disease in performing Activities of Daily Living (ADL). An introduction to the egocentric interaction modeling framework is provided and the virtual reality based development methodology is discusssed.
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| 7. |
- Ekholm, Elisabeth, et al.
(författare)
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Expression of stratum corneum chymotryptic enzyme in human sebaceous follicles
- 1998
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Ingår i: Acta Dermato-Venereologica. - : Society for the Publication of Acta Dermato - Venereologica. - 0001-5555 .- 1651-2057. ; 78:5, s. 343-347
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Tidskriftsartikel (refereegranskat)abstract
- Stratum corneum chymotryptic enzyme (SCCE) may be involved in desquamation, a process necessary for maintaining a normal anatomy at all sites where there is continuous turnover of cornified epithelia. Using immunohistochemistry and in situ hybridization, we have, in this work, analysed SCCE expression in the sebaceous follicle. We found expression of SCCE in luminal parts of the pilary canal, common sebaceous ducts and proximal sebaceous ducts. In addition, SCCE was seen in cells apparently situated within the distal parts of the glandular lobules. Co-expression of SCCE and keratin 10 was seen only in the pilary canal and the common sebaceous ducts. The results give further support for SCCE being involved in desquamation-like processes. The association with cornification seems to be more general for SCCE than for keratin 10. The possible role of SCCE in diseases involving disturbances in the turnover of cornified cells in the sebaceous follicle, such as acne vulgaris, is a question for future studies.
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| 8. |
- Eliasson, Alf, 1957-, et al.
(författare)
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Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants
- 2000
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786 .- 1942-4434. ; 15:4, s. 505-510
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Tidskriftsartikel (refereegranskat)abstract
- This study examined whether it is possible to restore an edentulous mandible with a complete-arch fixed prosthesis retained by only 4 implants without decreasing the survival rate. One hundred nineteen patients received complete-arch mandibular prostheses retained by 4 implants. Most patients were followed for 3 years or more. All patients followed a routine protocol, including annual check-ups and regular radiographic examinations. Twenty-one patients dropped out. Radiographic measurements used the threads of the implants as a basis for comparison. No indication was found that the number of supporting implants could have influenced the observed frequency of technical and surgical complications. Three implants were lost, 2 after 1 year and 1 after 5 years. A statistically significant difference in bone loss between the mesial and distal implants was found. The number of fractured resin teeth in mandibular prostheses was higher when patients had an implant-supported prosthesis in the maxilla. The present study revealed an implant survival rate of 98.6% after 5 years. Therefore, it was concluded that there may not be a need for more than 4 implants to support a fixed mandibular prosthesis, when implants at least 10 mm long can be used.
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| 9. |
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| 10. |
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| 11. |
- Nyberg, Lars, et al.
(författare)
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The development of a virtual reality system to study tendency of falling among older people
- 2005
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Ingår i: International Journal on Disability and Human Development. - 1565-012X. ; 4:3, s. 239-243
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Tidskriftsartikel (refereegranskat)abstract
- Injuries related to falls are a major threat to the health of older persons. A fall may result not only in an injury but also in a decreased sense of autonomy in the daily life. To be able to prevent such falls, a need to further understand the complex mechanisms involved in balance and walking is needed. Here we present an immersive virtual reality system, in which a person can move around while being subjected to various events, which may influence balance and walking
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| 12. |
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| 13. |
- Sondell, Björn, et al.
(författare)
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In situ evidence that the population of Langerhans cells in normal human epidermis may be heterogeneous
- 1997
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 0007-0963 .- 1365-2133. ; 136:5, s. 687-693
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Tidskriftsartikel (refereegranskat)abstract
- Epidermal Langerhans cells (LC) may occur in subsets with different phenotypic and functional characteristics. In this work give further evidence that the CD1a-positive LC population in the normal human epidermis may be heterogeneous. We found that one of our monoclonal antibodies (TE4B) to stratum corneum chymotryptic enzyme (SCCE) stained a population of dendritic cells in the normal epidermis in addition to high suprabasal keratinocytes. The staining of the dendritic cells was seen only when the biopsies had been fixed with formaldehyde and when the sections had been pretreated, either with proteolytic enzymes or with Triton X-100. The binding of the antibody was mediated through its antigen binding site, as it could be inhibited by adsorption with recombinant pro-SCCE. Experiments with double labelling showed that the TE4B-positive dendritic cells were also CD1a-positive. On the other hand, not all CD1a-positive cells were TE4B-positive. By means of confocal microscopy of double-labelled cells, the TE4B binding site could be localized intracellularly. SCCE-mRNA could be detected by in situ hybridization in high suprabasal keratinocytes only. A possible explanation may be that there is a subset of LC which have taken up SCCE secreted by high suprabasal keratinocytes. Alternatively, TE4B may bind to an epitope present in a subgroup of epidermal LC which cross-reacts immunologically with SCCE. It is suggested that the demonstrated heterogeneity of the population of LC in the normal epidermis should be taken into account in studies on the possible role of epidermal autoantigens in the development of immune-mediated skin diseases.
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| 14. |
- Sondell, Katarina, et al.
(författare)
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Dental care utilization in a Swedish county in 1993 and 2003
- 2010
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Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 34:4, s. 217-228
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study is to analyse factors influencing the patterns of utilization of dental care in an adult urban Swedish population aged between 30 and 80 in the years 1993 and 2003.This study is part of two large epidemiological dental studies of randomly selected Individuals, performed in 1993 and 2003. It comprises clinical and questionnaire data from 555 and 505 individuals in the two study years. In 1993, more patients visited the private dental care system more often than the public system. This difference still existed in 2003, but to a 50% lower extent. All age groups had less utilization of dental care in 2003 than in 1993. The largest change was seen in the 30-year age group in utilization patterns of dental care between the two study years. A hierarchical block regression method was performed in four steps, analysing utilization for the two study years separately. The dental service system influenced the utilization patterns significantly for both years. The health factors strengthened this main result. Irrespective of dental health, patients were predicted to visit the private dental ca re service system more often in both 1993 and 2OO3. The socio-economic differences between people in Sweden were of no consequence for dental care utilization. As to age and attitude towards treatment costs, a substantial change was observed and might reflect a change in social patterns with greater inequalities, but the overall picture of equal access in dental care in Sweden remains.
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| 15. |
- Sondell, Katarina, et al.
(författare)
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The dentist's communicative role in prosthodontic treatment
- 2004
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Ingår i: International Journal of Prosthodontics. - : Quintessence. - 0893-2174 .- 1139-9791. ; 17:6, s. 666-671
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- PURPOSE: Dentist-patient verbal communicatioo is important for patient satisfaction The aim of this study was to investigate the dentist´s role in the provider-patient relationship as to verbal communication and patient satisfaction with the treatment outcome in prosthetic dentistry. The dentist-specific properties were analyzed in random coefficient modeling MATERIALS AND METHODS: Sixty-one dentist-patient pairs were followed through 61 prosthodontic treatment periods. The treatment performed was ftxed prosthodontic restorations on teeth or implants One encounter at the end of each treatment period was tape recorded. The verbal communication on the recordings was analyzed using an interaction analysis instrument. Various measures of communication were used, summarizing the variational pattern of verbal interaction. Two differrent aspects of the patient satisfaction concept were used as dependent variables: cure (overall patient satisfaction with prosthodontic treatment), and care (patient satisfaction with a particular dental encounter during the prosthodontic treatment period). RESULTS: In the multilevel model for care, the dentist variance was mostly explained by the communication variables. In the cure model, there was no dentist variance. The communication patterns used by the dentists thus influenced patient satisfaction in a shortterm perspective but not in an intermediate perspective. CONCLUSION: Patient evaluation of the care during an encounter is dependent on the dentist´s verbal communication activity during the encounter, but this communication has no impact on the patient evaluation of overall prosthetic treatment outcome in the intermediate time perspective.
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| 16. |
- Sondell, Katarina, et al.
(författare)
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Underlying dimensions of verbal communication between dentists and patients in prosthetic dentistry
- 2003
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 50:2, s. 157-165
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The study explores whether the task-focused and socio-emotional dimensions of clinical communication is recognizable in the verbal communication context of prosthetic dentistry, as well as if there are other dimensions of communication in that context. Sixty-one audio recordings were made at three specialist clinics of prosthetic dentistry in Sweden. Sixty-one patients and 15 dentists participated. Sixty-one prosthetic rehabilitation periods were followed. Tooth- or implant-supported fixed prostheses were placed during this time. One visit near the end of each rehabilitation period was audiorecorded. The verbal communication was analyzed with the Roter Interaction Analysis System (RIAS)-dental. The categories were subjected to exploratory factor analysis. Patient and dentist verbal behavior could not be defined exclusively as socio-emotional or task-focused but had to be defined in other dimensions; Emotional exchange, information exchange-patient horizon, relation building exchange, information exchange-dentist horizon, and administrative and counseling exchange. Since the 'emotional exchange' factor was found to capture the largest share of the variance in the communicated patterns, the present study suggests that prosthetic care in dentistry is basically a human relationship with strong emotional communicative content.
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