| 1. |
- Al-Harthy, Mohammad H.
(författare)
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Cross-cultural differences in patients with temporomandibular disorders-pain : a multi-center study
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall objective of this thesis was to investigate patients with TMD-pain and TMD-free controls in three cultures (Saudi Arabia, Sweden, and Italy) to determine the influence of culture on and crosscultural differences in pain prevalence and intensity, sensitivity to mechanical and electrical stimulation, pain-related disability for four comorbid pain conditions (back, head, chest, and stomach pain) in the last 6 months, and the type of treatment that patients with TMD pain received. The specific aims were: (i) To determine the frequency of TMD pain in Saudi Arabians (I). (ii) To compare psychophysical responses to mechanical and electrical stimuli in female TMD patients and TMD-free controls, nested within each of three cultures (Saudi, Italian, and Swedish) (II). (iii) To assess pain prevalence and intensity, and pain-related disability associated with comorbid pain conditions by testing for the interaction effect between three different cultures and case-status (III). (iv) To assess the type of treatment that female patients with TMD-pain in three cultures received, and their beliefs about the factors that contribute to and aggravate TMD, as well as the factors that are important to include in TMD treatment (IV). Study (I) material included 325 Saudi Arabian patients (135 males, 190 females) aged 20–40, who were referred to the Specialist Dental Center at Alnoor Specialist Hospital, Makkah and answered a history questionnaire. We offered a clinical examination to patients reporting TMD pain in the last month and assessment according to the Arabic version of the Research Diagnostic Criteria for TMD (RDC/TMD). Of these patients, 58 (18%) reported TMD pain and 46 underwent clinical examination. All TMD pain patients had a diagnosis of myofascial pain, and 65% had diagnoses of arthralgia or osteoarthritis. The TMD-pain group reported high levels of both headaches/migraines in the last 6 months (93%) differing significantly (P < 0.01) from the TMD-pain-free groups. All pain group were suffering at least from one TMD subdiagnosis The TMD-pain group had high depression and somatization scores but low disability grades on the Graded Chronic Pain Scale (GCPS). Studies (II-IV) compared 122 female cases of chronic TMD pain (39 Saudis, 41 Swedes, and 42 Italians) to equal numbers of agematched TMD-free controls. The study (II) measured pressure pain threshold (PPT) and tolerance (PPTo) over one hand and two masticatory muscles, and electrical perception threshold, electrical pain threshold (EPT), and electrical pain tolerance (EPTo) between the thumb and index fingers. Italian females reported significantly lower PPT in the masseter muscle than the other cultures (P < 0.01) and in the temporalis muscle than Saudis (P < 0.01). Swedes reported significantly higher PPT in the thenar muscle than the other cultures (P = 0.017). Italians reported significantly lower PPTo in all muscles than Swedes (P < 0.01) and in the masseter muscle than Saudis (P < 0.01). Italians reported significantly lower EPTo than other cultures (P = 0.01). TMD cases reported lower PPT and PPTo than TMD-free controls in all three muscles (P < 0.01). Cultural differences appeared in PPT, PPTo and EPTo. Overall, Italian females reported the highest sensitivity to both mechanical and electrical stimulation, while Swedes reported the lowest sensitivity. Mechanical pain thresholds differed more across cultures than did electrical pain thresholds. Cultural factors may influence response to type of pain test. In Study (III), self-report questionnaires assessed back, chest, stomach, and head pain for prevalence, intensity, and interference with daily activities in the last 6 months. Logistic regression assessed binary variables and ANCOVA provided parametric data analysis, adjusting for age and education. Back pain was the only comorbid condition that varied in prevalence across cultures; Headache was the most common comorbid pain condition in all three cultures; the average head pain intensity was lower, however, among Swedes compared to Saudis (P = 0.029). The total number of comorbid conditions did not differ cross-culturally, but the TMD group reported more comorbid conditions compared to TMD-free controls (P < 0.01). For both back and head pain, TMD cases reported higher average pain intensities (P < 0.01) and interference with daily activities (P < 0.01) than TMD-free controls. Among TMD patients, Italians reported the highest pain-related disability (P < 0.01). This study indicates that culture influences the comorbidity of common pain conditions with TMD. The cultural influence on pain expression is reflected in different patterns of physical representation. Study (IV) compared patient characteristics, treatment beliefs, and type of practitioner advice received before referral for TMD treatment. Patients responded to a questionnaire that assessed treatments received, then completed an explanatory model form about their beliefs regarding which factors contribute to and aggravate TMD, and what factors are important for treatment to address. Of the various treatments, Swedes most commonly sought behavioral therapy and Saudis Islamic medicine (P < 0.01). Swedes received acupuncture and occlusal appliance therapy significantly more than Saudis (P < 0.01) or Italians (P = 0.012). Italians were significantly less likely than Saudis and Swedes (P = 0.042) to believe that TMD pain treatment should address behavioral factors. Among Saudi, Italian, and Swedish females with chronic TMD pain, culture did not influence the type of practitioner consulted before visiting a TMD specialist or their beliefs about factors contributing to or aggravating their pain. Overall, the treatments patients received and beliefs about behavioral factors differed cross-culturally. Islamic medicine was fairly common among Saudis and acupuncture was common among Swedes.
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| 2. |
- Anderud, Jonas
(författare)
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On guided bone regeneration using ceramic membranes
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Regeneration of bone in the oral and maxillofacial region can beachieved with different techniques such as autologous bone grafts,bone substitutes and guided bone regeneration. Guided boneregeneration is defined as creating a space between the bone and itssurrounding tissues, using a barrier that allows new bone to migrateinto the space while preventing other cell types from interfering. Thebarrier material should be biocompatible, have suitable occlusiveproperties and be able to maintain the created space for boneregeneration. A wide range of different materials has been used.The general aim was to evaluate a novel method of guided boneregeneration using designed ceramic space maintaining devices onanimals and humans. An experimental rabbit model was used in studies I, II and III.60 different domes shaped as halfspheres were fixed with titaniumscrews to the skull bone of 30 rabbits. The domes had 5 differentcharacteristics; 1) Dense hydroxyapatite with a moderately roughinner surface (HA rough), 2) Dense hydroxyapatite with a smoothinner surface (HA smooth), 3) Microporous hydroxyapatite with amoderately rough inner surface (HA μ), 4) Dense hydroxyapatite witha moderately rough inner surface and macroscopic holes (HA holes)and 5) Zirconia with a moderately rough inner surface (Zirconia).The domes were left to heal for 12 weeks before the animals wereeuthanized and the results were analysed with histomorphology andmicro-CT. The results revealed that Zirconia with a moderately rough innersurface produced the largest amount of newly formed bone althoughthe results were difficult to interpret as the Zirconia domes weredifficult to X-ray because of the very dense nature of the material.In study IV, 3 patients had bone regeneration treatment with aZirconia barrier. Patient 1 had posterior maxillary bone deficiencyin a transverse direction. Patient 2 had anterior maxillary bonedeficiency in a vertical and transverse direction. Patient 3 hadposterior mandibular bone deficiency in a vertical direction. Basedon individual digital models, Zirconia membranes correspondingto the amount of bone intended to be regenerated were designedand manufactured. The Zirconia membranes, were attached tothe underlying bone with titanium screws and covered with theperiosteum and mucosa. After a mean healing time of 7 months themembranes were removed and dental implants were installed. The results showed new bone regeneration corresponding tothe design of the space maintained. None of the patients had anymajor complications aside from normal postoperative discomfort.According to evaluation with CBCT all patients gained new bone inthe desired and preoperatively planned region.
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| 3. |
- Diogo Löfgren, Christina
(författare)
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Oral dryness in relation to film-forming properties of saliva
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dry mouth, or oral dryness, is a complex and quite commoncondition, reported with a varying prevalence of 10-80 %, expressed as a physiological deficiency with or without perceived dysfunction. This condition can severely affect oral health, oral function andquality of life.This thesis is based on four studies:Study I is a systematic review of the scientific literature and anevaluation of the quality of the evidence for diagnostic methods used to identify oral dryness. The literature included publications during the time period January 1966 to February 2011.Results and conclusions: The database searches resulted in 224 titles and abstracts. A total of 18 original studies were judged relevant and interpreted for this review. When evaluating the included studies witha quality assessment tool for diagnostic accuracy, many of the studiesexhibited shortcomings. The most common shortcomings were that the patient selection criteria were not clearly described and the test or reference methods were not described in sufficient detail. Seven of the included studies presented their results as a percentage of correct diagnoses. The evidence for the efficacy of clinical methods to assess oral dryness is sparse and improved standards for the reporting ofdiagnostic accuracy are needed in order to assure the methodological quality of studies. Furthermore, a global consensus regarding theterminology of oral dryness is needed in order to facilitate diagnostic procedures, choice of treatment and research design. Salivary dysfunction has mainly been described as being related to low salivary flow rate but the correlation between salivary flow rate and symptoms has shown to be weak. This suggests that not onlyquantity as a parameter, but also qualitative parameters of saliva,are needed to be included as factors of importance in evaluatingthe perception of oral dryness. The protective functions of salivaare performed both through and within the bulk liquid phase ofsaliva, but maybe more implicit through saliva components beingdynamically associated as a thin intermediary film on all surfacesexposed in the oral cavity. For instance, examples of qualitativeprotective functions of surface associated saliva would be the film- forming capacity and rheological characteristics of saliva. Today thereis a lack of clinical diagnostic methods that systematically combine individual’s perception of saliva and tests of protective functions of saliva, which in combination may identify individuals at risk andneed of directed preventive regimens.The overall aim of this thesis was to evaluate scientifically reported diagnostic methods in use to identify oral dryness and to exploremethods for clinical monitoring of protective functional characteristicsof salivary films Study II surveyed the occurrence of subjective and objective oraldryness in two populations, one randomly selected group and onedental care-seeking group. The relationship between subjectiveand objective oral dryness to clinical parameters was analyzed and individuals were designated into one of four groups depending onthe occurrence of subjectively described and /or clinically measured oral dryness.Results and conclusions: No association between subjective oraldryness and flow rates of unstimulated and stimulated saliva wasfound in either of the two populations studied. Individuals identified with subjective oral dryness or objective oral dryness presented to a greater extent a history of oral rehabilitation compared to individualswho showed no indications of oral dryness. Results and conclusions: Individuals with subjective oral drynessexhibited lower values for saliva viscosity and elasticity, whencompared to the other groups. Additionally, the amount of salivaassociated to a germanium prism was the lowest measured in thisgroup, even if the total protein concentration was not extremely low. These test results in combination with a moderate decrease in surfacetension after 600 s may be indicative of a lower film forming capacityof saliva from individuals expressing subjective oral dryness.
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| 4. |
- Galli, Silvia
(författare)
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On magnesium-containing implants for bone applications
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The biomedical technologies for bone application are employed in millions of patients every year to restore function and aesthetics following trauma, diseases and congenital deformities. They achieved significant advancements in the last decades and have resulted in the development of implants that function for long periods of time. However, some fundamental clinical challenges still remain and are exacerbated by the aging of the population and by the increased life expectancy of the patients.First of all, permanent implants, despite having very high success rates, still face the risk for marginal bone loss and peri-implant osteolysis in some number of cases. Strategies to fasten, to strengthen and to maintain the bone integration of these implants are desired to enhance the implant clinical performances especially in situation of compromised bone. Secondly, the fixation of fractures and the repair of bone defects are required in a large number of clinical situations, where the intrinsic ability of bone to repair itself is limited. A constantly advocated requirement for osteosynthetic devices is the biodegradability, to avoid a second surgery for implant removal or the permanence of the device in the body for long time, with possible adverse effects. However, especially for osteosynthesis devices, materials that possess adequate mechanical properties for load-bearing applications and that biodegrade upon the substitution of new healthy osseous tissue are not yet available. Magnesium (Mg) is a material that offers potential benefits in these clinical issues. Magnesium is a natural component of the human body, which is involved in numerous enzymatic reactions and metabolic processes; thus, it is tolerated at high levels. It has a prominent role in bone homeostasis and bone health in general and it is considered bioactive, osteoconductive and angiogenetic. Therefore it could be applied as a doping agent to permanent implants and bone grafts, to increase their osseointegration. In addition, magnesium is potentially unique in the field of orthopaedic and cranio-maxillofacial surgery because it provides the mechanical properties of metals, although with an elastic modulus closer to that of cortical bone, and at the same time it degrades under physiological conditions in non-toxic by-products. Based on these clinical needs and on these observations, one aim of the current thesis was to explore the effects of the local release of Mg ions directly at the peri-implant sites on the osseointegration of titanium implants in healthy bone and in bone compromised by osteoporosis. In particular, it was of interest to attempt to elucidate the molecular and biochemical pathways that were stimulated in the peri-implant tissues by the presence of Mg ions and to correlate those to biomechanical and histomorphometrical observation. The other aim of this thesis was to characterize in vivo the degradation behaviour of 3 Mg-alloys tailored for biodegradable osteosynthesis devices and their associated bone response. In Study I to IV, the effects of the local release of Mg ions on the osseointegration of titanium implants in both healthy and osteoporotic bone were investigated. Mg ions were loaded into engineered mesoporous titanium dioxide (TiO2) carriers coated onto titanium implants. Mesoporous films acted as reservoir of drugs and bioactive substances and released them directly at the implant interface in a sustained fashion. After surface characterization of the mesoporous carriers with and without Mg ions by means of scanning electron microscopy (SEM), optical light interferometry (IFM) and atomic force microscopy (AFM), the same types of implants were implanted in animal models.In Study I, Mg-loaded implants were placed in the hind limb of rabbits for 3 weeks and examined with biomechanical analysis and histology. The results suggested that the increased local availability of Mg could accelerate and strengthen the early bone fixation of titanium implants.In Study II, the activation of biological pathways of bone healing and osseointegration of Mg-releasing implants installed in the rabbit tibia model was investigated at the gene level by means of real-time polymerase chain reaction (qPCR) after 3 weeks in vivo. The results found that several osteogenic markers (OC, RUNX-2, IGF-1) were significantly up-regulated in the presence of Mg during the first weeks of healing. This finding was correlated with the histological results, since significantly more threads for the Mg-doped implants were filled with new bone compared to the TiO2 implants without Mg. In Study III, the performance of Mg-loaded implants in bone was studied at a longer healing time of 6 weeks. It was found that the effects of Mg release are prominent in the early healing phases than compared to the later healing, presumably due to the rapid mobilization of the Mg ions from the coatings. In fact, the expression of osteogenic genes in the bone around control implants were dominantly expressed approximately 3 weeks after the dominant expression in the Mg-loaded group. Within the limitation of the observed healing period, no signs of increased inflammation and activation of bone remodelling were triggered by Mg release.In Study IV, the potential benefits of the local administration of Mg ions on implant osseointegration were tested in ovariectomized rats, which mimicked osteoporotic conditions. The presence of Mg-doped implants in osteoporotic subjects induced a significantly faster new bone formation compared to Ti controls and the activation of BMP6, an important anabolic agent that is normally suppressed in osteoporosis. In addition, other osteogenic factors, such as VEGF, were up-regulated in presence of Mg. In Study V, 3 recently developed Mg-alloys intended as temporary materials for osthesynthesis applications were tested in vivo to evaluate their degradation behaviour and the response they elicited in tissues. Mg-2Ag, Mg-10Gd and Mg-4Y-3RE in the form of mini-screws were implanted in the tibia and femur of rats for 4 and 12 weeks. Their degradation rates were investigated by means of high-resolution synchrotron-based micro computed tomography (SRµCT) and by histological sectioning. The tissue reaction to the different materials was analyzed both on histology and on 3D reconstructions of the bone-implant samples. In addition, the chemical composition of the degradation layers was assessed with Electron Probe Micro Analysis (EPMA). Finally, the expression of genes in the tissues in proximity of the mini-screws was investigated by means of qPCR employing a super-array technique.The SRµCT enabled the identification of the degradation layers, the original metal and the bone, thanks to the high spatial and density resolution. The 3-months degradation rates were similar for all materials, but the behaviour of the degradation products differed. The products of Mg-2Ag underwent rapid solubilisation. The rapid loss of sample integrity for this material led to fibrous encapsulation, rather than the desired osseous encapsulation. In the other 2 alloys, the degradation layers deposited in the same shape as the original screws and were mainly stable. That allowed the growth of bone in direct contact with the surfaces of the degradation products and they were osseointegrated at the 3-month healing time. That was confirmed on the histological slides. In addition, the chemical analysis revealed that the degradation products of the alloys were not formed by Mg, but contained Ca, P, C and O in similar amount to the surrounding bone The combination of histological, tomographic and chemical images provided new insight on the nature of the bone-to-implant interface and of the degradation products, which appeared to have great similarities to the host bone. Finally, the analysis of the genes expressed in the peri-implant bone, showed up-regulation of several genes related to osteogenesis around Mg implants compared to Ti ones. In conclusion, this thesis demonstrated that Mg is a suitable doping agent to increase the bone encapsulation of endosseous implants, especially at the early stages of healing and in particular in osteoporotic subjects. That is desirable to shorten the healing period and when early implant loading is considered an option. In addition, Mg-10Gd and Mg-4Y-3RE are biodegradable alloys with a degradation rate and behaviour that is suggested to be suitable for the new bone regeneration and the bone encapsulation.
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| 5. |
- Hafen, Niklas, 1980-
(författare)
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En vandring längs välviljans väg : en studie om idrott och internationellt utvecklingsarbete genom de skandinaviska exemplen LdB FC For Life i Sydafrika och Open Fun Football Schools i Moldavien
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this doctoral thesis is to analyze Sport for Development and Peace (SDP) initiatives from the initiators, sponsors and donor’s perspective through the Scandinavian examples LdB FC For Life in South Africa and Open Fun Football Schools in Moldova. On this basis, it seeks to explore the relationship between rhetoric and practice surrounding both projects. The study is grounded in neo-institutional theory – primarily through the work of John Meyer and Brian Rowan, Nils Brunsson and Mark Suchman. On a general level, neo-institutional theory is suitable when studying the social interaction between organizations and their environments. Given the thesis aim and explicit focus on two SDP organizations it thus becomes appropriate to use. Current study is predominantly based on data constructed through fieldwork in Sweden, Denmark, South Africa and Moldova during a period between 2011 and 2013. The methods used are qualitative ranging from observations to semi-structured interviews. In addition, homepages and documents relating to the two projects have been analyzed. A case study research methodology has been applied and the writing has been inspired by ethnographic fiction. The study shows that there is indeed a discrepancy between theory and practice – that is a gap between intention and implementation meaning initiators, sponsors and donors do not exactly practice what they preach. This inconsistency has been explained by the use of the theoretical concepts of decoupling, moral legitimacy and organizational hypocricy. A common feature of LdB FC For Life and Open Fun Football Schools is that they position themselves as SDP initiatives using sport merely as a means, not an end. This can be illustrated by their objectives, which is to mitigate the spread of HIV/AIDS and create political stability. However, from observations and interviews on site in South Africa and Moldova an opposite picture emerge, namely a strong focus on the development of sport through training and competition. In addition, the empirical findings show that both initiatives serve as a means by which initiators and sponsors can create lucrative advantages on a competitive market. Moreover, the undertaken activities function as a means by which they can be associated with something that the general public considers good, namely social responsibility. Even if both initiatives have good intentions, more research has proven crucial to justify the existence and magnitude of many of today´s SDP programs. This study has aimed to contribute to that discussion, mainly by examining the pros and cons of two specific examples. Consequently, it hopes to fill the parts of a missing gap.
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| 6. |
- Isma, Gabriella E
(författare)
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Overweight and obesity in young children : preventive work in child health care with fokus on nurses´ perceptions and parental risk factors
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Childhood obesity is a global public health threat correlated with several comorbidities and increased mortality in adult life. Heredity and physical development concomitant with environment culture and lifestyle habits are contributing key factors for the onset of overweight. Non-genetic components related to unhealthy dietary and activity patterns shared in families, are environmental factors that are possible to prevent before habits are set. Research indicates that there are several barriers against the proper management of this often long-term condition, where preschool children are an understudied group. This thesis aims to investigate how the Child Health Care (CHC) nurses pursue the preventive work on childhood overweight and obesity in CHC and further, to explore parental risk factors in relation to overweight and obesity in children. In the first study (Paper I), 18 nurses at 17 CHC centers in the southern part of Sweden were interviewed using semi-structured interviews with a phenomenographic approach. This study aimed to elucidate the conceptions of childhood overweight, including obesity, among nurses working in CHC. The analysis yielded 11 different conceptions from which emerged four categories of description; “Perception of childhood overweight changes”, “Overweight in younger children, a neglected concern”, “Overweight, a delicate issue” and “The importance of family lifestyle”. The results show that CHC nurses conceived overweight and primarily obesity in children to be an extensive and serious health problem, mainly due to parent’s lifestyle. Childhood overweight during infancy and their preschool years was conceived as a minor concern and further nurses perceived it as a provoking and sensitive issue that was difficult to define. Despite there being an adaption towards the acceptance of larger children, childhood overweight and obesity were considered to be undesirable by both the CHC and the Swedish society in general. Both nurses and parents were more concerned about the children’s appearance and the risk of their being bullied than about the children’s health. Nurses conceived that it was important to protect the parent-nurse relationship. Therefore in order not to jeopardize this relationship; the subject of childhood obesity was avoided. The second study (Paper II) aimed to elucidate the CHC nurses conceptions of their preventive work with childhood overweight and obesity in CHC. Study II was conducted at 17 CHC units using semi-structured interviews with 18 CHC nurses in the southern part of Sweden. The interviews had a phenomenographic approach which elucidated seven conceptions, from which emerged two categories of description; “internal obstacles to nurses’ work with overweight in children” and “external obstacles to the management of overweight in children”. The results show that the CHC nurses work was conceived to be complicated and constrained by several obstacles. Nurses’ preventive work was affected by factors linked to personal traits, lack of sufficient knowledge and lack of several resources affecting their ability to conduct preventive work. The third and the fourth study (Paper III and IV), were based on a crosssectional survey with a questionnaire administered to a stratified and randomized selection of parents to preschool children registered at CHCs in the southern part of Sweden. In total, 598 parents participated in the study, divided into 255 fathers and 343mothers to 372 children, i.e. 372 families. The third study (Paper III), examined socio- and demographic parental risk factors for overweight and obesity in children and the frequency of overweight and obesity in the context of child health care. Descriptive analyses were used to present the frequency of parental and childhood overweight and obesity, and logistic regression was used to estimate the relation between parental socio- and biodemographic factors and children’s risk for overweight or obesity. Our results show that the frequency of overweight and obesity was 14.5 % in children, 56.0 % in fathers and 36.5 % in mothers. A distressed financial situation in fathers (OR 2.85, CI 1.06-7.69) was associated with increased risk for overweight and obesity in children. After adjusting for potential confounders in mutually adjusted models, the aggregated results for both parents showed that mothers and fathers born outside of Sweden (OR 4.50, CI 1.55-13.12 and OR 4.94, CI 1.72-14.20) was the strongest risk factor for overweight and obesity in children.The fourth and final study (Paper IV) aimed to investigate parental lifestyle habits as risk factors for overweight and obesity in children. The relation between parental lifestyle habits and children’s risk for overweight and obesity was analyzed using logistic regression. Our results show that there might be a trend indicating an increased risk for children to develop overweight and obesity if the father is a daily smoker (OR 4.11, CI 1.45-11.68) and the mother is physically inactive (OR 2.33, CI 1.11-4.90). This thesis comprises four studies of both qualitative and quantitative character, with focus on nurses’ preventive work with childhood overweight and obesity in CHC and parental risk factors. Our findings identify multiple levels of barriers to the prevention work on childhood overweight. Nurses’ lack of sufficient knowledge, nurses’ negative conceptions of families with overweight problems, parents’ lack of awareness and the sensitive nature of the issue are circumstances that complicate nurses’ work. Additionally, society’s adaption to the increased proportion of children with overweight has led to an acceptance of excess weight in children. Further, parental risk factors were also identified. Parents being born outside Sweden was associated with increased risk of childhood overweight and obesity, as well as financial distress within the family. Further, the findings show a trend that indicates that paternal smoking and maternal physical inactivity might be factors associated with enhanced risk of overweight and obesity in younger children. We conclude that there exists a need to supplement the existing nurse education in child health care by putting the accent on intensifying education related to childhood overweight and weight assessment, with emphasis on the younger child. Further, this thesis implies that there is a need to better prepare specialist nurse student’s clinical skills related to their encounters with families and children at risk for overweight and obesity, through raising their awareness of their own perceptions of overweight in young children. Childhood overweight should be recognized and prioritized in CHC, further, the implementation of research results needs to be prioritized in the clinical work. The identification of risk factors may help health care personnel to identify and target children in risky family environments.
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| 7. |
- Korduner, Eva-Karin
(författare)
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The Shortened Dental Arch (SDA) concept and Swedish general dental practitioners : attitudes and prosthodontic decision-making
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 10ABSTRACTA Shortened Dental Arch (SDA) is defined as a dentition where most posterior teeth are missing. The SDA concept, described by Käyser and co-workers in the 1980s, was developed mainly for elderly and high risk-patients, those with poor general health and those with accumulation of dental problems. It was however, proposed as a treatment option based on individual preferences. The SDA concept suggested that a dentition comprising teeth in the anterior and premolar region might meet the requirements of a functional dentition. The aim of this thesis was to study attitudes towards the Shortened Dental Arch (SDA) concept and to explore the factors affecting prosthodontic decision-making, with a focus on the SDA concept, among Swedish General Dental Practitioners (GDPs).Two different research approaches (quantitative and qualitative) were used: a questionnaire study (Study I and II) and an interview study (Study III and IV). The base in the questionnaire study was made up of 102 responses from a random sample of 189 Swedish GDPs. The sample was taken from the membership register of the Swedish Dental Association. Besides questions about gender, age, years in profession and place of dental education, the questionnaire contained questions about factors to be considered when planning for a prosthetic treatment in an SDA. There were also questions related to risks and benefits of an SDA and various statements concerning the SDA concept. For all items the dentists were asked to mark on a Visual Analogue Scale ranging from 0 to 10 with different anchors for each section. The data was described and analyzed in contingency and frequency tables. The treatment planning statements were subjected to principal component analysis. A multiple linear regression analysis was used to study explanatory patterns regarding the assessment of importance for the variables influencing dentists’ choice of treatment in an SDA. Eleven Swedish GDPs were strategically selected for the interview study, the necessary inclusion criterion being that the participant had to have at least one year of practice to ensure experience of treating dentitions without molar support. The in-depth, semi-structured interviews dealt with treatment considerations relating to two patient cases and the participants’ opinions on pre-formulated statements about the SDA concept. Two authentic patient cases were discussed; initially with complete dental arches, and later a final treatment plan based on an SDA. The cases involved patients with compromised teeth situated mainly in the molar regions. One patient suffered from extensive caries and the other from severe periodontal disease. Qualitative Content Analysis was used to analyze the data. The participants of the questionnaire study received a short description of the SDA as an introduction and the participants of the interview study were given a brief explanation of the SDA concept after discussing the two patient cases. Attitudes towards the SDA and the SDA concept, results and conclusionsThe questionnaire study (I) showed that the Swedish GDPs had a positive attitude towards the SDA concept which they also considered carried few risks. There were small differences in attitudes between different groups of dentists (private practice dentists/dentists employed in the public dental health service and male/female dentists) but vast differences in attitudes among individual practitioners. Female practitioners envisaged a higher risk of impaired oral function, periodontitis and TMD in an SDA than male practitioners. Private practice dentists saw fewer advantages in using the SDA concept compared to Public Dental Health Service dentists in terms of reduced risk of overtreatment, better patient costs, and the patients’ ability to keep their own natural teeth as they aged. The results of the interview study (III) showed that none of the GDPs was familiar with the SDA concept of treatment although two dentists had heard the expression SDA before. Swedish GDPs showed little or no cognizance of the concept and they did not appear to apply it in their treatment planning.Prosthodontic decision-making with a focus on SDA and compromised molars, results and conclusionsThe study with a quantitative approach (II) showed that there were vast individual differences when Swedish GDPs ranked the importance of various patient-related items when planning a treatment in an SDA. The results of a factor analysis showed that dental care delivery system, place of dental education and also attitudinal factors influenced the decision-making process in relation to the SDA. The analysis also indicated that it was possible to capture common dimensions (“technical”, “comfort” and “time”) of decision-making in prosthodontics compared to other decision-making situations. The study with a qualitative approach (IV) showed that preserving a dental arch which included molars appeared to be important to Swedish GDPs. The SDA concept did not seem to have any substantial impact on prosthodontic decision-making in relation to dentitions with compromised molars. The dentist’s experience, as well as the advice of colleagues or specialists, together with etiological factors and the patient’s individual situation, influenced decision-making more than the SDA concept. There was a contradictory relevance between the patient’s age and the need for molar support when considering the SDA, mainly due to the individual patient’s need. These conflicting results in the prosthetic decision-making process require further investigation.
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