Changes in dental conditions during a decade in a middle-aged and older Swedish population

A questionnaire measuring dental conditions was sent to 2708 individuals aged 55–79 years in O¨rebro County, who about 10 years earlier had been randomly selected for a similar study. The response rate was 68% (1848 individuals). Of those, 1665 had participated also in the 1989 study. The objectives were to study changes in dental conditions having occurred during a decade and to evaluate whether impairment in dental conditions among the participants had resulted in prosthodontic treatments. Only small changes in dental conditions were registered among those who participated both in 1989 and in 1999. Loss of a single tooth was the most frequently reported change. Ten per cent fewer reported that they had all teeth remaining in 1999 compared with conditions in 1989. The number of subjects wearing removable dentures increased only slightly. Although the reported changes in dental conditions were small, there had been a need for prosthodontic treatment in many of the subjects. Ten percent of the subjects reported that they had received FPD treatment during the past 10 years. To conclude, the present study showed that only small changes in dental conditions had occurred among the participants during a decade. Nevertheless, a substantial increase in the prevalence of prosthodontic appliances, especially of fixed restorations, was noted.     

Individualized 6‐mercaptopurine increments in consolidation treatment of childhood acute lymphoblastic leukemia: A NOPHO randomized controlled trial

Objectives

This randomized controlled trial tested the hypothesis that children with non‐high‐risk acute lymphoblastic leukemia could benefit from individualized 6‐mercaptopurine increments during consolidation therapy (NCT00816049). Primary and secondary end points were end of consolidation minimal residual disease (MRD) positivity and event‐free survival.

Methods

392 patients were randomized to experimental and 396 to standard therapy. Patients allocated to standard therapy received oral 6‐mercaptopurine (25 mg/m²/day) from days 30 to 85, while the experimental arm received stepwise increments of additional 25 mg/m²/day beginning on days 50 and/or 71 unless dose‐limiting myelosuppression had occurred.

Results

In the experimental arm, 166 patients (42%) received one dose increment, and 62 (16%) received two. Fifty‐seven of 387 (15%) patients in the experimental arm were MRD positive at end of consolidation vs 77 of 389 (20%) in the control arm (P = .08). Five‐year probability of event‐free survival was 0.89 (95% CI: 0.85‐0.93) in the experimental arm vs 0.93 (0.90‐0.96) in the control arm (P = .13). The median accumulated length of 6‐mercaptopurine treatment interruptions was 7 (IQR 2‐12) in the experimental arm vs 4 (IQR 0‐10) in the control arm (P = .002).

Conclusion

This study found no benefit from individualized 6‐mercaptopurine increments compared to standard therapy.     

Neonatal pain assessment in Sweden – a fifteen‐year follow up

Background: It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines. Methods: A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools. Results: The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty‐four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions. Conclusion: The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment.     

Use of the burn intervention score to calculate the charges of the care of burns

Background

To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care.

Utilization of dental health services among middle-aged people in Sweden and Denmark

In 1999, questionnaires were sent to random samples of 1001 Swedish citizens aged 55-79 years and 1175 Danish citizens aged 45-69 years. Various questions were asked concerning dental conditions, dental visit frequency per year, and money spent annually on dental care, etc. The objectives were to assess differences in the utilization of dental services and to compare out-of-pocket costs for dental care in Sweden and Denmark with control for age, gender, dental conditions and income. More than 80% of the subjects reported that a dentist had examined them less than 1 year previously. However, 77% of the Danes reported dental visits twice a year or more compared to 28% of the Swedes. Although the Danes reported a more frequent use of dental services, they had poorer dental conditions compared to the Swedes. Even though the Swedes used dental services less often than the Danes did, more subjects reported high 12-month out-of-pocket costs. In the present study, separate models were constructed for the two countries because there could be different mechanisms at play, as indicated by the results. The different insurance systems along with different degrees of commercialization in the two countries might be the most decisive factors in this context.     

Transmission of Clostridium difficile spores in isolation room environments and through hospital beds

The aim of this study was to determine the dissemination of Clostridium difficile (CD) spores in a hospital setting where the potassium monopersulfate‐based disinfectant Virkon^TM was used for cleaning. In the initial part of the study, we sampled 16 areas of frequent patient contact in 10 patient rooms where a patient with CD infection (CDI) had been accommodated. In the second part of the study, we obtained samples from 10 patient beds after discharge of CDI patients, both before and after the beds were cleaned. In the first part, CDspores were isolated in only 30% of the rooms. In the second part, which focused on transmission to hospital beds, C. difficile was found in four of 10 beds either before or after cleaning. In conclusion, in both parts of the study, we demonstrated a moderate spread of CD spores to the environment despite routine cleaning procedures involving Virkon^TM.