ASYMMETRY OF GAIT AFTER FREE FLAP RECONSTRUCTION OF SEVERE TIBIAL FRACTURES WITH EXTENSIVE SOFT-TISSUE DAMAGE

Gait patterns of the preferred speed were investigated on 17 patients recovering (9 months-14 years) after reconstruction of severe tibial fractures. A novel data-acquisition system was used to record the plantar pressures as well as electromyographic (EMG) activities during walking. The results indicated incomplete recovery of symmetrical gait patterns. In particular, the duration of the stance phase was shorter on the operated side (mean (SD) 701 (90) ms compared with 765 (128) ms, p < 0.001). The peak pressure points under the foot were different on bilateral comparison, the operated side being regularly higher under the lateral forefoot area. This may imply attempts to reduce the loading of the ankle joint during stance. The pressure distribution models reflected these asymmetrical patterns more specifically than the EMG activities of the lower leg muscles examined.     

The need and total cost of Finnish eyecare services: a simulation model for 2005–2040

Purpose: The aims of this study were: (i) to create a structural simulation model capable of predicting the future need and cost of eyecare services in Finland; and (ii) to test and rank different policy alternatives for access to care and the required physician workforce. Methods: Using the system dynamics approach, the number and cost of patients with cataract, glaucoma, diabetic retinopathy and age‐related macular degeneration (AMD) were described with causal‐loop diagrams and were then translated into a set of mathematical equations to build a computer simulation model. Mathematically, the problem was formulated as a set of differential equations that were solved numerically with specialized software. The validity of the model was tested against prevalence and administrative historical data. The costs covered by the public sector in Finland were obtained from 2003 from the Finnish Hospital Discharge Register (including outpatient care), the Finnish Social Insurance Institution and a survey of hospital price lists. Different levels of access to public care were then simulated in four eye diseases, for which the model estimated the need for services and resources and their costs in the years 2005–2040. Results: The model forecasted that the adoption of the 2005 national ‘access to care’ criteria for cataract surgery would shorten waiting lists. If the workload of Finnish ophthalmologists were kept at the 2003 level, the graduation rate of new ophthalmologists would have to increase by 75% from the current level. If all glaucoma patients were followed in the public sector in future, even this increase in training would not meet the demand for physician workforce. The current model indicated that the screening frequency of diabetes can be increased without large sacrifices in terms of costs. AMD therapy has a significant role in the allocation of future resources in eyecare. The modelling study predicted that ageing alone will increase the costs of eyecare during the next four decades in Finland by about 1% per year in real terms (undiscounted and without inflation of unit costs). The increases in total yearly costs were on average 8.6% between 2001 and 2003. Conclusions: The results of this modelling study indicate that policy initiatives, such as defining criteria for access to care, can have substantial implications on the demand for care and waiting times whereas the effect of ageing alone was relatively small. Measures to control several other factors – such as the adoption and price level of new technologies, treatments and practice patterns – will be at least equally important in order to restrain healthcare costs effectively.     

Changes in glomerular mesangium in kidneys with congenital nephrotic syndrome of the Finnish type

Congenital nephrotic syndrome of the Finnish type (NPHS1, CNF) is an autosomal recessive disease caused by mutations in a major podocyte protein, nephrin. NPHS1 is associated with heavy proteinuria and the development of glomerular scarring. We studied the cellular and molecular changes affecting the glomerular mesangium in NPHS1 kidneys. Marked hyperplasia of mesangial cells (MC) was mainly responsible for the early mesangial expansion in NPHS1 glomeruli. The levels of the proliferation marker, mindbomb homolog 1 and the major MC mitogen, platelet-derived growth factor, and its receptors, however, were quite normal. Only a small number of cells were positive for CD68 (marker for phagocytic cells) and CD34 (marker for mesenchymal precursor cells) in the NPHS1 mesangium. MCs strongly expressed α-smooth muscle actin, indicating myofibloblast transformation. The expression levels of the profibrotic mediators osteopontin and transforming growth factor β were up-regulated in NPHS1 glomeruli by 3.2 and 1.6-fold, respectively, compared to the controls. The synthesis by MCs of the typical fibroblast products collagen I, fibronectin, and tenascin, however, was low, and the extracellular matrix increase was caused by the accumulation of a normal MC product, collagen IV. The results indicate that severe glomerular sclerosis can develop without major qualitative cellular or molecular changes in the mesangium.     

Children’s oral health‐related behaviors: individual stability and stage transitions

Tolvanen M, Lahti S, Poutanen R, Seppä L, Hausen H. Children’s oral health‐related behaviors: individual stability and stage transitions. Community Dent Oral Epidemiol 2010; 38: 445–452. © 2010 John Wiley & Sons A/S Abstract – In 2001?2005 in Pori, Finland, a program of oral health promotion (OHP) was targeted to schoolchildren and people involved in their life to provide social support for participants of the experimental group of a randomized clinical trial (RCT) on controlling caries. Objectives: Our aim was to describe the individual stability and stage transitions for behaviors among children exposed to OHP in Pori and to ascertain whether these phenomena differed in the group that was also exposed to the experimental regimen of the RCT. Methods: The study population consisted of all 5th and 6th graders who started the 2001?2002 school year in Pori (n = 1691); 1362 of them were monitored throughout the 3.4‐year study. Of these children, 1138 were exposed to OHP and 224 to OHP and the experimental regimen of the RCT. Data on toothbrushing and use of xylitol products, candies, and soft‐ and sports drinks were gathered with questionnaires. Behavior variables were dichotomized into good and poor. The stability of behaviors and stage transitions was evaluated. Results: Over half of the children had stable behaviors throughout the study. For those children whose behaviors changed, the behavior was more likely to improve than to worsen. For most behaviors, good behavior at baseline was associated with the ability to maintain the achieved good behavior and to recover from lapses to poor behaviors. Conclusion: In childhood, behaviors, especially good ones, are rather stable. If healthy behaviors are learned young, lapses into poor behaviors, for instance during the teens, are likely be temporary rather than permanent.     

Developmental Dental Defects in Children Who Reside by a River Polluted by Dioxins and Furans

The authors determined that demarcated hypomineralizations of developing teeth are a biological indicator of an early dioxin exposure in a healthy population of children. In the current study, the authors examined the prevalences of the demarcated hypomineralization lesions of teeth in 2 Finnish towns by the Kymijoki River—a river that is severely contaminated by dioxins and furans. The 4,120 permanent first molars of 1,030 children were studied. The prevailing levels of dioxins and furans in human milk were measured. The prevalences of the defects in children in Kotka and Anjalankoski were 14.2% and 5.6%, respectively, and the corresponding dioxins and furans in human milk were 13.4 pg/gm fat and 10.9 pg/gm fat (International Toxic Equivalents). In Anjalankoski, the duration of total breast-feeding was associated with the prevalence of the defects. Compared with the figures reported earlier in Finland, neither the prevalence of dental lesions nor the levels of dioxins and furans in human milk were increased in riverside residents.     

How can a cost/benefit ratio be optimized for an output measurement program of external photon radiotherapy beams?

We estimated cost/benefit ratios for different quality control programs of radiation output measurements of medical linear accelerators. The cost/benefit ratios of quality control (QC) programs (a combination of output measurement time interval and measurement action levels) were defined as workload divided by achievable dose accuracy. Dose accuracy was assumed to be inversely proportional to the 99% confidence limit of shifts of total treatment doses and workload as inversely proportional to the output measurement time interval. Our previously reported method was used to estimate the distribution of shifts of total treatment doses due to changes in accelerator radiation output (Gy/MU). The confidence limits of dose shifts were estimated for different QC programs and for different levels of output measurement reproducibility. Output shifts used in the estimations had previously been observed for four linear accelerators over 5 years. We observed that the cost/benefit ratio increases remarkably when the output measurement time interval is less than 1 month. The ratio depends strongly on the action levels and reproducibility of the QC measurements. Improvement of these factors optimizes the cost/benefit ratio by a factor of several times. The most cost-effective output measurement time interval to achieve 99% confidence limits of ±2, ±2.5 or ±3% for dose shifts ranged from 0.25 month to as much as 6 months depending on the factors given above and the intended accuracy level. It is several times more cost effective to increase dose accuracy by lowering the action levels of the QC measurements and by attempting to improve their reproducibility than by simply shortening the time interval of the output measurements. Methods improving utilization and interpretation of the results of the QC measurements play a key role in further optimization of cost/benefit ratios in dosimetric QC.