CRITERIA FOR SELECTING SPECIAL HEALTH CARE NEEDS PATIENTS FOR GENERAL ANESTHESIA IN DENTAL TREATMENT: A SYSTEMATIC REVIEW

Objective:This systematic review aimed to investigate the available evidence on how to decide whether your special health care needs patient needs GA for dental treatments or not. Materials and methods:A systematic search was conducted in four electronic databases PubMed, Google Scholar, ResearchGate and SDL. The search was restricted to articles published between 2005 and 2020. Publications reporting on the special health care needs patients dental treatment were included. The papers were analyzed regarding title and abstract contents to eliminate the ones that were out of context and not relevant to the review. Results:The search strategy resulted in 99 unique and potentially relevant articles. In total, 6 publications which include 5 retrospective articles and one cross-sectional study were selected. Conclusions:The main standards for selecting patients for hospitalized dental treatments include a full analysis of SNP including their medical history, behavior and emotional factors, oral health status, allergies, social and non-clinical factors, and caregivers factors. It is important for general dentists and families of these patients to be acquainted with the procedure, its need, and its contraindications.

Provision of dental services for vulnerable groups: a scoping review on children with special health care needs

Background The provision of dental services for children with special health care needs (CSHCN) needs to be considered by policymakers. This study is aimed to explore the determinant factors affecting dental and oral services provision for this vulnerable group. Methods A review was conducted applying the 9-steps approach. Five scientific databases of PUBMED, SCOPUS, Web of Science and PROQUEST and EMBASE were searched up to 10.07.2021, applying appropriate keywords. Thematic analysis was used to analyse the extracted data, and a conceptual map was developed according to JBI manual for evidence synthesis. Results From the abstracts of the 136 articles that fulfilled the inclusion criteria, 56 articles were included. Five main themes were identified as determinants affecting the provision of dentistry services for CSHCN, including needs assessment, policy advice, oral health interventions, providers’ perception and access barriers. According to the developed conceptual map, assessing the needs of CSHCN can lead to particular policy advice. Regarding the policies, appropriate oral health interventions can be presented. These interventions, along with providers’ perception about service delivery to CSHCN and the barriers to access them, determine the provision of dentistry services for CSHCN. Conclusions An effective needs assessment of CSHCN and their parents/carers can lead to evidence-informed policymaking and applicable policy advice according to the needs. Then policymakers should develop interventions to improve the community’s health literacy, as well as support the seeking behaviours for appropriate services. Policymakers should also consider how to limit the barriers to accessing oral and dental health by CSHCN to decrease disparities.

Sydänkuntoutus ja erikoissairaanhoidon palvelujen käyttö

Sydänkuntoutuksen vaikuttavuutta on perinteisesti arvioitu käyttäen osoittimina vaaratekijöiden alenemista, kuolleisuutta, työkyvyn palautumista sekä elämänlaadun kohenemista. Huomattavasti vähemmän on selvitetty sitä, onko sydänkuntoutuksella yhteyttä myöhempään terveyspalvelujen käyttöön. Tämä tutkimus on toinen osa hanketta, jossa selvitettiin yli 60-vuotiaiden sepelvaltimotautipotilaiden kuntoutusohjelman toimivuutta ja vaikuttavuutta satunnaistetulla, kontrolloidulla tutkimusasetelmalla. Tämän tutkimuksen toisen vaiheen tavoitteena oli selvittää iäkkäille sydänpotilaille suunnatun kuntoutusohjelman mahdollinen yhteys myöhempään erikoissairaanhoidon palvelujen käyttöön sekä tutkia, mitkä perussairauteen, vaaratekijöihin tai toimintakykyyn liittyvät tekijät voisivat selittää palvelujen käyttöä. Hankkeeseen osallistui kaikkiaan 312 sepelvaltimotautipotilasta, jotka oli satunnaistettu kuntoutusryhmään ja vertailuryhmään. THL:n Hilmo-tietokannasta laskettiin kahden ja puolen vuoden ajalta erikoissairaanhoidon toimenpiteiden ja käyntimäärien summa, jossa otettiin huomioon sydän- ja verisuonitautien hoidon vuoksi tapahtuneet käynnit ja toimenpiteet. Tulokset osoittivat, että lähes puolella osallistujista (44,8 %) ei ollut lainkaan rekisteriin merkittyjä erikoissairaanhoidon käyntejä tai toimenpiteitä 2,5 vuoden seurantajakson aikana. Palveluja käyttäneiden käyntimäärät vaihtelivat yleisimmin (41,7 %) välillä 1–5/seurantajakso, ja vain 13,3 %:n osalta käyntejä tai toimenpiteitä oli tätä enemmän. Kajoavien toimenpiteiden osuus kaikista käynneistä oli vain 1,6 %. Kuntoutusinterventioon osallistuneiden ja verrokkien välillä ei ollut eroa palvelujen käytössä. Voimakkaimmin käyntimääriä selittäväksi tekijäryhmäksi osoittautuivat fyysistä suoritus- ja toimintakykyä kuvaavat muuttujat, erityisesti rasituskokeen tulos. Kuntoutuksen menetelmien kehittämisen kannalta tämän tutkimuksen tulokset tukevat tuoreimpia suosituksia, jotka korostavat fyysisen toimintakyvyn kohentamisen ja säilyttämisen merkitystä myös iäkkäämpien sepelvaltimotautipotilaiden kohdalla. AbstractRehabilitation of elderly coronary heart disease patients and use of special health care services. Results of a randomized, controlled trial Risk factor levels, mortality, and physical as well as psycho-social functioning have traditionally been used as out-come criteria for efficacy of cardiac rehabilitation. Less is known about the possible impact of cardiac rehabilitation on use of later health care services. This report is the second part of a project where the feasibility and efficacy of an age-tailored rehabilitation program for cardiac patients over 60 years of age was evaluated. A controlled, randomized design was used. Subjects in the intervention group participated in a weekly organized, ten-day rehabilitation program. Control group participated in same assessments (including risk factor evaluation with laboratory tests and questionnaires, and exercise test), otherwise they were treated and followed-up according to usual care. The aim of this second part of the study was to evaluate if the applied rehabilitation program had any impact on the use of special health care services during the following two and half years. And, furthermore, to investigate which disease related, risk factors and/or indicators of functional capacity might predict use of services. Participants were 312 coronary heart disease patients (mean age 69,5 yrs, women 46,8 %) recruited from health centers in cities of Helsinki and Vantaa. For each patient, the number of visits or interventions related to vascular health, and recorded as a special health care service was calculated from the Hilmo-register, provided by the National Institute for Health and Wellfare. Also, data of mortality and causes of death were received from Statistics Finland data base. Results showed that nearly half (44,8 %) of the participants had no registered visits or interventions in special health care because of vascular health problems. The number of visits for those who had used special health care varied usually (41,7 %) between one to five, and only for 13,3 % of participants the total number of visits exceeded five. The total number of invasive interventions was only 11, i.e., 1,6 % of all visits. Between the two study groups there was no difference in the number of special health care visits or interventions. The most significant predictors of high number of visits were factors related to poor physical functioning, especially a low functional capacity in the clinical exercise test. Even statistically significant raw correlations of some socio-demographic factors such as old age and living alone for men with the number of visits lost their significance when analyzed together with indicators of physical functioning. In sum, the results of this study support the recent recommendations for cardiac rehabilitation which underline the importance of promotion and maintenance of good physical functioning also among elderly coronary patients. Key words: coronary heart disease; cardiac rehabilitation; health services; ageing; physical fitness