Adults' dental treatment in 2001-2013 in Finnish public dental service.

BACKGROUND: All adults over 17 years of age have access to the Public Dental Service after the Finnish Dental Care Reform in 2001-2002. This study aimed to survey the treatment needs and treatment measures provided for adult patients and changes in these during the period 2001-2013. METHODS: Sing each person's unique identifier, demographic data on dental visits during the period 2001-2013 were collected from municipal databases in five PDS-units covering 320,000 inhabitants. The numbers of visitors, those in need of basic periodontal or caries treatment (CPI > 2 and D + d > 0) were calculated for three age groups. Treatment provided was also calculated in 13 treatment categories. Trend analyses were performed to study changes during the study period. RESULTS: Restorative treatments (968,772; 23.6%), examinations (658,394; 16.1%), radiographs taken (529,875; 12.9%) anaesthesia used (521,169; 12.7%) and emergency treatments (348,229; 8.5%) made up 73.8% of all treatment measures during the entire study period. Periodontal treatment (7.8%) and caries prevention (3.9%) made up a small part of the care provided and prosthetics and treatment of TMJ disorders were extremely uncommon (fewer than 1%). Treatments related to caries (restorative treatment, examinations, endodontics, emergencies, anaesthesia and radiographs) made up 60.4% of the dental personnel's treatment time. During the study period, statistically significant increasing trends were found for radiographs (p < 0.001***), anaesthesia (p = 0.003**) and total number of treatments (p = 0.009**). There was a slight decreasing trend in treatment need among the youngest adults (18-39 years; p = 0.033*). CONCLUSION: Compared with the results of national epidemiological studies, insufficient periodontal treatment is provided and prosthetic treatment is almost totally neglected in the PDS. Rather, adults' dental treatment concentrates on treatment of caries. The unmet needs may be due to tradition, inadequate treatment processes or a lack of resources or failed salary incentives.

Children and adolescents´ dental treatment in 2001-2013 in the Finnish public dental service.

BACKGROUND: The Public Dental Service (PDS) in Finland has catered for the overwhelming majority of the young for more than 50 years. They have had examinations, preventive measures and all other necessary treatment free of charge. This study aimed to survey the treatment needs and treatment measures provided for children and adolescents and changes in these during the period 2001-2013. METHODS: Using each person's unique identifier, data on patients (< 18 years), their oral health (CPI > 2, D + d > 0) and treatment received in the period 2001-2013 were collected retrospectively from municipal databases in five PDS-units covering 320,000 inhabitants. The National Institute for Health and Welfare gave ethical approval. Permission to use local data was received from the Directors in the PDS units. Treatment measures were grouped into 14 categories and patients into three age categories (0-6 years, 7-13 years and 14-17 years). Trend analysis was used to test changes over time. RESULTS: About 40,000 children and adolescents visited the PDS each year and 2,488,805 treatment measures were provided for them during the entire study period. The proportion of those in need of treatment decreased from 44.4 to 33.2% during the study period. The most common treatment categories were examinations (613,753, 24.7%), orthodontics (499,033, 20.1%), preventive measures (372,473, 15.0%) and restorative treatment (355,325, 14.3%); these made up 74% of all treatment measures. During the study period, statistically highly significant (p < 0.001***) increasing trends were found for examinations, anaesthesia and the total number of treatment measures, and a significant (p < 0.001***) decreasing trend in restorative treatment were found for all the young. More preventive treatment measures were provided for those not in need of treatment compared with those in need of treatment. CONCLUSION: Although children's oral health had improved and restorative treatment provided had decreased, the total number of treatment measures increased. Healthy children received frequent examinations and high numbers of preventive treatment measures. Targeting treatment according to needs was not satisfactory.

Internationally adopted children in Finland: parental evaluations of symptoms of reactive attachment disorder and learning difficulties - FINADO study.

OBJECTIVE: This study investigated the association between psychological symptoms, such as features of reactive attachment disorder (RAD), and learning difficulties among international adoptees in Finland. METHODS: The data for this study came from the FINnish ADOption (FINADO) study covering all internationally adopted children in Finland (n= 1450), with a response rate of 55.7%. The subsample consisted of 395 adopted children aged 9-15 (51.6% girls, 48.4% boys). Learning difficulties were evaluated by a screening questionnaire 'Five To Fifteen' and symptoms of RAD by FINADO RAD scale. RESULTS: The parents estimated that one-third (33.4%) of the internationally adopted children had some, and 12.7% had severe learning difficulties, i.e. three and six times more than in normal population, respectively. RAD symptoms at the time of adoption were associated with learning difficulties at school age (OR 4.57, 95% CI 2.57-8.13). CONCLUSIONS: Learning difficulties are common among internationally adopted children in Finland and symptoms of RAD are associated with a child's learning difficulties.

Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: a 1-year prospective study.

BACKGROUND: Although twin deliveries after assisted reproduction treatment (ART) are common, the mental health of the parents has scarcely been addressed. Therefore, we evaluated the psychological well-being of ART and spontaneously conceiving parents of twins and singletons. Furthermore, the impact of parity and children's health-related factors on mental health was evaluated. METHODS: We conducted a prospective longitudinal questionnaire study among ART parents of 91 pairs of twins and of 367 singletons and on control parents of 20 pairs of twins and of 379 singletons in the 2nd trimester of pregnancy (T1), and when the children were 2 months (T2) and 1-year old (T3). Symptoms of depression and anxiety, sleeping difficulties and social dysfunction were addressed via a questionnaire. The effects of parity and child-related factors were assessed at T2. RESULTS: At T1, ART mothers of twins showed fewer symptoms of depression than control mothers of twins (P < 0.05). At T2, both ART and control mothers of twins had more symptoms of depression and anxiety than all mothers of singletons (F = 5.20, P < 0.05 and F = 3.93, P < 0.05, respectively). At T3, both ART and control mothers of twins continued to report more symptoms of depression than the mothers of singletons (F = 10.01, P < 0.01), but a difference in anxiety symptoms was seen only in the control group. All fathers had similar mental health at T1. At T2, ART and control fathers of twins reported more symptoms of depression (F = 4.15, P < 0.05) and social dysfunction than fathers of singletons. At T3, both ART and control fathers of twins had more symptoms of depression (F = 4.29, P < 0.05) and anxiety (F = 5.40, P < 0.05) than fathers of singletons. Control fathers of twins had more sleeping difficulties than fathers of singletons (F = 6.66, P < 0.01). Parity did not differently affect parental mental health at T2 in the study groups. Prematurity did not affect maternal mental health, but it had a negative impact on control fathers' social dysfunction (F = 3.34, P < 0.05). CONCLUSIONS: Twin parenthood, but not ART, has a negative impact on the mental health of mothers and fathers during the transition to parenthood. ART parents' mental health was not affected by parity or children's health-related factors.

Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls.

BACKGROUND: Evidence about the effects of infertility and assisted reproduction technique (ART) on marital relationships is discrepant. Here, we examined the impact of ART on marital relationships. The roles of life stressors, infertility and treatment characteristics in predicting marital relations were also evaluated. SUBJECTS: 367 couples with singleton IVF/ICSI pregnancies. CONTROLS: 379 couples with spontaneous singleton pregnancies. Women and men were assessed when the child was 2 months (T2) and 12 months old (T3). They further reported stressful life events at T2 and depression in pregnancy. RESULTS: No between-group differences were found in marital satisfaction and dyadic cohesion. Dyadic consensus deteriorated from T2 to T3 only among control women. Sexual affection was low among control men at T2 and stressful life events decreased it further. Depression during pregnancy predicted deteriorated marital relations only in control couples. Several unsuccessful treatment attempts were associated with good dyadic consensus and cohesion among ART women. Spontaneous abortions and multiple parity predicted poor marital satisfaction in ART women, whereas long duration of infertility and multiple parity predicted poor marital relations in ART men. CONCLUSIONS: Successful ART does not constitute a risk for marital adjustment. The shared stress of infertility may even stabilize marital relationships.

Maternal mental health and medical predictors of infant developmental and health problems from pregnancy to one year: does former infertility matter?

BACKGROUND: Transition to parenthood involves considerable psychological, social and physiological changes. We examined how prenatal and perinatal mental health and medical conditions predict infant's developmental and health status at 12 months, and whether former infertility and assisted reproduction treatment (ART) affect the predictor model. METHODS: The participants were 520 mothers who filled in questionnaires at the second trimester of pregnancy (T1), and when the child was 2 months (T2) and 12 months old (T3). Depressive and anxiety symptoms indicate reduced levels of mental health, and medical factors involve problems in pregnancy (e.g., high blood pressure and bleeding) and birth complications (pain and loss of blood). Neonatal health refers to, e.g., birth-weight and neurological status. At 12 months mothers reported infants' verbal and motor development and general health status. RESULTS: First, it was shown that generally maternal prenatal anxiety and medical problems in pregnancy together predicted infant's developmental problems at 12 months through poor neonatal health, and medical problems alone also through increased level of birth complications. Second, the predictor models differed according to the history of infertility. In the ART group prenatal depression and anxiety and medical problems together predicted infant's developmental problems through maternal post-partum depression, and medical problems also through birth complications, whereas in the spontaneous conception group psychological and medical paths were separated and did not carry on developmental and health problems into 12 months. CONCLUSIONS: Maternal health care should consider both psychological and medical risk paths across the whole transition to parenthood, and be aware of specific mediating paths in the risk groups.

Impact of infertility characteristics and treatment modalities on singleton pregnancies after assisted reproduction.

Obstetric and neonatal outcomes of assisted reproduction and control singletons were evaluated after taking into account treatment characteristics and infertility background. The elective single embryo transfer (eSET) group (n = 45) was compared with the compulsory single embryo transfer (cSET; n = 52), double embryo transfer (DET; n = 227) and control (n = 304) groups. Infertility-related prognostic factors for neonatal outcomes were also analysed. Data were collected with structured questionnaires at gestational week 20 and 8 weeks after delivery. Spontaneous onset of delivery was more typical of the eSET group than of cSET and DET groups (68.9 versus 52.0%, P = 0.02). Mean (+/-SD) gestation at birth (39.3 +/- 1.6 weeks) and mean birth weight (3,470 +/- 505 g) of eSET singletons were comparable with other assisted reproduction groups, but gestational duration was lower than in the eSET group than in the control group (39.9 +/- 1.4; P < 0.05). However, numbers of preterm births and low birth weight infants were similar between groups. History of induced abortion increased risk of preterm birth (OR 4.5 and 95% CI 1.2-17.1) in assisted reproduction singletons. A small though clinically unimportant difference in gestational age at birth and birth weight between assisted reproduction and control singletons was found regardless of the number of embryos transferred.

The impact of successful assisted reproduction treatment on female and male mental health during transition to parenthood: a prospective controlled study.

BACKGROUND: The dynamics of mental health during the transition to parenthood have not been a focus of research. Our prospective longitudinal study was designed to reveal whether there are differences in mental health during the transition to parenthood between parents undergoing treatment with assisted reproduction techniques (ART) and those who conceive spontaneously. STUDY GROUP: 367 couples with a singleton ART pregnancy using their own gametes. CONTROL GROUP: 379 couples with a spontaneous singleton pregnancy. Men and women separately filled in questionnaires including the General Health Questionnaire: at the 18th-20th week of pregnancy, 2 months postpartum and 1 year postpartum (T3). The effect of social and child-related factors on mental health was examined. RESULTS: ART women had fewer depressive symptoms during pregnancy than controls, but at T3 their depressive symptoms were at the same level as seen in controls. Anxiety symptoms increased among control but not among ART women across the transition. ART men reported generally fewer mental health symptoms than their controls. Social and child-related stressors had negative impacts on mental health changes among control couples, whereas no impact was found among ART couples. CONCLUSIONS: Successful ART did not predict mental health problems during the transition to parenthood. Moreover, ART couples' mental health was remarkably resistant to social and child-related stress during the transition to parenthood.

Finnish children in foster care: evaluating the breakdown of long-term placements.

Save the Children studied risk factors associated with placement disruption or breakdown in cases where long-term foster care was intended. Before their placement in 180 foster families, most of the 234 children studied (75%) had experienced neglect. The followup time after initial placement averaged four years and two months. Achieving long-term beneficial foster care placement of children of varied ages and experiences with abuse and neglect, involved considering the needs of the foster parents who may or may not have their own children or other children in their care. Some children were reunified with their parents; careful evaluation is needed before such reunion.

Bankruptcy analysis with self-organizing maps in learning metrics.

We introduce a method for deriving a metric, locally based on the Fisher information matrix, into the data space. A self-organizing map (SOM) is computed in the new metric to explore financial statements of enterprises. The metric measures local distances in terms of changes in the distribution of an auxiliary random variable that reflects what is important in the data. In this paper the variable indicates bankruptcy within the next few years. The conditional density of the auxiliary variable is first estimated, and the change in the estimate resulting from local displacements in the primary data space is measured using the Fisher information matrix. When a self-organizing map is computed in the new metric it still visualizes the data space in a topology-preserving fashion, but represents the (local) directions in which the probability of bankruptcy changes the most.

Psychosocial impact of an X-linked hereditary disease: a study of Alport syndrome patients and family members.

A nationwide search for patients with Alport syndrome (AS), a hereditary nephritis with sensorineural hearing loss and occasional ocular anomalies, was performed. As AS is usually transmitted in an X-linked fashion, its form is usually severe in male and mild in female patients. Semi-structured interviews were conducted with 24 patients with AS and their family members from 17 families and 11 pedigrees. The emphasis was on psychosocial stress experienced in everyday life, as well as the influence of AS on family relationships, especially mother-son relationships. Special attention was paid to children's reactions and feelings as well as the coping strategies of the family. Denial was the most common psychological defence found in our study. We found several cases where AS had led to chronic mental suffering. One of the patterns was a combination of maternal depression and an overprotective attitude toward an AS-affected son. In other instances, depressive symptomatology and anxiety were seen in connection with complications and an adverse outcome of the disease. Families with any AS manifestations should be encouraged to discuss openly the past histories of family members, their fears, feelings of guilt, hopes and expectations. The role and empathic attitude of the clinician is crucial in this process. Mildly affected mothers who have sons with AS are especially in need of psychological support. Professional psychological help should be made available but not given routinely.

Towards optimal recording and analysis of the mismatch negativity.

In this paper, the conceptual and practical issues related to the measurement of mismatch negativity (MMN) are discussed from the viewpoint of cost-efficiency. First, various criteria for efficiency or optimality of measurements are described, including reliability and signal-to-noise ratio. Then a critical look is taken at some currently used concepts and data analysis methods. Practical guidelines for the measurement and analysis of MMN are given, complementing the earlier reviews on the subject. Finally, reliability studies on MMN are critically reviewed.

Specific changes in somatosensory evoked magnetic fields during recovery from sensorimotor stroke.

We studied recovery-induced changes in the responsiveness of the primary somatosensory cortex in stroke patients with sensory and/or motor symptoms. Somatosensory evoked magnetic fields, in response to median nerve stimulation, were recorded in 14 patients with their first symptomatic unilateral stroke 1 to 15 days from the first symptoms and again 2 to 3 months later. Neuronal activity at the contralateral primary somatosensory cortex was modeled with equivalent current dipoles at the peak latencies of the first two cortical deflections at about 20 msec (N1m) and at 28 to 91 msec (P1m). Twenty-three age-matched healthy volunteers, 9 of whom were tested also in serial recordings, served as control subjects. At follow-up, 6 patients showed a significant increase of P1m amplitude, whereas N1m increased only in 1. Clinical improvement of two-point discrimination ability, but not of other basic somatosensory skills, was significantly correlated with the increase of P1m. We conclude that the recovery of discriminative touch after stroke is paralleled by the growth of the P1m somatosensory evoked magnetic field deflection, and we propose that this may reflect re-establishment of lateral inhibitory functions at the primary somatosensory cortex.

Harmonic partials facilitate pitch discrimination in humans: electrophysiological and behavioral evidence.

The effect of the spectral tone structure on pre-attentive and attentive pitch discrimination was investigated. The mismatch negativity (MMN) component was recorded from reading subjects to pitch changes of identical magnitude in pure tones with only one sinusoidal frequency component and in spectrally rich tones with two additional harmonic partials. In a separate condition, subjects were asked to indicate detection of pitch change by a button press. The MMN was elicited with a larger amplitude and shorter latency by change in spectrally rich tones than by change in pure tones. Furthermore, the subjects' behavioral responses were more accurate for spectrally rich tones than for sinusoidal tones. Together these data indicate that pre-attentive and attentive pitch discrimination is facilitated with spectrally rich sounds in comparison to pure sinusoidal tones.

Test-retest reliability of mismatch negativity for duration, frequency and intensity changes.

OBJECTIVES: The test-retest reliabilities of the mismatch negativity (MMN) elicited by deviances in sound duration, frequency, and intensity were compared. METHODS: The MMN was recorded with a 64-channel electroencephalograph (EEG) from 15 healthy adult subjects in two sessions over intervals of 1-27 days. During the recordings, subjects watched a silent movie while they were presented with one long stimulus sequence consisting of 6 types of tones. The standard tone (P = 0.8) of 75 ms in duration consisted of 3 lowest harmonic partials with 500 Hz as the fundamental frequency. Each of the 5 different deviant tones was presented with P = 0.04: frequency deviants (+/-5%, +/-10%), duration deviants (-66%, -33%), and intensity deviants (- 15 dB). RESULTS: The 66% duration decrement elicited MMN with the most replicable amplitude (r = 0.78) and latency (r = 0.76) among the deviances tested. CONCLUSIONS: Since these reliabilities considerably exceed those reported previously, these data support the use of the duration decrement deviance presented with spectrally rich tones while investigating the integrity of the patients' cognitive brain functions using the MMN.

Task effects on fatigue symptoms in overnight driving.

This study examined the effects of task and time-on-task on fatigue symptoms in overnight driving. Four participants drove an instrumented car 1200 km overnight and completed the same trip as passengers on another night. Subjective ratings of drowsiness, eye blink frequency and duration, microsleeps, and steering-wheel inputs were analysed as a function of time-on-task, and for separate samples when meeting oncoming heavy vehicles. Four video cameras were used to monitor the road view and the face of both the driver and passenger. In terms of eye closure duration, the reported microsleeps were shorter while driving (mean = 0.7 s, SD = 0.2 s) than as a passenger (mean = 2.6 s, SD = 2.0 s). Blink frequency increased with time-on-task as expected, indicating tiredness, and decreased when approaching an oncoming heavy vehicle, indicating attentive response to a potential critical situation. No consistent effect of time-on-task on high-frequency steering-wheel inputs when meeting oncoming heavy vehicles was found. The results raise the important question of what makes a driver wake from a microsleep earlier than a passenger and, given proper monitoring of long eyelid closures, what the proper intervention should be.

Analysis of speech sounds is left-hemisphere predominant at 100-150ms after sound onset.

Hemispheric specialization of human speech processing has been found in brain imaging studies using fMRI and PET. Due to the restricted time resolution, these methods cannot, however, determine the stage of auditory processing at which this specialization first emerges. We used a dense electrode array covering the whole scalp to record the mismatch negativity (MMN), an event-related brain potential (ERP) automatically elicited by occasional changes in sounds, which ranged from non-phonetic (tones) to phonetic (vowels). MMN can be used to probe auditory central processing on a millisecond scale with no attention-dependent task requirements. Our results indicate that speech processing occurs predominantly in the left hemisphere at the early, pre-attentive level of auditory analysis.