Skeletal outcome in long-term survivors of childhood high-risk neuroblastoma treated with high-dose therapy and autologous stem cell rescue.

High-dose therapy and hematopoietic stem cell transplantation (HSCT) have been shown to improve survival rates in high-risk neuroblastoma (HR-NBL), but may cause adverse effects on the growing skeleton. We studied skeletal health in a national cohort of long-term survivors of HR-NBL (n=21; age 16-30 years, median 22 years) and in 20 healthy age- and sex-matched controls. In addition to clinical evaluation and measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry, we performed spinal magnetic resonance imaging. Skeletal complications were categorized according to Common Terminology Criteria for Adverse Events (CTCAE). Altogether, 18/21 survivors presented with at least one skeletal adverse event according to CTCAE, the most common skeletal complications being short stature (n=14) and osteopenia (n=13). Altogether, 38% of the subjects had a severe complication (CTCAE score ⩾3) including bilateral slipped capital femoral epiphyseolysis in 3/21. Fracture rate was not increased. In spinal MRI, no vertebral fractures were found and degenerative intervertebral disc changes were equally prevalent in survivors and controls. BMD was lower in survivors than controls, but differences became non-significant when adjusted for bone size. In conclusion, skeletal late complications are common and can significantly impair the quality of life in young adult survivors of HR-NBL treated with high-dose protocols and HSCT.

Can brief intervention through community dental care have an effect on adolescent smoking?

BACKGROUND: Community dental clinics are good settings for smoking intervention. The aim here was to put forward a strategy for preventing adolescent smoking by means of a brief intervention. METHODS: A total of 2,586 12-year-olds participated in this follow-up study. They were asked upon arrival for their annual routine dental examination to complete a smoking questionnaire and were randomly assigned to either the intervention group or the usual care control group according to the last digit of their date of birth (odd or even). The intervention comprised annually inquiring about smoking, showing photographs of the harmful effects of smoking on the teeth, allowing participants to examine their own mouth with a mirror, and finally counselling them in accordance with their answer to the question on smoking habits. The smoking status reported was not verified by other means. RESULTS: The prevalence of smoking at the end of the 2-year follow-up was 18.1%, in the intervention group and 20.8% among the controls. However, no statistically significant differences between groups were found. CONCLUSIONS: These results reflect the difficulties of achieving successful results with long-term smoking cessation programs with adolescents in unstable conditions.

Changes in the oral health of adolescents treated by the Finnish public dental services between the ages of 13 and 15 years.

Oral cavity health was monitored in 2422 young people aged 13-15 years attending four health centres in Finland between 1992 and 1995. Assessments were made in terms of DMF, D and CPITN indices at clinical examinations. Of those who had no carious teeth at the initial examination, 60% did not develop cavities during the whole period, whereas half of those who had at least two carious teeth at the initial examination developed at least three new carious teeth. The treatment time needed by the latter accounted for half of the total time expended by the researchers until the end of the period. Costs can be saved or new patients brought into the dental care system by reorganizing the treatment of the patients who suffer from abundant caries and by reducing the resources devoted to the treatment of healthy patients.

Incidence of edentulousness, reasons for full clearance, and health status of teeth before extractions in rural Finland.

Incidence of edentulousness, reasons for full clearance, and clinical status before extractions were studied in a longitudinal setting in 47 rural communities in Finland. The annual incidence of total loss of teeth was 50/100,000 inhabitants and loss of maxillary teeth 20/100,000 inhabitants. The rates were about twice as high for men as for women. Of the teeth to be extracted, 70% were roots or decayed, 20% were affected by severe periodontal disease and 10% were extracted for prosthetic reasons without caries or periodontal disease. The incidence rates indicate that the number of dentulous subjects in Finland is growing very rapidly.

Economic aspects of dental care in Finnish health centers.

In recent years economic evaluations of publicly funded governmental and community based activities have become more common. Although the Public Dental Service in Finland has been in operation for 17 yr, little is known of the effectiveness of the system. The aim of this study was to assess the effectiveness, output and costs of dental care using available data from 34 randomly selected health centers during 1982-85. Great differences were found in running expenses and productivity between the health centers studied. The study indicated that dental care arrangements tended to be more expensive in communities with high governmental subsidies than in those with low ones. The ratio of chairside assistants to dentists was also shown to have a statistically significant positive correlation with the cost of a dental visit.