One for all or all for one? An integrative review of research on frequent callers.

Objective: Telephone health services is an increasing and integral part of health care in several countries. Callers who call repeatedly, in the current study "frequent callers" are present in all kinds of healthcare services, often constitute a considerable proportion of the total amount of calls and are complicated to help. The aim was to provide a comprehensive overview of research on frequent callers at a variety of telephone health services. Methods: An integrative literature review. Literature was searched for the period 2011-2020 in CINAHL Plus, MEDLINE, APA PsycArticles, APA PsycInfo, and PubMed, and resulted in the inclusion of 20 articles. Results: Studies on frequent callers (FCs) were found in the context of emergency medical services, telephone helplines, primary healthcare, and specialist medicine clinics. Frequent calling was associated with psychiatric comorbidity, and the reasons for calling were often multifaceted. Conclusion: The strategies suggested for handling calls involved an individual approach, which could be enabled through multidisciplinary work. Innovation: The main findings indicate a need for a systematic approach and guidelines to enable optimal help for FCs. Cooperation among healthcare instances seems to contribute to a more individual care for FCs.

Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis.

Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. A randomly selected sample of 588 patients who all had received implant-supported therapy 9 y earlier was clinically and radiographically examined. Prevalence of peri-implantitis was assessed and risk indicators were identified by multilevel regression analysis. Forty-five percent of all patients presented with peri-implantitis (bleeding on probing/suppuration and bone loss >0.5 mm). Moderate/severe peri-implantitis (bleeding on probing/suppuration and bone loss >2 mm) was diagnosed in 14.5%. Patients with periodontitis and with ≥4 implants, as well as implants of certain brands and prosthetic therapy delivered by general practitioners, exhibited higher odds ratios for moderate/severe peri-implantitis. Similarly, higher odds ratios were identified for implants installed in the mandible and with crown restoration margins positioned ≤1.5 mm from the crestal bone at baseline. It is suggested that peri-implantitis is a common condition and that several patient- and implant-related factors influence the risk for moderate/severe peri-implantitis (ClinicalTrials.gov NCT01825772).

Twenty-year follow-up of root filled teeth in a Swedish population receiving high-cost dental care.

AIM: To study the 20-year survival rate and periapical status of root filled teeth in a Swedish population requiring high-cost dental care and to identify factors related to survival and normal periapical status at follow-up. METHODOLOGY: The study population comprised 104 patients selected from four local health insurance districts with treatment plans including radiographs submitted for approval for reimbursement from the Swedish National Dental Insurance in 1977. In 1998, a clinical and radiographic follow-up examination was conducted, to register the status of 449 teeth identified as root filled at baseline. Differences in tooth survival and periapical status at follow-up, with reference to periapical status and quality of root filling at baseline, were analysed by chi-square tests. Multiple regression analysis was used to describe tooth survival and normal periapical status at follow-up, with the explanatory baseline variables: tooth type, type of restoration, type of post, quality of root filling, periapical status, marginal bone loss and caries. Differences were considered significant at a 5% level. RESULTS: Two hundred and ninety (65%) of the root filled teeth survived at follow-up. Baseline variables associated with low odds for tooth survival were mandibular molar, maxillary premolar, prefabricated posts other than screw posts, severe marginal bone loss, caries and apical periodontitis (AP). Normal periapical status at follow-up was registered in 49% of the root filled teeth. Baseline variables associated with low odds for normal periapical status (high risk for AP) at follow-up were mandibular molar, maxillary premolar, AP, severe marginal bone loss and inadequate root filling quality. Of the root filled teeth with AP at baseline, 42% had been left untreated during the observation period, and at follow-up, the AP persisted in 57% of these teeth. CONCLUSIONS: After 20 years, 65% of the root filled teeth had survived and one-third remained with a sound periapical condition, without any further treatment. Almost half of the APs registered at baseline were left without treatment, and more than half of them persisted after 20 years.

Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss.

Treatment outcomes in implant dentistry have been mainly assessed as implant survival rates in small, selected patient groups of specialist or university clinical settings. This study reports on loss of dental implants assessed in a large and randomly selected patient sample. The results were aimed at representing evaluation of effectiveness of implant dentistry. Using the national data register of the Swedish Social Insurance Agency, 4,716 patients were randomly selected. All had been provided with implant-supported restorative therapy in 2003. Patient files of 2,765 patients (11,311 implants) were collected from more than 800 clinicians. Information on patients, treatment procedures, and outcomes related to the implant-supported restorative therapy was extracted from the files. In total, 596 of the 2,765 subjects, provided with 2,367 implants, attended a clinical examination 9 y after therapy. Implant loss that occurred prior to connection of the supraconstruction was scored as an early implant loss, while later occurring loss was considered late implant loss. Early implant loss occurred in 4.4% of patients (1.4% of implants), while 4.2% of the patients who were examined 9 y after therapy presented with late implant loss (2.0% of implants). Overall, 7.6% of the patients had lost at least 1 implant. Multilevel analysis revealed higher odds ratios for early implant loss among smokers and patients with an initial diagnosis of periodontitis. Implants shorter than 10 mm and representing certain brands also showed higher odds ratios for early implant loss. Implant brand also influenced late implant loss. Implant loss is not an uncommon event, and patient and implant characteristics influence outcomes (ClinicalTrials.gov NCT01825772).

A lactoferrin-derived peptide (PXL01) for the reduction of adhesion formation in flexor tendon surgery: an experimental study in rabbits.

Injuries to flexor tendons can lead to loss of finger function after healing due to adhesion formation. The aim of this study was to assess the efficacy and safety of the new peptide, PXL01, in the prevention of peritendinous adhesions. The effect of a single intraoperative administration of PXL01 in sodium hyaluronate on mobility of the affected digit after surgery was assessed in a rabbit model by measuring total active motion, metatarsophalangeal-claw distance and resistance to bending the digits. Load-to-failure testing was done in the same specimens to assess tendon healing. The results demonstrated that a single application of PXL01 in sodium hyaluronate significantly improved mobility of the treated digits compared with the digits in which the same surgery was carried out but no treatment was provided. No negative effects on tendon healing were observed in connection with the treatment.

Social interactions in Red Junglefowl (Gallus gallus) and White Leghorn layers in stable groups and after re-grouping.

Although social behaviour is a major factor affecting the coping of poultry in production environments little is known about how it has been affected by intensive selection processes in fowl. We attempted to clarify selection effects on overall repertoire and occurrence of different social behaviours as well as on aggressive responses to re-grouping with unfamiliar birds by comparing high-producing White Leghorn layers to wild type Red Junglefowl. In the first experiment we observed 8 stable mixed sex groups/breed each consisting of four 24-week-old birds previously familiar to each other. During 9 consecutive days, a wide range of social signals, sexual and aggressive interactions as well as spacing behaviour and activity were recorded over a 12-h photoperiod. In the second experiment, starting at 19 weeks of age, 16 single sex groups of three birds from each breed were formed by mixing unfamiliar individuals. Aggressive behaviours were recorded 0, 5, 24 and 48 h after re-grouping. Results from the stable groups indicated that the repertoire of social behaviours has been preserved during selection with few changes in frequencies and intensities. However, Leghorns showed a more cohesive spacing pattern than junglefowl. In the second experiment, aggressive activity was higher immediately and after 24 h following re-grouping in Leghorns, but there was a drop in the aggressiveness at 5 h to the same level as junglefowl. We suggest that this may indicate poorer social learning capacity with a weaker ability to cope with group disruptions compared to the ancestral breed.

Indications for and outcome of antidepressant medication in a general population: a prescription database and medical record study, in Jämtland county, Sweden, 1995.

OBJECTIVE: To examine the indications for prescribing antidepressants and the clinical outcome when they are prescribed for the treatment of depression, and compare tricyclic antidepressants (TCAs) and selective serotonin re-uptake inhibitors (SSRIs) in these respects. METHOD: A naturalistic study of a prospective prescription monitoring database and medical records. RESULTS: Depression was the indication for 23% of the tricyclic treatments and for 82% of the SSRI treatments. A successful treatment of the depression was found in 20% of the TCA cases and 41% of the SSRI cases (NS). CONCLUSION: This study provides evidence that the main use of SSRIs in 1995 is the treatment of depression. The study implies that SSRIs have a more favourable outcome in "real life" than TCAs.

Oral health and cardiovascular disease in Sweden.

OBJECTIVE: The purpose of the present study was to assess the relation between dental health and cardiovascular disease in an adult Swedish population. MATERIAL AND METHOD: A questionnaire was sent to 4811 randomly selected Swedes. It contained 52 questions about dental care habits, oral health, cardiovascular disease and their socio-economic situation. Odd ratios for all cardiovascular diseases (CVD) and the subgroup myocardial infarction, stroke and high blood pressure were calculated with a logistic regression model adjusted for age, gender, smoking, income, civil status and education. These ratios were calculated for subjects > or =41 years since few people suffer from CVD before this. RESULTS: The national questionnaire was answered by 2839 (59%) people between 20-84 years of age and, of them, 1577 were 41 years of age or more. We found a significant association between self-reported bleeding gums (odds ratio 1.60, p=0.0017), presence of dentures (odds ratio 1.57, p=0.0076) and known CVD, which has also been reported in international studies. However, no association between loose teeth, deep pockets and known CVD was detected. CONCLUSION: The results indicate that oral health and, especially gingival inflammation is associated with CVD.

Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness.

OBJECTIVE: To evaluate the effect of balance training in group in elderly people with nonperipheral vertigo and unsteadiness. DESIGN: Randomized controlled study. SETTING: Ear-, nose- and throat department, University Hospital, Sweden. SUBJECTS: Twenty-three elderly subjects with nonperipheral vertigo and/or unsteadiness randomized into training group and control group. INTERVENTION: The training group attended balance training in group twice a week for eight weeks. MAIN OUTCOME MEASURES: Timed static balance tests, walking tests and six sensory organization tests on EquiTest dynamic posturography were performed before and after the training period. Besides, the patients estimated their vertigo and unsteadiness on a visual analogue scale (VAS) before and after the training period. RESULTS: The training group improved significantly in standing on one leg with eyes open, walking forward on a line, walking speed, in three out of six tests on dynamic posturography and estimated less vertigo and unsteadiness measured with VAS. No changes were seen in the control group. CONCLUSION: Balance training in elderly people with nonperipheral vertigo and unsteadiness seems to improve both objective and perceived balance.

Attitudes to dental health and care among 20 to 25-year-old Swedes: results from a questionnaire.

During the last 3 decades, large resources have been allocated through the organized dental care system for the improvement of dental health among children and teenagers in Sweden. The aim of this study was to describe attitudes related to dental health and dental care among 20 to 25-year-old Swedes. A random sample of 650 individuals was drawn from the database of the National Social Insurance Board of Sweden. A postal questionnaire comprising 70 questions was delivered to the subjects and the response rate was 78%. A high proportion of the respondents considered themselves to have a high need for dental care. They had a strong conception of being able to influence their own dental health. Quite a few were concerned about their dental health. A high proportion indicated that they were satisfied with their dental function, but fewer individuals were satisfied with the appearance of their teeth. The respondents also reported good reception by their dentists, although opinions differed between the sexes. Women reported a significantly higher degree of discomfort and unease than men. Most respondents had adopted good oral hygiene habits but dental floss was rarely used. The majority of subjects indicated that they attended dental examinations on an annual basis. There is a need for further investigation into patients' attitudes to dental health and dental care. It is important to understand the significance patients attach to different concepts in the dental treatment. This would enhance our understanding of how the concept of felt need is expressed and transformed into demand for care.