E.SUUNTERVEYS E.001 Maahanmuuttajien suunterveys ja suun terveydenhuollon palvelujen käyttö Suomessa... 2 E.002 The association of employment status with oral health and oral health related behaviors... 3 E.003 Oral health care utilization among immigrants residing in Finland... 5 E.004. Hammaslääkärikäyntien yhteys lääkärikäynteihin maahanmuuttajilla.... 7 E.005 The association between mental health and oral health in Russian, Somali and Kurdish migrants living in Finland.... 8
E.001 Maahanmuuttajien suunterveys ja suun terveydenhuollon palvelujen käyttö Suomessa Maahanmuuttajien terveydestä ja terveyspalveluiden käytöstä on Suomesta niukasti tietoa. Tämä koskee myös heidän suunterveyttään ja suun terveydenhuollon palveluiden käyttöä. Muissa Pohjoismaissa tehdyissä tutkimuksissa on todettu eroja suunterveydessä maahanmuuttajien ja kantaväestön välillä. Suomi kuitenkin eroaa muista Pohjoismaista maahanmuuttajien määrässä suhteessa väkilukuun siten, että Suomessa maahanmuuttajia on huomattavasti vähemmän. Tutkimuskysymykset Tutkimuksen tavoitteena on kuvata työikäisten maahanmuuttajien suunterveyttä ja suun terveydenhuollon palvelujen käyttöä Suomessa. Tarkemmin selvitetään, miten maahanmuuttajien suunterveys ja palveluiden käyttö eroavat kantaväestön suunterveydestä ja palveluiden käytöstä sekä mikä merkitys on maahanmuuttajien etnisellä taustalla ja sosioekonomisilla tekijöillä. Tutkimuksessa tarvittavan aineiston kuvaus Terveyden ja hyvinvoinnin laitos (THL) on selvittämässä maahanmuuttajien terveys- ja hyvinvointitutkimuksessa (Maamu) Suomessa asuvien työikäisten venäläisten, somalien ja kurdien (n=3000) terveyttä kuudessa kaupungissa: Helsinki, Vantaa, Espoo, Tampere, Turku ja Vaasa. Aineiston keruu tapahtuu vuosina 2010-2012 ja aineisto kerätään kotikäyntihaastatteluina ja hoitajien tekeminä terveystarkastuksina. Nyt tehtävä tutkimus on osa Maamu-tutkimusta ja siinä hyödynnetään Helsingin ja Espoon kaupungeista kerättyjä aineistoja siten, että haastatteluosuudesta aineistona olisi suun terveyden kokonaisuus ja terveystarkastuksesta suun tarkastus mukaan lukien taustatiedot (etninen tausta ja sosioekonomiset tekijät). Tekijät Hammaslääketieteen kandidaatti (HLK) Nina Suontausta Ohjaajat: professori Liisa Suominen, dosentti Kaisu Pienihäkkinen Aikataulu Aineisto on kerätty Helsingin ja Espoon kaupunkien osalta. Tutkimussuunnitelma ja kirjallisuuskatsaus valmistuvat ja aineiston analysointi alkaa syksyn 2011 aikana. Kirjoitustyö aloitetaan keväällä 2012. Julkaisumuoto ja -kieli Tavoitteena on laatia julkaisu Suomen Hammaslääkärilehteen, joka korvaa hammaslääketieteen syventävien opintojen kirjallisen työn. Tämän lisäksi tavoitteena on jatkaa analyysejä tähtäimenä kansainvälinen, tieteellinen hammaslääketieteen alan julkaisu, jossa on analysoitu kaikkien kaupunkien aineistoja. Kansainvälinen artikkeli julkaistaan aikasintaan vuonna 2013. Yhteistyötahot Maamu- aineiston sisällön ja keruun vastuuhenkilö(itä). Rahoitus/resurssit Kyseessä on hammaslääketieteen opiskelijan syventävien opintojen kirjallinen osa, joten resursseja ei tutkimukseen tarvita.
E.002 The association of employment status with oral health and oral health related behaviors I. Background With the advancement of health research, effects of socio-economic status on health has been in focus. At present, it is obvious that socio-economic status has its own specific effect on health [1], and it suggested to be comprised from three main parts: Employment, Education, and Income [1]. Socio-economic status also proved to have an effect on oral health and oral health-related behavior [2]. Work or employment could be an exposure for some adverse effects on oral health and general health [3], but at the same time, unemployment is an important issue that should take some attention as determinant to the oral health and oral health-related behaviors. Reports from Finnish Ministry of Employment showed that the percentage of unemployment in Finland is about 9 % with some variation in 2010. This means that about quarter million unemployed persons are living in Finland [4]. Unemployment could be a determinant of oral health or as a risk factor for bad oral health in terms of dental caries, periodontal diseases, dental plaque, or other oral cavity diseases. The magnitude of the effect of employment status on oral health and oral health-related behaviors has not been researched. The previous studies focused on social gradient of oral health in employed people or dental care utilization [5]. The need to assess the effect of unemployment status on oral health and oral health-related behavior is important because in every society there is a specific rate of unemployed persons who could be a risk group of oral diseases or bad oral health-related behaviors. The consequence of such study would be beneficial because if the results showed that unemployed persons are risk group for oral diseases or/and bad oral health-related behaviors, dental public health would start focusing on these risk groups for better oral health. In addition to that, keeping good oral health of unemployed people will make them more ready to go back for the work market with more confidence and opportunities if they are healthy and not suffering from any health problems [7]. To my knowledge, little has been done to know the difference of oral health, oral health-related behaviors among employed and unemployed persons in Finland. II. Aim and objectives 1-To examine if there is any association between employment status and oral health and oral healthrelated quality of life. 2- To test if there is any association between employment status and oral health-related behaviors. 3- To examine the effect of oral health-related behaviors on the pathway between employment status and oral health and oral health-related quality of life. III. Methods and Materials Data about employment status, oral health, and oral health-related behaviors required for the research will be requested from the National Institute for Health and Welfare (THL) of the following studies: 1- The Health 2000 Survey [8]. The study has been carried out in 2000-2001 and included three nationally representative random population samples. One detailed sample comprised of 8,028 adults aged 30 years old or over. The other two populations were young adults aged 18 to 29 years and a sub-population who took part in the Mini- Finland Survey 20 years earlier. Aim of the survey was to obtain up-to-date information on the most important public health problems in Finland.
The survey concerning adults age 30 year or over included an interview, several questionnaires and a clinical health examination. Information on oral health and oral health-related behaviour was gathered by interviews, postal questionnaires, clinical oral examinations (6,335 participants) and panoramic radiography (6,115 participants). Aim was to illustrate the prevalence and distribution of self-reported and clinically determined oral health and oral health-related habits, as well as to evaluate the factors associating with them. 2- The Paltamo Project: Employment, health, and well-being. Evidence from the Paltamo Employment model evaluation [9]. The Paltamo project aims to reduce the overall costs of unemployment by improving the health of jobseekers. The National Institute of Health and Welfare (THL) coordinates the evaluation on the effects of the project. Corresponding studies are conducted between 2009 and 2013 and carried out by several cooperating organisations. The project included interventions between the unemployed of Paltamo and two control groups, the unemployed of Sonkajärvi and a fitted sample of employed persons in Paltamo. The study comprised 900 persons aged 15-64, approximately 300 persons per group. Data collection in the baseline was carried out by interviews, questionnaires, and health examinations during autumn 2009 and spring 2010. Participation rates of the groups varied between 52 and 62 percent. Follow-up data has been gathered during autumn 2010 and spring 2011 in order to evaluate first effects of project interventions. A third data collection will be carried out in the beginning of 2012. The interview included questions on selfreported oral health and oral health-related behaviour. During the follow-up health examination, the nurse determined number of teeth by jaw, and recorded the type and location of removable dentures by jaw and examined them for cleanliness and need for repair. 3- The Maamu Study: Migrant Health and Wellbeing Study [10]. The study is collecting information about 3000 adults of Russian-speaking, Somali and Kurdish origin in six cities in Finland. The objective of the study is to produce information regarding health and wellbeing, work ability and need for services of migrants, as well as the factors influencing them. The information from this study will be used to improve the health and wellbeing of ethnic minorities, the quality of services for migrants, and the labor market potential for people of migrant origin. Interviews and health examinations are carried out in Helsinki (2010-2011), Espoo, Vantaa, Turku (2011), Tampere and Vaasa (2012). Interview included questions about perceived oral health (pain, self-reported oral health, use of removable dentures, need for dental care), and oral health-related behaviours (tooth brushing frequency, use of dental services). During the health examination, the nurse determined number of teeth by jaw, and recorded the type and location of removable dentures by jaw and examined them for cleanliness and need for repair. 4- The Health 2011 follow-up study [11]. The Health 2000 follow-up study is a longitudinal panel study that collects data from the participants of the Health 2000 survey carried out in the years 2000-2001. The feasibility study carried out in April and the ongoing main study began in August 2011. The purpose of the panel study is to assess the dynamics of change of health in the Finnish population, obtain individual data on gross change and determine causal effects for health and well-being outcomes. A follow-up includes a wide and diverse health assessment, interviews and questionnaires. In the interview, the subject's most important background information, medical history and information on diseases and medicines, the use of health services, lifestyle, living environment, functional capacity, work and work ability, quality of life as well as the need for ssistance will be collected. Information about oral health, oral health related quality of life, and oral health-related behaviours will be collected using oral examinations, interviews, and questionnaires. IV. List of the planned publications included in the thesis: 1 The association between employment status and oral health and oral health related behaviour (The Health 2000 Survey). 2 The effect of employment status on oral health and oral health-related behaviours (The Health 2000
follow-up study). 3 Oral health and oral health-related behaviours of the unemployed. A comparative study between adult immigrants and the Finnish population (The Maamu Study and the Health 2000 Survey). 4 Differences in self-reported oral health and oral health-related behaviour between the employed and unemployed before and after an employment intervention, and effects of the employment process (The Paltamo Project). 5 Unemployment and oral health-related quality of life (The Health 2000 Survey and the Health 2011 follow-up study). VI. Researchers: Fouad Younis Hussien Al-Sudani, B.D.S, M.Sc. / University of Eastern Finland Prof. Liisa Suominen, D.D.S., Ph.D. / University of Eastern Finland (1st supervisor of the thesis) Dr. Miira Vehkalahti, D.D.S, Docent, Ph.D. / University of Helsinki ( 2nd supervisor of the thesis) Dr. Tuija Martelin, Ph.D., M.Sc., National Institute for Health and Welfare (THL) Other researchers from the Health 2000 Survey, the Paltamo project, and the Maamu project. VIII. Financing: The student will apply for grants to support the study from different Finnish national academic funders. The fund will be used for living cost of the PhD student. The PhD student is using the facilities of the Institute of Dentistry for the research work. IX. Purpose: To publish four/five articles about the subject and writing Ph.D. thesis. Applicant : Name: Fouad Younis Hussien Al-Sudani B.D.S, MSc. Research Place : Institute of Dentistry/ Faculty of Health Sciences/ University of Eastern Finland/ Kuopio Campus. E.003 Oral health care utilization among immigrants residing in Finland Background: There has been a considerable increase in immigration throughout Europe over the past couple of years. Most urban cities in Finland see a growing number of immigrants coming from Asia and Africa each year. Change in environment and lifestyle as well as culture and language barriers make immigrants more prone to health problem and reluctant in seeking health care. As in many societies, oral health is mostly overlooked over other health problems. The lack of financial resources and the lack of knowledge about the health care system may just be a few reasons that could make the immigrants ignore oral health problems and avoid seeking proper oral health care. Utilization of health care is depended on many factors some of which include health behavior, societal determinant, influences from the health care system and also individual perceptions. In 1960, Anderson and Newman proposed a framework that took into account all of these factors and since has been extensively used to conceptually organize the factors that influence the utilization of general as well as oral health care. This model is used under the assumption that oral health care utilization is based on predisposing characteristics such as gender, education and health beliefs, enabling factors such as income, access to health care and social network and need factors such perceived health status and disease severity.
Aim: To assess the oral health care utilization among the immigrants in Finland Objectives: -To determine the oral health care utilization of the immigrants and the factors associated with the use of oral health care services. -To describe the immigrants satisfaction of the oral health care service. Methods and Variables Data for this study will be obtained from the Migrant Health and Wellbeing Study (Maamu) conducted by National Institute for Health and Welfare (THL). This cross sectional study was carried out in six different cities of Finland namely Helsinki, Vaasa, Turku, Vantaa, Espoo and Tampere. We will be using the questionnaire and interviews that were collected during the Maamu study. We will be using the conceptual model proposed by Andersen and Newman for evaluating the utilization of oral health care. This model assumes that a person s access to health service is a function of predisposing, enabling and need factors. The variables for the study will be chosen with regard to the model. The outcome variables will be the use of oral health care services (E05 and E06) Predisposing factors Enabling factors Need Factors Age Level of Income (A801 A802) Need for care(e10) Gender Residence (A401) Dental Pain (E02) Marital status (A201) Family size (A301) Prosthesis (E03) Time in Finland (A101) Social functioning (G101) Self-Reported Oral health (E01) Nationality (A106) Social Relationships and support(g303,g304,g305,g308) Self-Reported general health (B101) Religion (A107) Barriers to medical treatment ( B203) Long term Injury (B102) Language (A501,A508-A510) Discrimination in health care services (C404) Education (A 601) Trust in Public health services (C403) Occupation(H201, H202) Dental Beliefs [Fear] (E11) and Dental Behavior[Dental visits] (E05) Health Behavior (Smoking(F201-F209) & Oral Hygiene Practice(E04) In Addition to these variables we will be using the variables for describing the satisfaction of oral health care. (E09, E08, E07) Collaborators: The study is part of Masters Thesis of University of Eastern Finland for the fulfillment of Masters Degree in Public Health. The Collaborators for the study are: -Evan Manandhar ( Masters Degree Student, evanm@student.uef.fi) -Prof. Liisa Suominen (Institute of Dentistry, University of Eastern Finland, Kuopio) -Dr. Sohaib Khan (Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio) -Researches from the Maamu Study ( National Institute for Health and Welfare, THL) Time Table Proposal - October Literature Review - November - January
Results -February Discussion - March - April Draft Report - May Final Submission - June E.004. Hammaslääkärikäyntien yhteys lääkärikäynteihin maahanmuuttajilla. Tutkimuksen tarkoitus/tavoitteet -Maahanmuuttajien avoterveydenhuollon palveluiden käytöstä on tehty Suomessa vähän tutkimuksia, erityisesti suun terveydenhuollon palveluista ja sen yhteydestä muiden palveluiden käyttöön. Maahanmuuttajien tyytyväisyydestä avoterveydenhuollon palveluita kohtaan Suomessa ei ole juuri lainkaan tietoa. Tutkimuksen tavoitteet Selvittää kuinka suuri osa maahanmuuttajista oli käyttänyt lääkäri- ja hammaslääkäripalveluita viimeisen 12 kuukauden aikana ja verrata tekijöitä, jotka ovat yhteydessä näiden palvelujen käyttöön. Tutkimuksessa myös verrataan löytyykö hammaslääkäri- ja lääkäripalvelujen käyttäjillä eroja tyytyväisyydessä saamaansa hoitoon. Aineisto ja menetelmät Käytetään osaa Terveyden ja hyvinvoinnin laitoksen Maamu-tutkimuksen aineistoa (Castaneda ym. 2012) liittyen hammaslääkäri- sekä lääkäripalvelujen käyttöön. Rajataan tarkasteluväli koskemaan lääkäri- ja hammaslääkäripalveluiden käyttöä viimeisen 12 kuukauden aikana (E06, D201), poislukien pitkäaikaissairaat (E01, B102). Käytettävät muuttujat: Sukupuoli Ikä Viiteryhmä (A106) Suomessa oloaika (A101) Koulutustaso (A601-A607) Siviilisääty (A201) Maahanmuuttotausta (A104) Pääasiallinen toiminta (A701) Tyytyväisyys palveluihin (E09A-E09E, D306A-D306F) Lääkärissä/hammaslääkärissä viimeisen 12kk aikana (E06, D201) Aineisto Maamu (lisätietoja) -Rajataan tarkasteluväli koskemaan lääkäri- ja hammaslääkäripalveluiden käyttöä viimeisen 12 kuukauden aikana (E06, D201), poislukien pitkäaikaissairaat (E01, B102). Sosiodemografiset tekijät ja elinolot Suun terveys Palveluiden käyttö ja tarve
Tutkimusasetelma Poikkileikkaustutkimus Tutkimussuunnitelmasta vastuussa oleva henkilö Nimi Yritys / Organisaatio Pyry Mattila Itä-Suomen yliopisto, hammaslääketieteen yksikkö Muut tekijä(t) -Yhteistyö Hammaslääketieteen yo Pyry Mattila, hammaslääketieteen yksikkö, Itä-Suomen yliopisto. Ohjaajat: Professori Liisa Suominen, Suun terveydenhuolto, hammaslääketieteen yksikkö, Itä-Suomen yliopisto. Xxxxx xxxxxx, Maamu-tutkimus, Terveyden ja hyvinvoinnin laitos. Alustavasti keskusteltiin, että tutkimusryhmästä saataisiin toinen ohjaaja syventävälle tutkimukselle, mutta ei ollut vielä nimettyä henkilöä THL:n puolelta. Aikataulu Aloitusajankohta: Valmistumisajankohta: 1.10.2013 1.9.2014 Julkaisumuoto: opinnäytetyön raportti (esim. pro gradu) Lisätietoja: -Julkaisumuoto Syventävien opintojen tutkielma Tutkimussuunnitelmaa ei ole vielä laitettu yliopistolle hyväksyttäväksi. E.005 The association between mental health and oral health in Russian, Somali and Kurdish migrants living in Finland. Aims/objectives A. Background of the study Previous studies done in United States, Scotland, and in other places in the world have shown that there may be an association between poor mental health and poor oral health. However, studies have not been conducted to compare this association between different ethnicities. B. Aims of the study The aim of the study is to determine if there is an association between mental health and oral health among the Russian, Somali and Kurdish and Finnish populations. The specific aims are: 1. To describe the overall oral health of Russian, Somali, Kurdish and Finnish ethnicities. 2. To determine the association between depression and oral health ( self-reported oral health, history of recent tooth pain, frequency of tooth brushing, use of dental services) among the Russian, Somali, Kurdish
and Finnish ethnicities. 3. To determine if there is a difference in the association between depression and oral health (see Aim 2 above) across different ethnicities. The results of the mental health and oral health obtained from the MAAMU study will be tested for the three migrant groups. The results will be compared to the Finnish population as a reference group. C. Methods The study will determine by statistical testing if there is an association between mental health and oral health among the migrant groups in the MAAMU study using the MAAMU data. The results will be compared to the Finnish population as a reference group, from the Health 2011 Follow up study. The data will be analyzed using STATA software. D. Reporting An article based paper. It will be written for the Master s thesis which is a partial fulfilment of the requirements for the award of the Masters of Health Sciences degree (Public Health) from the University of Tampere. Data Health 2011 -study, Migrant Health and Wellbeing Study (Maamu) Socio-demographic factors and living conditions, Mental health and psychological well-being, Oral health Design Cross-sectional study Contact information of the person in charge of the study proposal Name Enterprise/organization Lynda Aleburu Masters degree student,public Health, University of Tampere, Finland The names of other researchers involved: Candidate: Lynda Aleburu Supervisor: Tarja Kinnunen, docent, PhD (epidermiology), University of Tampere. Resource Person: Prof Liisa Suominen (University of Eastern Finland). Timetable 20.06.2016-31.02.2017 Type of publication Other scientific article, Thesis report (for example Master s thesis) Further information The study proposal has been approved by the supervisors.