Universal Service Policies in Europe & Latam: Evidence on Bridging the Divide in Rural Areas

Broadband access is a key factor for economic and social development. However, providing broadband to rural areas is not attractive to private telecommunications operators due its low or zero investment return. To deal with broadband provision in rural areas, different governance systems based on private and public cooperation have appeared. This paper not only identifies and defines public and private cooperation models but also assesses their impact on overcoming the digital divide in rural areas. The results show that public ownership infrastructure under private management policy has had positive effects on reducing the broadband digital divide and being applied to areas with higher digital divide; subsides to private operators providers only positive effects on reducing broadband digital divide; but public infrastructure with public management programs did not. The results, obtained using quasi-experimental methods, suggest the importance of incentives and control mechanisms in broadband universal service provision plans.

Epilepsy priorities in Europe: A report of the ILAE-IBE Epilepsy Advocacy Europe Task Force.

The European Forum on Epilepsy Research (ERF2013), which took place in Dublin, Ireland, on May 26-29, 2013, was designed to appraise epilepsy research priorities in Europe through consultation with clinical and basic scientists as well as representatives of lay organizations and health care providers. The ultimate goal was to provide a platform to improve the lives of persons with epilepsy by influencing the political agenda of the EU. The Forum highlighted the epidemiologic, medical, and social importance of epilepsy in Europe, and addressed three separate but closely related concepts. First, possibilities were explored as to how the stigma and social burden associated with epilepsy could be reduced through targeted initiatives at EU national and regional levels. Second, ways to ensure optimal standards of care throughout Europe were specifically discussed. Finally, a need for further funding in epilepsy research within the European Horizon 2020 funding programme was communicated to politicians and policymakers participating to the forum. Research topics discussed specifically included (1) epilepsy in the developing brain; (2) novel targets for innovative diagnostics and treatment of epilepsy; (3) what is required for prevention and cure of epilepsy; and (4) epilepsy and comorbidities, with a special focus on aging and mental health. This report provides a summary of recommendations that emerged at ERF2013 about how to (1) strengthen epilepsy research, (2) reduce the treatment gap, and (3) reduce the burden and stigma associated with epilepsy. Half of the 6 million European citizens with epilepsy feel stigmatized and experience social exclusion, stressing the need for funding trans-European awareness campaigns and monitoring their impact on stigma, in line with the global commitment of the European Commission and with the recommendations made in the 2011 Written Declaration on Epilepsy. Epilepsy care has high rates of misdiagnosis and considerable variability in organization and quality across European countries, translating into huge societal cost (0.2% GDP) and stressing the need for cost-effective programs of harmonization and optimization of epilepsy care throughout Europe. There is currently no cure or prevention for epilepsy, and 30% of affected persons are not controlled by current treatments, stressing the need for pursuing research efforts in the field within Horizon 2020. Priorities should include (1) development of innovative biomarkers and therapeutic targets and strategies, from gene and cell-based therapies to technologically advanced surgical treatment; (2) addressing issues raised by pediatric and aging populations, as well as by specific etiologies and comorbidities such as traumatic brain injury (TBI) and cognitive dysfunction, toward more personalized medicine and prevention; and (3) translational studies and clinical trials built upon well-established European consortia.

Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care.

UNLABELLED: The aim of this study was to compare perceived barriers to and the most preferred age for successful transition to adult health care between young people with chronic disorders who had not yet transferred from pediatric to adult health care (pre-transfer) and those who had already transferred (post-transfer). In a cross-sectional study, we compared 283 pre-transfer with 89 post-transfer young people, using a 28-item questionnaire that focused on perceived barriers to transition and beliefs about the most preferred age to transfer. Feeling at ease with the pediatrician was the most important barrier to successful transition in both groups, but was rated significantly higher in the pre-transfer compared to the post-transfer group (OR = 2.03, 95 %CI 1.12-3.71). Anxiety and lack of information were the next most important barriers, rated equally highly by the two groups (OR = 0.67, 95 %CI 0.35-1.28 and OR = 0.71, 95 %CI 0.36-1.38, respectively). More than 80 % of the respondents in both groups reported that 16-19 years was the most preferred age to transfer; more than half of all the respondents reported 18-19 years and older as the most preferred age. CONCLUSION: Better transition planning through the provision of regular and more detailed information about adult health-care providers and the transition process could reduce anxiety and contribute to a more positive attitude to overcome perceived barriers to transition from young people's perspective. Young people's preferences about transferring to adult health care provide a challenge to those children's hospitals that transfer to adult health care at a younger age.

Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study.

BACKGROUND: Pediatric advance care planning differs from the adult setting in several aspects, including patients' diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals' perspective. AIM: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. DESIGN: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. SETTING/PARTICIPANTS: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. RESULTS: Perceived problems with pediatric advance care planning relate to professionals' discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor's advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. CONCLUSION: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers.

What young people with spina bifida want to know about sex and are not being told.

OBJECTIVE: The aim of this paper was to examine sexual knowledge, concerns and needs of youth with spina bifida (SB) to inform the medical community on ways to better support their sexual health. METHODS: As part of the Video Intervention/Prevention Assessment (VIA) - transitions, a prospective cohort study, 309 h of video data were collected from 14 participants (13-28 years old) with SB. Participants were loaned a video camcorder for 8-12 weeks to shoot visual narratives about any aspects of their lives. V/A visual narratives were analysed with grounded theory using NVivo. RESULTS: Out of 14 participants, 11 (six women) addressed issues surrounding romantic relationships and sexuality in their video clips. Analysis revealed shared concerns, questions and challenges regarding sexuality gathered under four main themes: romantic relationships, sexuality, fertility and parenthood, and need for more talk on sexuality. CONCLUSIONS: Youth with SB reported difficulties in finding answers to questions regarding their sexuality, romantic relationships and fertility. This study revealed a need for help from the medical community to inform and empower youth with SB in the area of sexual health. Through sexual and reproductive health education with patients and parents starting at an early age, medical providers can further encourage healthy emotional and physical development in adolescents transitioning into adulthood.

Challenges to patient-centred care in a general internal medicine context: findings from an exploratory study

Introduction. If we are to promote more patient-centred approaches in care delivery, we have to better characterize the situations in which being patient-centred is difficult to achieve. Data from professionals in health and social care are important because they are the people charged with operationalizing patient-centred care (PCC) in their daily practice. However, empirical accounts from frontline care providers are still lacking, and it is important to gather experiences not only from doctors but also from the other care providers. Indeed, experiences from different professions can help inform our understanding of patient care, which is expected to be both patient-centred and collaborative. Methods. This study was based on the following research question: What factors make the provision of PCC difficult to achieve? Sample and setting. A purposeful sampling technique was used, allowing for a series of choices about the participants and their professional affiliation. Because patient-centredness is the focus, 3 professions appeared to be of special interest: general internists, nurses and social workers. The study was undertaken in the General Internal Medicine Division of a teaching hospital located in a North American context. Data Collection. To answer the research question, a methodological approach based on a theory called phenomenology was chosen. Accordingly, semi-structured interviews were used since they generate understanding of the meanings different individuals have of their lived world. Interviews with 8 physicians, 10 nurses and 10 social workers were eventually conducted. Data analysis. An inductive thematic analysis was employed to make sense of the interview data. Results. The thematic analysis allowed identifying various types of challenges to PCC. Although most of the challenges were perceived by all three groups of professionals, they were perceived to a different degree across the professions, which likely reflected the scope of practice of each profession. The challenges and their distribution across the professions are illustrated in Table 1. Examples of challenges are provided in Table 2. Discussion. There is a tension between what is supposed to be done - what stands in the philosophy of patient -centredness - and what is currently done - the real life with all the challenges to PCC. According to some participants' accounts, PCC clearly risks becoming a mere illusion for health care professionals on which too great pressures are imposed.

Simulated Patient as Co-facilitators: Benefits and Challenges of the Interprofessional Team OSCE (Submission #9350).

Hypothesis: The quality of care for chronic patients depends on the collaborative skills of the healthcare providers.1,2 The literature lacks reports of the use of simulation to teach collaborative skills in non-acute care settings. We posit that simulation offers benefits for supporting the development of collaborative practice in non-acute settings. We explored the benefits and challenges of using an Interprofessional Team - Objective Structured Clinical Examination (IT-OSCE) as a formative assessment tool. IT-OSCE is an intervention which involves an interprofessional team of trainees interacting with a simulated patient (SP) enabling them to practice collaborative skills in non-acute care settings.5 A simulated patient are people trained to portray patients in a simulated scenario for educational purposes.6,7 Since interprofessional education (IPE) ultimately aims to provide collaborative patient-centered care.8,9 We sought to promote patient-centeredness in the learning process. Methods: The IT-OSCE was conducted with four trios of students from different professions. The debriefing was co-facilitated by the SP with a faculty. The participants were final-year students in nursing, physiotherapy and medicine. Our research question focused on the introduction of co-facilitated (SP and faculty) debriefing after an IT-OSCE: 1) What are the benefits and challenges of involving the SP during the debriefing? and 2) To evaluate the IT-OSCE, an exploratory case study was used to provide fine grained data 10, 11. Three focus groups were conducted - two with students (n=6; n=5), one with SPs (n=3) and one with faculty (n=4). Audiotapes were transcribed for thematic analysis performed by three researchers, who found a consensus on the final set of themes. Results: The thematic analysis showed little differentiation between SPs, student and faculty perspectives. The analysis of transcripts revealed more particularly, that the SP's co-facilitation during the debriefing of an IT-OSCE proved to be feasible. It was appreciated by all the participants and appeared to value and to promote patient-centeredness in the learning process. The main challenge consisted in SPs feedback, more particularly in how they could report accurate observations to a students' group rather than individual students. Conclusion: In conclusion, SP methodology using an IT-OSCE seems to be a useful and promising way to train collaborative skills, aligning IPE, simulation-based team training in a non-acute care setting and patient-centeredness. We acknowledge the limitations of the study, especially the small sample and consider the exploration of SP-based IPE in non-acute care settings as strength. Future studies could consider the preparation of SPs and faculty as co-facilitators. References: 1. Borrill CS, Carletta J, Carter AJ, et al. The effectiveness of health care teams in the National Health Service. Aston centre for Health Service Organisational Research. 2001. 2. Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. Oxford: Wiley-Blackwell; 2010. 3. Issenberg S, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning - a BEME systematic review. Medical Teacher. 2005;27(1):10-28. 4. McGaghie W, Petrusa ER, Gordon DL, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Medical Education. 2010;44(1):50-63. 5. Simmons B, Egan-Lee E, Wagner SJ, Esdaile M, Baker L, Reeves S. Assessment of interprofessional learning: the design of an interprofessional objective structured clinical examination (iOSCE) approach. Journal of Interprofessional Care. 2011;25(1):73-74. 6. Nestel D, Layat Burn C, Pritchard SA, Glastonbury R, Tabak D. The use of simulated patients in medical education: Guide Supplement 42.1 - Viewpoint. Medical teacher. 2011;33(12):1027-1029. Disclosures: None (C) 2014 by Lippincott Williams & Wilkins, Inc.

Development of a population-based cost-effectiveness model of chronic graft versus host disease in Spain

Chronic graft-versus-host disease (cGvHD) is the leading cause of late nonrelapse mortality (transplant-related mortality) after hematopoietic stem cell transplant. Given that there are a wide range of treatment options for cGvHD, assessment of the associated costs and efficacy can help clinicians and health care providers allocate health care resources more efficiently. OBJECTIVE: The purpose of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with rituximab (Rmb) and with imatinib (Imt) in patients with cGvHD at 5 years from the perspective of the Spanish National Health System. METHODS: The model assessed the incremental cost-effectiveness/utility ratio of ECP versus Rmb or Imt for 1000 hypothetical patients by using microsimulation cost-effectiveness techniques. Model probabilities were obtained from the literature. Treatment pathways and adverse events were evaluated taking clinical opinion and published reports into consideration. Local data on costs (2010 Euros) and health care resources utilization were validated by the clinical authors. Probabilistic sensitivity analyses were used to assess the robustness of the model. RESULTS: The greater efficacy of ECP resulted in a gain of 0.011 to 0.024 quality-adjusted life-year in the first year and 0.062 to 0.094 at year 5 compared with Rmb or Imt. The results showed that the higher acquisition cost of ECP versus Imt was compensated for at 9 months by greater efficacy; this higher cost was partially compensated for ( 517) by year 5 versus Rmb. After 9 months, ECP was dominant (cheaper and more effective) compared with Imt. The incremental cost-effectiveness ratio of ECP versus Rmb was 29,646 per life-year gained and 24,442 per quality-adjusted life-year gained at year 2.5. Probabilistic sensitivity analysis confirmed the results. The main study limitation was that to assess relative treatment effects, only small studies were available for indirect comparison. CONCLUSION: ECP as a third-line therapy for cGvHD is a more cost-effective strategy than Rmb or Imt.

Tools and data services registry: a community effort to document bioinformatics resources.

Life sciences are yielding huge data sets that underpin scientific discoveries fundamental to improvement in human health, agriculture and the environment. In support of these discoveries, a plethora of databases and tools are deployed, in technically complex and diverse implementations, across a spectrum of scientific disciplines. The corpus of documentation of these resources is fragmented across the Web, with much redundancy, and has lacked a common standard of information. The outcome is that scientists must often struggle to find, understand, compare and use the best resources for the task at hand.Here we present a community-driven curation effort, supported by ELIXIR-the European infrastructure for biological information-that aspires to a comprehensive and consistent registry of information about bioinformatics resources. The sustainable upkeep of this Tools and Data Services Registry is assured by a curation effort driven by and tailored to local needs, and shared amongst a network of engaged partners.As of November 2015, the registry includes 1785 resources, with depositions from 126 individual registrations including 52 institutional providers and 74 individuals. With community support, the registry can become a standard for dissemination of information about bioinformatics resources: we welcome everyone to join us in this common endeavour. The registry is freely available at https://bio.tools.

Security and Privacy in a Ubiquitous Information Screen

We expose the ubiquitous interaction between an information screen and its’ viewers mobile devices, highlights the communication vulnerabilities, suggest mitigation strategies and finally implement these strategies to secure the communication. The screen infers information preferences’ of viewers within its vicinity transparently from their mobile devices over Bluetooth. Backend processing then retrieves up-to-date versions of preferred information from content providers. Retrieved content such as sporting news, weather forecasts, advertisements, stock markets and aviation schedules, are systematically displayed on the screen. To maximise users’ benefit, experience and acceptance, the service is provided with no user interaction at the screen and securely upholding preferences privacy and viewers anonymity. Compelled by the personal nature of mobile devices, their contents privacy, preferences confidentiality, and vulnerabilities imposed by screen, the service’s security is fortified. Fortification is predominantly through efficient cryptographic algorithms inspired by elliptic curves cryptosystems, access control and anonymity mechanisms. These mechanisms are demonstrated to attain set objectives within reasonable performance.

Tietointensiivisten yrityspalveluiden tuotteistaminen Case: Lappeenrannan teknillisen yliopiston Tietohallinto

Työ käsittelee tietohallintoa tietointensiivisenä yrityspalveluna Lappeenrannan teknillisessä yliopistossa. Yliopiston tulee keskittyä omaan ydinosaamiseensa sekä erottaa sisäiset yrityspalvelut omiksi kokonaisuuksikseen. Tähän on käytetty tietohallinnon osalta tilaaja tuottajamallia. Mallin puitteissa tietohallintoyksikkö on kattavasti tunnistanut ja määritellyt oman toimintansa sekä asiakkaidensa perustarpeet. Tietohallinnon palvelut ovat tietointensiivisiä yrityspalveluita, joiden tarkoituksena on täydentää asiakkaiden osaamista ja kykyä tuottaa innovaatioita sekä välittää muualla tuotettua tietoa ja teknisiä ratkaisuja tähän tarpeeseen. Tietointensiivisen palveluntuottajan asiantuntijuus on kokemusperäistä ja hiljaista tietoa, jota on lähtökohtaisesti vaikea muuttaa organisatoriseksi tiedoksi eli lisäarvoksi organisaation toiminnalle. Tuotteistamista on hyödynnetty tietohallinnon prosessien muuttamiseksi eksplisiittisiksi. Tuotteistamalla standardoidaan prosesseihin liittyvät parhaat käytänteet, joka tarkoittaa kokemusperäisesti hyväksi havaittujen toimintatapojen rutinoimista. Tuotetut palvelut on tuotteistettu palvelupaketeiksi, joista on laadittu yksityiskohtainen palvelukuvaus sekä laskettu tuotekohtainen hinta. Palvelumallin soveltaminen takaa yksikkökustannusten, skaalaetujen, riskin jakaantumisen ja teknologisen kehityksen optimoinnin yliopistossa.

Mittausvirtoihin liittyvä standardointi- ja kooditusehdotus uusilla energiamarkkinoilla

Sähkömarkkinaosapuolet ovat havainneet lukuisia puutteita ja haasteita tietojärjestelmien tiedonvaihtoon liittyvissä kysymyksissä. Tässä työssä käsitellään tiedonvaihdon ongelmaa mittausvirtojen kannalta. Tiedonvaihdon lisääntyminen ja sanomien monipuolistuminen on johtanut siihen, että läheskään kaikki tarpeelliset sanomat eivät ole standardoitu, ja jo luoduissa tai ehdotetuissa standardeissa on huomattavia eroavaisuuksia mm. eri maiden välillä. Tässä työssä kuvataan nykyinen automaattisen mittarinlukujärjestelmän ja jakeluverkkoyhtiön mittaustietovaraston välinen tiedonvaihtoratkaisu ja siihen liittyvät mittaustietovirrat. Työssä esitellään myös älykkäiden mittarien tuomia hyötyjä ja pohditaan uusien mittausten tuomia mahdollisuuksia. Lisäksi pohditaan nykyisten tietovirtojen koodituskäytäntöjen toimivuutta ja niiden puutteita ja ongelmia. Työssä laaditaan esimerkki standardi mittausvirtakonfiguraation mallintamiseksi sähkömarkkinoilla. Työn painopiste on energiamittaustietojen tietovirroissa lähtien laskutuksen tarpeista. Tavoitteena on automaattisten mittarinhallintaprojektien tuomien älykkäiden mittarien uusien mittausten aiheuttaman ja mahdollistaman tietovirran standardointi. Työssä pohditaan, kuinka tietovirta saadaan eheästi siirtymään mittauspalveluntarjoajan ja jakeluverkkoyhtiön järjestelmien välillä sekä miten uudet tiedonkäyttötarpeet tulisi koodittaa. Uudet sanomastandardiehdotukset esitetään XML-mallein, ja lopuksi pohditaan mallien toimivuutta ja niihin tarvittavia jatkokehitystarpeita.

Kansainvälisen liiketoimintaosaamisen kehittämistarpeet suomalaisissa pk-yrityksissä

Tämän pro gradu -tutkielman tavoitteena oli kartoittaa suomalaisten pk-yritysten kansainvälisen liiketoimintaosaamisen kehittämistarpeita ja esittää kuinka kansainvälistymispalveluita voitaisiin kehittää vastaamaan tarpeisiin paremmin. Tutkielma jakautuu teoreettiseen ja empiiriseen osaan. Empiirisessä osassa hyödynnettiin valmista, survey-menetelmällä toteutettua tutkimusmateriaalia, jonka 122 pk-yritystä tutkittiin kvantitatiivisesti. Tutkimuksen mukaan suomalaisten pk-yritysten keskeisin kansainvälisen liiketoimintaosaamisen kehittämistarve on myynti- ja markkinointi-osaaminen. Pk-yritykset tarvitsevat ulkopuolista apua erityisesti ulkomaisten asiakkaiden ja yhteistyökumppaneiden löytämisessä. Tutkimuksen mukaan kansainvälistymispalveluiden käyttämättä jättämiseen ei vaikuta se, ettei palveluista ole saatu tarpeeksi tietoa, vaan se, ettei palveluita koeta hyödyllisiksi ja tarpeisiin vastaaviksi. Pk-yritysten kansainvälisen osaamisen kehittämiseen tarjottavat palvelut eivät täysin vastaa yritysten tarpeita. Kansainvälistymispalveluita tulisi kehittää erityisesti tarjoamalla yrityksille käytännön apua koulutuksen sijasta, tunnistamalla osaamistarpeet tehokkaammin, parantamalla alueellista tiedotusta ja lisäämällä palveluntarjoajien keskeistä yhteistyötä.

UDDI palvelurekisterin merkitys Web palveluissa

Tietojärjestelmien integraatio on nykypäivänä tärkeä osa alue yritysten toiminnassa ja kilpailukyvyn ylläpitämisessä. Palvelukeskeinen arkkitehtuuri ja Web palvelut on uusi joustava tapa tehdä tietojärjestelmien välinen integraatio. Web palveluiden yksi ydinkomponentti on UDDI, Universal Description, Discovery and Integration. UDDI toimii palvelurekisterin tavoin. UDDI määrittää tavan julkaista, löytää ja ottaa käyttöön Web palveluja. Web palveluja voidaan hakea UDDI:sta erilaisin kriteerein, kuten esimerkiksi palvelun sijainnin, yrityksen nimen ja toimialan perusteella. UDDI on myös itsessään Web palvelu, joka perustuu XML kuvauskieleen ja SOAP protokollaan. Työssä paneudutaan tarkemmin UDDI:in. UDDI:ta käsitellään tarkemmin myös teknisesti. Oleellinen osa UDDI:ta on ollut julkaisijoiden ja käyttäjien mielestä tietoturvan puute, joka on rajoittanut huomattavasti UDDI:n käyttöä ja käyttöönottamista. Työssä tarkastellaankin tarkemmin juuri tietoturvaan liittyviä asioita ja ratkaisuja sekä myös UDDI:n merkitystä yrityksille.

Cumulative Costs of Caries Prevention and Treatment in Children - with Special Reference to Work Division and Cohort Effect

Lapsen karieshoidon kustannuskertymän muutokset ja karieshoidon toimintakäytäntöjen yhteys kustannuksiin Tutkimuksen tavoitteena oli mitata terveyskeskuksessa hoidettavien lasten karieshoidon kumulatiivisia kustannuksia ja verrata niitä kahden erilaisen toimintatavan välillä. Lisäksi tarkasteltiin lasten hampaiden terveyttä. Tutkimus tehtiin julkisen palvelutuottajan näkökulmasta. Tutkimusaineisto kerättiin Kemin ja Tornion terveyskeskusten suun terveydenhuollon potilaskertomuksista. Kemin kohortit 1980, 1983 ja 1986 (n = 600) ja Tornion kohortit 1980 ja 1992 (n = 400) edustivat perinteistä ja Kemin kohortit 1989, 1992 ja 1995 (n = 600) uutta toimintatapaa työnjaon ja ehkäisyn ajoituksen suhteen. Kohortteja ja kaupunkeja verrattiin hampaiden terveyden (dmft/DMFT = 0 ja dmft ja DMFT keskiarvot 5 ja 12 vuoden iässä) ja voimavarojen käytön suhteen. Panoskäyttö johdettiin käyntimäärien avulla laskennallisen työajan kautta. Kustannuskertymät muodostettiin käyttämällä henkilöstömenoista laskettuja suorittajakohtaisia yksikkökustannuksia. Panoskäytön ja yksikkökustannusten kautta muodostettiin kustannuskertymät. Kustannusten ja terveysvaikutusten suhteita arvioitiin kustannus-vaikuttavuusanalyysissä. Suuhygienistien työpanosta hyödyntävällä varhaisen ehkäisyn toimintamallilla saavutettiin vähäisemmin kustannuksin alle kouluiässä parempi ja kouluiässä yhtä hyvä hammasterveys kuin perinteisellä, enemmän hammaslääkärien työpanokseen perustuvalla tavalla. Karieksen hoitoon liittyvien käyntien määrä oli nuorimmissa syntymävuosikohorteissa pienempi kuin vanhimmissa kohorteissa. Käynnit hammaslääkärissä vähenivät eniten. Toimintatavalla oli merkittävä vaikutus lapsen karieshoidon kokonaiskustannuksiin. Herkkyysanalyysin mukaan karieshoidon kustannukset olivat työnjakoa hyödyntämällä kolmanneksen pienemmät, kuin jos hoidon suorittajana olisi ollut ainoastaan hammaslääkäri-hoitaja työpari. Lasten karieshoidon kustannusvaikuttavuus kohentui molemmissa terveyskeskuksissa nuoremmissa kohorteissa vanhempiin verrattuna. Suun terveydenhuollon potilaskertomuksia olisi hyödynnettävä toiminnan kehittämisessä. Varhaisen ehkäisyn avulla voitaisiin kaikkien suun terveydenhuollon ammattihenkilöiden työpanos kohdentaa kustannustehokkaasti.