<p>The majority of Cameroonians depend on traditional medicines for their health care needs and about seven per cent of the average household health budget is spent on traditional medicines irrespective of their incomes. The aim of this study was (i) to assess the role of traditional healers (THs) in providing oral care services in Cameroon / (ii) to determine their cost of treatment and to investigate reasons why people visit THs. The present study was cross sectional and consisted of a sample of 21 THs and 52 clients with a history of dental problems. It utilized semi structured questionnaires and photographs to collect data. The mean age of THs was 46.0 years (range 20-77 years). Thirty per cent of THs were above 40 years and the majority males. Nearly a quarter of the THs practiced as herbalists and the remainder practiced both divination and herbalism. More than two thirds of Cameroonians, who patronize THs for their oral health needs, fall within the 20-40 year age group. THs in this region are experienced and enjoy good relationships with hospitals and other THs. However, collaboration between the oral health work force and THs is very poor as only 6% of all patients seen by THs are referred to the dentist. Socio-cultural and economic factors affect the oral health care seeking behavior of patients in this area and only 6.5% of patients visit dental clinics. Reasons for not attending dental clinics included cost, poor accessibility, superstition and fear.</p>

<p>The majority of Cameroonians depend on traditional medicines for their health care needs and about seven per cent of the average household health budget is spent on traditional medicines irrespective of their incomes. The aim of this study was (i) to assess the role of traditional healers (THs) in providing oral care services in Cameroon / (ii) to determine their cost of treatment and to investigate reasons why people visit THs. The present study was cross sectional and consisted of a sample of 21 THs and 52 clients with a history of dental problems. It utilized semi structured questionnaires and photographs to collect data. The mean age of THs was 46.0 years (range 20-77 years). Thirty per cent of THs were above 40 years and the majority males. Nearly a quarter of the THs practiced as herbalists and the remainder practiced both divination and herbalism. More than two thirds of Cameroonians, who patronize THs for their oral health needs, fall within the 20-40 year age group. THs in this region are experienced and enjoy good relationships with hospitals and other THs. However, collaboration between the oral health work force and THs is very poor as only 6% of all patients seen by THs are referred to the dentist. Socio-cultural and economic factors affect the oral health care seeking behavior of patients in this area and only 6.5% of patients visit dental clinics. Reasons for not attending dental clinics included cost, poor accessibility, superstition and fear.</p>

Magister Scientiae Dentium - MSc(Dent) / The majority of Cameroonians depend on traditional medicines for their health care needs and about seven per cent of the average household health budget is spent on traditional medicines irrespective of their incomes. The aim of this study was (i) to assess the role of traditional healers (THs) in providing oral care services in Cameroon; (ii) to determine their cost of treatment and to investigate reasons why people visit THs. The present study was cross sectional and consisted of a sample of 21 THs and 52 clients with a history of dental problems. It utilized semi structured questionnaires and photographs to collect data. The mean age of THs was 46.0 years (range 20-77 years). Thirty per cent of THs were above 40 years and the majority males. Nearly a quarter of the THs practiced as herbalists and the remainder practiced both divination and herbalism. More than two thirds of Cameroonians, who patronize THs for their oral health needs, fall within the 20-40 year age group. THs in this region are experienced and enjoy good relationships with hospitals and other THs. However, collaboration between the oral health work force and THs is very poor as only 6% of all patients seen by THs are referred to the dentist. Socio-cultural and economic factors affect the oral health care seeking behavior of patients in this area and only 6.5% of patients visit dental clinics. Reasons for not attending dental clinics included cost, poor accessibility, superstition and fear. / South Africa

Abstract The aim of this 11-year retrospective study was to evaluate the impact of two spending patterns in glaucoma care on patient outcomes. Two cities were selected to the study because the statistics of Finnish Social Insurance Institution have repeatedly shown a difference in their mean costs of glaucoma medications per patient, i.e. Oulu spending more and Turku less than the national average. Patients with newly diagnosed open angle in 1994–96 were identified from the national register for reimbursement of medication costs. Patients were 45–74 years old when treatment was initiated after which they had consistently used glaucoma medication &#8805;&#160;10 years. For availability of cost data, their place of residence was required to remain unchanged during 1994–2006. In 2006 Social Insurance Institution sent invitations to 360 patients of whom 168 patients (47%) participated and completed the protocol (85 in Oulu and 83 patients in Turku). All patients underwent an ophthalmic examination (visual acuity, intraocular pressure, visual field test, retinal nerve fiber layer and optic disc photography). In addition, patients filled out the 15D health related quality of life questionnaire. All costs of glaucoma care during 11 years were collected for each patient individually. For each follow up year, the total cost was added up including medications, physician visits, diagnostic and follow-up tests as well as laser or surgical procedures. The total 11-year costs of glaucoma care per patient were 35% higher in Oulu (6010&#160;€) compared to Turku (4452&#160;€). Total costs increased with worsening of the disease. After 11 years on treatment, 40% of patients did not show any structural or functional damage. Medication costs accounted up to 73% of total costs. In addition to 29% higher medication costs in Oulu, other than medication costs were also 46% higher in Oulu. In different stages of glaucoma, more treatments (medication, laser and surgery) and more tests (photographs and visual fields) were taken in Oulu. In spite of the higher resource consumption, the 15D instrument did not indicate better quality of life in patients living in Oulu. There was actually a statistically significant counterintuitive difference in the early glaucoma group, i.e. patients using more resources reported worse quality of life. This is the first study evaluating the impact of high resource utilization on quality of life and reporting 15D utility values in different stages of glaucoma. Results from this study indicate that the higher resource allocation may not always lead to measurable benefits to the patients or society in terms of less glaucoma-induced visual disability and/or better quality of life. Further data from randomized trials with both unselected populations as well pragmatic randomized trials of ‘usual patients’ with large sample sizes are required. / Tiivistelmä Tämän 11 vuoden retrospektiivisen tutkimuksen tavoite oli arvioida kahta eri kuluttamismallia glaukooman hoidossa ja niiden vaikutusta hoitotuloksiin. Tutkimusalueiksi valitut kaksi kaupunkia ovat vuosia erottuneet toisistaan Kansaneläkelaitoksen (Kelan) tilastoissa glaukoomapotilaiden keskimääräisten vuosittaisten lääkekustannusten osalta. Oulussa kustannukset potilasta kohden vuodessa ovat olleet korkeammat kuin Turussa. Turussa vuosittaiset lääkekustannukset ovat vuosia jääneet alle kansallisen keskiarvon. Kelan lääkekorvausrekisteristä poimittiin potilaita, joilla oli todettu tuore avokulmaglaukooma ja aloitettu hoito vuosien 1994–96 välillä. Potilaat olivat 45–74-vuotiaita lääkityksen alkaessa. Tämän jälkeen he olivat käyttäneet lääkitystä yhtäjaksoisesti yli 10 vuotta. Kustannustietojen saatavuuden vuoksi potilaiden tuli olla asunut samalla paikkakunnalla 1994–2006 välisen ajan. Vuonna 2006 Kela lähetti kutsun tutkimukseen 360 potilaalle, joista 168 (47&#160;%) osallistui (85 Oulusta ja 83 Turusta). Kaikki potilaat kävivät silmätutkimuksessa (näöntarkkuus, silmänpaine, näkökentät, hermosäie- ja näköhermonpään valokuvaus). Lisäksi potilaat täyttivät 15D-kyselykaavakkeen elämänlaadusta. Kaikki glaukooman hoidosta aiheutuneet suorat kustannukset kerättiin potilaskohtaisesti 11 vuoden ajalta. Jokaisen seurantavuoden osalta määritettiin kokonaiskustannukset, sisältäen lääkityksen, lääkärikäynnit, näkökentät, valokuvat, laser- ja kirurgiset toimenpiteet. Kokonaiskustannukset 11 vuoden seurantajaksolla olivat 35&#160;% korkeammat Oulussa (6010&#160;€) verrattuna Turkuun (4452&#160;€). Kokonaiskustannukset nousivat glaukooman vaikeusasteen kasvaessa. 11 vuoden lääkehoidon jälkeen 40&#160;%:lla potilaista ei ollut glaukoomaan viittaavia vaurioita silmissään. Lääkekulujen osuus kokonaiskuluista oli jopa 73&#160;%. Oulussa lääkekustannukset olivat 29&#160;% ja muut hoitokustannukset 46&#160;% korkeammat kuin Turussa. Jokaisella glaukooman vaikeusasteella hoitoresursseja käytettiin Oulussa Turkua enemmän. 15D-mittarilla tutkittuna Oulussa elämänlaatu ei ollut parempi kuin Turussa suuremmasta resurssikulutuksesta huolimatta. Tutkimuksessa todettiin yhden alaryhmän (varhainen glaukooma) kohdalla jopa viitteitä siitä, että elämänlaatu on huonompi suuremman resurssikulutuksen alueella. Tämä on ensimmäinen tutkimus, joka arvioi suuremman resurssikulutuksen vaikutusta elämänlaatuun. Tutkimus myös raportoi 15D-arvot eri glaukooman vaikeusasteilla. Tulokset viittaavat siihen, että suurempi resurssikulutus ei aina johda mitattaviin hyötyihin potilaan tai yhteiskunnan kannalta, kun päätetapahtumana on glaukooman aiheuttama näkövammaisuus tai parempi elämänlaatu. Tarvitsemme lisää suuremmalla potilasmäärällä tehtyjä satunnaistettuja tutkimuksia.

The subject of this thesis is to identify and quantificate costs of Breast Cancer Therapy. The goal is the quantification of costs for specific therapeutic modalities, which are used by the therapy. Obtained values are used for presentation of the cheapest and the most expensive mode of treatment.

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This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour. / Psychology / M.A. (Psychology)