Young adults' views on the relevance of three measures for oral health-related quality of life.

OBJECTIVE: The aim of this study was to explore the views of young adults on the relevance of three measures of oral health-related quality of life (OHRQoL). METHODS: Sixteen young adults aged 21-29 years were interviewed. The selection was strategic with reference to age (21-25 years.; 26-30 years), sex and education (university degree; upper secondary school). The interview guide covered areas on the content and construction of the measures: The Oral Health Impact Profile (OHIP), the Oral Impacts on Daily Performances (OIDP) and the Oral Health-Related Quality of Life UK (OHRQoL-UK). The data were analysed using qualitative content analysis. RESULTS: A theme expressing the latent content was formulated during the data analysis: 'young adults' own experiences were reflected in their views on the OHRQoL measures'; that is, the experiences of young adults of own oral problems and aspects that were found to be especially important for their age group influenced their view on the measures. The self-reported ability to understand and answer the questions varied and the perceived advantages and disadvantages were almost equally distributed among the three measures. CONCLUSIONS: The OHIP, OIDP and OHRQoL-UK were evaluated as being equal by the young adults in this study, with regard both to their pros and cons. The clarity of the measures was regarded as the most important factor, while the length and assessment period were less significant.

Gender inequity in Saudi Arabia and its role in public health.

In Saudi Arabia, local interpretations of Islamic laws and social norms have a negative impact on the health and well-being of women. The objective of this literature review was to discuss gender inequity in Saudi Arabia and its relation to public health. Despite the scarcity of recent statistics and information regarding gender inequity in Saudi Arabia, this review is an attempt to explore this sensitive issue in this country. Women's roles and rights in Saudi society were examined, including education, marriage, polygamy, fertility, job opportunities, car driving and identification cards. Further research to assess knowledge, attitudes and practices towards health care of Saudi men and women is recommended.

Monitoring oral health and dental attendance in an outpatient psychiatric population.

Impaired mental health has been associated with an increased need for dental care. Population surveys have indicated that people with enduring mental health problems make less frequent planned visits to the dentist and report a greater number of missing teeth than the general population. The study aims to examine oral health status, attendance to dental care, and medication in an outpatient psychiatric sample. A descriptive study combining a structured interview with a visual oral examination carried out in 113 outpatients under psychiatric care. Dental health was described in terms of sound, missing and/or filled teeth, and showed a relation between these categories and types of psychiatric diagnosis, age and numbers of antidepressant and neuroleptic drugs. Oral hygiene was found to be more neglected among men and in patients with the diagnosis of schizophrenia. The need of dental treatment was widespread, although regular dental visits were commonly reported. In order to maintain good oral health, regular dental check-ups should be encouraged for patients under psychiatric care. Further studies are required to reveal contributory causes for/to decreased oral health. The difficulty such individuals have in maintaining additional self-efficacy raises questions about the necessity for oral health interventions in outpatient psychiatric services.

Quality of life in patients with dental conditions: comparing patients' and providers' evaluation.

OBJECTIVE: To measure the agreement between patients and their caregivers in evaluating patients' oral quality of life. BASIC RESEARCH DESIGN: Cross-sectional study. CLINICAL SETTING: Data collected in four Swedish dental clinics in 2004. PARTICIPANTS: Consecutive patients. Data were completed for 444 patients. Fifteen dentists and 12 dental hygienists agreed to participate. INTERVENTIONS: For each patient, the patient him/herself and his/her caregiver completed the 14-item Oral Health Impact Profile (OHIP-14), a specific instrument used to measure quality of life in oral conditions, with higher scores indicating a worse quality of life. Information on personal and clinical characteristics of patients were also collected. MAIN OUTCOME MEASURES: Median OHIP-14 scores given by caregivers and patients were calculated and compared in different subgroups of patients. Cohen's kappa was calculated to measure the agreement between the evaluation of patients and caregivers. RESULTS: OHIP-14 scores median values were 3.0 among patients and 9.0 among caregivers. Caregivers always gave a higher score than patients, especially in older patients and patients with lower education. The concordance between patients' and caregivers' evaluation was very low (for different OHIP-14 cutoffs: Cohen's kappa from 0.10 to 0.15). CONCLUSIONS: In this study, great discrepancies were observed between patients and caregivers in the evaluation of patients' oral quality of life, with caregivers overestimating the burden of dental conditions on patients. It is important to improve patient-caregiver communication, in order to increase patient satisfaction and provide better care. A good patient-caregiver relationship is essential for the patients' well-being and their adherence to treatment.

Understanding politics? Some lessons from Swedish dentistry.

BACKGROUND: Medical and dental care are dependent on political settings for legislation and financing. The professionals in these organisations need to understand the political logic that shapes the environment of their organisation. A description of Swedish dentistry and recent legislation reports from commissions and bills to parliament from 1997 are analysed. AIM: The aims are to describe changes in the environment for dentistry in Sweden from 1998, to analyse the underlying political logic, and to point to some lessons to be learned. METHOD: The description is analysed using theories from strategic management and from decision-making. RESULTS: The objectives changed from a formal emphasis on prevention to insurance against high cost for the patient. Some ideas keep recurring in the political debates even if scientific logics contradict them. CONCLUSIONS: Health care system research methods and the "garbage can" model of decision-making can be used to describe and to gain a better understanding of the politically governed environment. Some political issues keep recurring in spite of earlier rational rejections. A better understanding of the political logic that forms the environment for an organisation is needed for a successful adaptation to that environment.

A multilevel analysis of factors affecting the difference in dental patients' and caregivers' evaluation of oral quality of life.

In a previous study, we observed that the concordance between patients' and caregivers' evaluation of oral health-related quality of life (OHRQoL) was low. The aim of this study was to use multilevel analysis to investigate the possible determinants of the low concordance, taking into account different patients' demographic and clinical variables, the financial system used by patients to pay for dental treatment, and the role of the different caregivers and clinics. The OHRQoL of patients was assessed both by the patients and by their caregivers, using the Oral Health Impact Profile (OHIP)-14. Data were collected in four clinics, and patients were evaluated by one of 27 caregivers. We tested eight multilevel models, using the difference (caregivers OHIP - patients OHIP) as the dependent variable. Data were complete for 432 patients. The mean difference was 4.4 (standard deviation = 8.2; higher scores indicated a higher impact on OHRQoL). The variance due to patients was partly explained by their age, gender, and number of teeth, with a greater OHIP difference for older vs. younger patients, for women than for men, and in patients with fewer teeth. Almost 30% of the variance was due to caregivers, while the effect of clinics was not significant. It is important to study the possible causes of the different judgments concerning patients' OHRQoL by patients and caregivers, in order to improve the patients' satisfaction with care.

Financial systems' impact on dental care; a review of fee-for-service and capitation systems.

OBJECTIVE: This review covers the impact of financial systems on dental care. BACKGROUND: Remuneration in fee-for-service (FFS) is done per service provided and in capitation (CAP) per patient enrolled. It may be expected that dentists' incentive in CAP is to keep the number of services provided at a minimum, while in FFS it is to keep the number of services at a maximum. This should lead to a different impact on care, with the dentists in CAP focusing more on prevention and dentists in FFS more on restorative treatment. Six questions were put: Does CAP increase or decrease caries incidence? Does CAP increase or decrease restorative treatments? Does CAP increase preventive care? Does CAP increase or decrease productivity? Does CAP increase or decrease the dentist's satisfaction with his/her work? Does CAP increase or decrease the patients' satisfaction with the oral care provided? METHODS: Literature was obtained through searches in databases. A format was developed to define the literature of interest. RESULTS: CAP decreases restorative treatment and there is a tendency of decreased caries incidence. "Supervised neglect" cannot be established. CAP increases preventive care. A conclusion regarding productivity was not possible. The results on dentist's satisfaction with work were inconclusive, as were the results regarding patient satisfaction. CONCLUSIONS: CAP has a different impact on provided care than FFS. More research is needed in this area and focus on efficiency is of importance.

Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects.

The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio-economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50- and 60-year-old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50- and 60-year-old subjects in two Swedish counties, Orebro and Ostergötland (n = 17,138; n50 = 8878; n60 = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72.8% (n = 12,468). The reported responses to questions regarding 'pain in the TMJ region' and 'difficulty to open the mouth wide' were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue-collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio-economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.

Measuring quality of life of patients with different clinical types of psoriasis using the SF-36.

BACKGROUND: Different specific and generic instruments are used to evaluate quality of life in dermatology, but their interrelationship is not well known. OBJECTIVES: To describe the quality of life in patients with different clinical types of psoriasis using the 36-item short form of the Medical Outcomes Study questionnaire (SF-36), and to study its correlation with dermatology-specific instruments. METHODS: We conducted a cross-sectional study of 380 inpatients with psoriasis. SF-36 mean scores were compared with the norms for medical and psychiatric disorders. Quality of life was also measured by both dermatology-specific (Skindex-29 and Dermatology Life Quality Index, DLQI) and psoriasis-specific instruments (Psoriasis Disability Index, PDI, and the Impact of Psoriasis Questionnaire, IPSO). A specific (Psoriasis Life Stress Inventory, PLSI) and a generic (12-item General Health Questionnaire, GHQ-12) measure of psychological distress was also used. A cluster analysis was performed to study the relationship among the different questionnaires. RESULTS: Our study population showed SF-36 physical health scores similar to minor medical conditions (e.g. physical functioning 79 for psoriasis, 80 for minor medical conditions, and 57 for severe medical conditions), but mental health scores quite similar to psychiatric illnesses (e.g. mental health 57 for psoriasis, 81 for minor medical conditions, 79 for severe medical conditions, and 53 for psychiatric conditions). The SF-36 showed two distinct patterns of impairment of quality of life, with a greater burden of disease for palmoplantar, pustular and arthropathic psoriasis. SF-36 scales tended to form separate clusters from the other dermatology-specific quality of life instruments. CONCLUSIONS: A generic quality of life instrument (e.g. the SF-36) provides information that is complementary to that derived from dermatological questionnaires, and may give further insight in the evaluation of the burden of psoriasis.

Factors behind change in knowledge after a mass media campaign targeting periodontitis.

The aim of this study was to investigate changes in knowledge before and after a mass media campaign, in relation to social attributes, care system attributes and oral health aspects. The study was based on a questionnaire in a cohort design, sent out to 900 randomly sampled people aged 50-75 in Sweden. The response rate to the questionnaire before and after the campaign was 70% and 65% respectively. Sixty-four percent answered both questionnaires. Two questions addressed knowledge, while 10 questions aimed to measure social attributes, care system attributes and oral health aspects. Data were analysed for bivariate relations as to change in knowledge and social attributes, care system attributes and oral health aspects. Data were also analysed in multiple regression analysis with knowledge before, knowledge after and knowledge differences as dependent variables. The results showed that there were a number of independent variables with influence on the dependent variables. Of the social attributes, secondary education gave almost 10% (P < 0.001) better knowledge both before and after the campaign. Among care system attributes, high care utilization was related to knowledge both before and after the campaign. The most important factors for knowledge about periodontitis were education, care utilization and perceived importance of oral health. In conclusion, this study demonstrates that mass media might increase knowledge about periodontitis as a health promotion strategy.

Hypointensity in T2-weighted images of the basal ganglia in solvent-exposed patients with multiple sclerosis: clinical, MRI and CSF characteristics.

Several studies have indicated an association between MS and organic solvent exposure. Our objective was to analyse differences regarding cerebrospinal fluid (CSF) properties, magnetic resonance imaging (MRI) features and cerebral metabolites, measured by proton spectroscopy (1H-MRS), in 20 patients with spontaneous multiple sclerosis (MS) and in 20 patients with MS after solvent exposure; 15 healthy subjects served as controls. CSF examinations were retrospectively reviewed from the medical files. There were no significant differences in the CSF regarding pleocytosis, spinal-serum albumin ratio or mean extended IgG index. However, T2-weighted images of the solvent-exposed MS patients showed more hypointenseareas in the basal ganglia. Hypointensity on T2-weighted images of the basal ganglia in the solvent-exposed MS patients may correspond to neurodegeneration and could be an early event in MS.

Self-assessments of general and oral health in persons with chronic whiplash-related disorders.

OBJECTIVE: The objectives of the study were 1) to describe general health and daily functioning in a group of subjects with whiplash-associated injuries, 2) to analyse self-assessments of oral disease relative to background factors, 3) to investigate if the Medical Outcomes Study Short Form 36 (SF-36) Health Survey variables were related to the oral disease variables. DESIGN: Questionnaires included the SF-36 Health Survey, and self-assessed oral health with regard to relevant background factors such as gender, age, education and marital status. Logistic regression modelling was performed. PARTICIPANTS: Members of a nationwide Swedish association enlisting persons who have problems concerning a whiplash injury (n = 1,928) were included. A total of 979 persons participated in the study, a response rate of 50.8%. RESULTS: More than twice as many females (n=680) as men (n=296) responded to the questionnaire. A general trend, in comparing SF-36 scores between the present study group and the normative sample, was that persons with whiplash associated disorders scored considerably lower on all scales. Older age and being of female gender, together with poorer physical functioning and poorer general health, were related to poorer oral health status. CONCLUSION: Self-assessed oral health was correlated to impairment in general health, a finding which is in agreement with an integrated holistic understanding of human health and disease. One causative chain for this may be through the stress mechanisms.

Stress markers in relation to job strain in human service organizations.

BACKGROUND: Workers in human service organizations are often confronted with conflicting demands in providing care or education. The aim of this cross-sectional study was to relate levels of endocrine stress markers to perceived job strain in two human service organizations. METHODS: Employees in two local units of the social insurance organization and two local units of the individual and family care sections of the social welfare in Sweden were selected and 103 employees participated (56% participation rate). The perceived job strain was assessed with a standardized questionnaire containing questions of the demand-control model. Questions specially designed to measure emotional demands were also included. The stress markers cortisol, prolactin, thyroid-stimulating hormone, testosterone and IgA and IgG were analysed in blood samples. RESULTS: The main finding was an association between high emotional strain and increased levels of prolactin. The levels of cortisol, but none of the other four stress markers, increased slightly with emotional strain. CONCLUSIONS: Emotional strain experienced in human service work may cause psychological stress. The increase in prolactin was modest but consistent with findings in other published studies on stress-related endocrine alterations.

Influence of dental care systems on dental status. A comparison between two countries with different systems but similar living standards.

OBJECTIVE: To evaluate the influence of two different dental care systems on dental status, taking into account relevant socio-economic factors. BASIC RESEARCH DESIGN: Questionnaire studies on randomly sampled subjects in Denmark and Sweden using questionnaire forms as identical as possible with regard to the different languages. SETTING: The studies were performed late in 1998 in both countries. PARTICIPANTS: Questionnaires were sent to 1,175 subjects aged 45-69 years in Denmark (response rate 73%) and to 1,001 subjects aged 55-79 years in Sweden (response rate 67%). MAIN OUTCOME MEASURES: Questions about dental status and about socioeconomic factors and attitudes toward dental care were included. In logistic regression models, various dichotomies of dental conditions were used as dependent variables. State (Denmark vs. Sweden) was used as an independent variable together with socioeconomic factors and attitudes. RESULTS: There were great differences between the countries in dental status. In the regression model with 'wearing removable denture(s)' as the dependent variable, state was the strongest predictor with an OR of above 4.1 for Denmark compared to Sweden. much stronger than variables such as age, income, education and residence. CONCLUSION: The results indicate that the Swedish dental care system has been superior to the Danish one regarding dental status in middle aged and older populations in these two countries.

Recall of an oral health education programme by nursing personnel in special housing facilities for the elderly.

OBJECTIVES: To investigate the recall of oral health knowledge and confidence by nursing personnel in special housing facilities for the elderly, three years after an education programme. DESIGN: A cross sectional design using a questionnaire. SAMPLE: All nursing personnel, a total of 2,901 subjects, in five municipalities in south-western Sweden; of whom 950 had attended the programme. The response rate was 67% (1930 subjects). INTERVENTION: An oral health education programme consisting of four one-hour lessons. RESULTS: The oral health education programme still had an effect on the participants' attitudes towards oral health three years later. When comparing the trained group (OHEP+) which attended the programme with those who did not have training (OHEP-), the perceived ability, opportunity and the knowledge of oral health were significantly better in the former group, p < 0.01 Further, within the OHEP- group who did not attend the programme there was a significant difference in the perceived ability, opportunity and the knowledge of oral health between those with a higher level of health care education, p < 0.01. CONCLUSIONS: The effect of an oral health education programme on the participants' attitudes towards oral health persists at least for three years. The data indicate that trainees with a low level of health care education benefit most.

Changes in dental conditions during a decade in a middle-aged and older Swedish population.

A questionnaire measuring dental conditions was sent to 2708 individuals aged 55 79 years in Orebro County, who about 10 years earlier had been randomly selected for a similar study. The response rate was 68% (1848 individuals). Of those, 1665 had participated also in the 1989 study. The objectives were to study changes in dental conditions having occurred during a decade and to evaluate whether impairment in dental conditions among the participants had resulted in prosthodontic treatments. Only small changes in dental conditions were registered among those who participated both in 1989 and in 1999. Loss of a single tooth was the most frequently reported change. Ten per cent fewer reported that they had all teeth remaining in 1999 compared with conditions in 1989. The number of subjects wearing removable dentures increased only slightly. Although the reported changes in dental conditions were small, there had been a need for prosthodontic treatment in many of the subjects. Ten percent of the subjects reported that they had received FPD treatment during the past 10 years. To conclude, the present study showed that only small changes in dental conditions had occurred among the participants during a decade. Nevertheless, a substantial increase in the prevalence of prosthodontic appliances, especially of fixed restorations, was noted.

Required qualifications in the Swedish Public Dental Health Service as indicators of organizational ideology.

The manifestly required qualifications in job advertisements in the Journal of the Swedish Dental Association were analyzed as indicators of the organizational ideology in the Swedish Public Dental Health Service from the employers' viewpoint. All job advertisements that concerned dentists and managers on different hierarchical levels in general dentistry from January 1990 to December 1998 were included (n = 1152). The number of vacancies was 1856. The textual material was analyzed by content analysis, permitting quantitative descriptions of the text and analysis of the latent characteristics. Words and phrases were classified into categories on different levels of abstraction developed from the theoretical background and the purpose of the study. Altogether 5705 required qualifications were categorized. The inter-coder reliability of the first-level categorization resulted in 81% correspondence of the classification, and lambda = 0.90. Qualifications were more frequently required with higher hierarchical job positions, and personality characteristics were more frequent than technical competence and knowledge. Qualifications interpreted as related to economic goals occurred more frequently than those related to odontological goals. The qualification demands reflected the language of human resource management (HRM), emphasizing the 'soft' people-centered approach and was interpreted as an 'ideal' model of HRM. Dentists were regarded as a profitable organizational asset rather than participants in relations with patients. In conclusion, the results indicate an organizational ideology primarily of economic character.

Dental conditions in middle-aged and older people in Denmark and Sweden: a comparative study of the influence of socioeconomic and attitudinal factors.

In 1998-99 two parallel questionnaire studies were performed in Denmark and Sweden. In Denmark the age group was 45-69 years and in Sweden 55-79 years. One aim was to study the influence of socioeconomic and attitudinal factors on dental status in the two countries. For the comparable age groups 55-69 years there was a striking difference in dental conditions between the countries. In Sweden, 72% had either all teeth remaining, missing teeth replaced by fixed prosthodontics, or only one or two single missing teeth not replaced. The corresponding figure for Denmark was 44%. Among Danes, 34% were wearing removable denture(s) or were edentulous in one jaw or both jaws, compared with 15%, among Swedes. In logistic regression models, higher income and longer education were significantly associated with the best dental status categories in Denmark but not in Sweden. In the model with wearing removable denture(s) as the dependent variable, lower income and lower education level showed a significant influence for the Danes. In Sweden, lower income showed a significant influence but education level was insignificant. In both Denmark and Sweden, a positive attitude toward the importance of dental appearance was associated with an increased risk of wearing removable denture(s).

Dentist-related factors influencing the amount of prosthodontic treatment provided.

OBJECTIVES: To evaluate, using multivariate methods, the associations between indicators of the amount of prosthodontic treatment and dentist-related factors. METHODS: Questionnaires were sent to a random sample of 2,059 general dentists, response rate was 76%. Two indicators of prosthodontic activity were used as dependent variables: 1) reported weekly working hours used for prosthodontics and 2) reported numbers of produced single crowns, fixed partial dentures, and removable dentures. Independent variables were 'social and demographic attributes', 'job situation' and 'attitudes of dentists'. Multiple regression analysis was used in models with continuous dependent variables and logistic regression analysis for categorical dependent variables. RESULTS: 'Weekly working hours used for dental care of adults' showed a strong association in all models with the dependent variable 'weekly working hours used for prosthodontics'. Male dentists provided more prosthodontic services than female dentists, even if reporting less time used for prosthodontics. Private practitioners produced more fixed prosthodontics than dentists employed in the public dental health service. Dentists in the public dental health service reported a higher production of removable dentures than private practitioners. CONCLUSION: The results indicate that factors, besides those in the rational clinical model for decision-making, e.g. gender and delivery system, play a role in the provision of prosthodontic services.