Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden

Abstract Background: A life course perspective recognizes influences of socially patterned exposures on oral health across the life span. This study assessed the influence of early and later life social conditions on tooth loss and oral impacts on daily performances (OIDP) of people aged 65 and 70 years. Whether social inequalities in oral health changed after the usual age of retirement was also examined. In accordance with "the latent effect life course model", it was hypothesized that adverse early-life social conditions increase the risk of subsequent tooth loss and impaired OIDP, independent of later-life social conditions. Methods: Data were obtained from two cohorts studies conducted in Sweden and Norway. The 2007 and 2012 waves of the surveys were used for the present study. Early-life social conditions were measured in terms of gender, education and country of birth, and later-life social conditions were assessed by working status, marital status and size of social network. Logistic regression and Generalized Estimating Equations (GEE) were used to analyse the data. Inverse probability weighting (IPW) was used to adjust estimates for missing responses and loss to follow-up. Results: Early-life social conditions contributed to tooth loss and OIDP in each survey year and both countries independent of later-life social conditions. Lower education correlated positively with tooth loss, but did not influence OIDP. Foreign country of birth correlated positively with oral impacts in Sweden only. Later-life social conditions were the strongest predictors of tooth loss and OIDP across survey years and countries. GEE revealed significant interactions between social network and survey year, and between marital status and survey year on tooth loss. Conclusion: The results confirmed the latent effect life course model in that early and later life social conditions had independent effects on tooth loss and OIDP among the elderly in Norway and Sweden. Between age 65 and 70, inequalities in tooth loss related to marital status declined, and inequalities related to social network increased

Экспериментальные исследования и расчет эффективности применения солнечной батареи в условиях Республики Беларусь

Материалы XIV Междунар. науч.-техн. конф. студентов, аспирантов и молодых ученых, Гомель, 24–25 апр. 2014 г

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Does different wording of a global oral health question provide different results?

Objective. Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions. Background. It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the 'global oral health question' is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is. Materials and methods. In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Orebro (T) and Ostergotland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression. Results. The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR = 5.6 and 5.2), chewing capacity (OR = 6.9 and 4.2), satisfaction with dental appearance (OR = 19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR = 3.5 and 3.9). Conclusion. Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants

Smoking cessation and associated dental factors in a cohort of smokers born in 1942 : 5 year follow up

INTRODUCTION: Tobacco usage is a serious threat to the health of a population and thus cessation of tobacco use is an important step in improving patients' quality of life. Cessation activities are essential also for middle aged and older people. Dental personnel have a unique role as they treat patients who might not otherwise have regular contact with general medical practitioners. OBJECTIVE: The aim of this study was to identify factors associated with smoking cessation in a cohort of smokers as they progressed from 65 to 70 years of age. MATERIAL AND METHODS: The base population was all inhabitants born in 1942 in two Swedish counties who had been followed by postal questionnaires every fifth year since 1992. Data had been collected and accumulated at the individual level. In this study, the 533 self-reported smokers in 2007 were selected and their smoking habits in 2012 were used as the outcome variable. Analyses used were bivariate associations and logistic regression. RESULTS: The total smoking-cessation rate was 28%. The logistic regression had a Nagelkerke R2 of 0.32 and showed that remembering information on tobacco cessation given in the dental office increased the reported chances of quitting smoking (odds ratio = 10, 95% confidence interval: 3.2-31.7). Also associated with smoking cessation was increased incidence of reporting bleeding gums. CONCLUSION: Information on smoking cessation given in dental clinics is effective for elderly people

"The "garbage can"; rational versus political logics"

Organisations that are dependent on external settings, among them political, need to understand the logics that shape their environment. The professionals in medical and dental organisations are used to decision-making processes based on “science logics” wherein each step is transparent and steps follow each other in a predictable manner. Political decision-making is often not possible to understand from that background, and Olsen (1972) described an alternative model of non-rational decision-making, the “garbage can model”. In this a decision will be made only when four “streams” of requisites are present at the same time. These are streams of 1/ problems to be solved, 2/ solutions, 3/ choice opportunities, and 4/ decision-makers. Aim. The aim of this study was to describe some changes in the National Dental Insurance (NDI) that is an important part of the environment for dentistry in Sweden, and to analyse the underlying political logic. Method. The description was made from backgrounds in official documents and proposals to reform the NDI and these descriptions were analysed using theories from decision-making. Results. The objectives in the NDI changed from a formal emphasis on prevention to an insurance against high cost for specified groups of patients. These changes were in contradiction to the stated objectives in the reformed NDI. These changes can be better understood by using a non-rational model of decision-making. Conclusions. The “garbage-can” model for decision-making can be used to gain a better understanding of the logics in the political system that forms the environment for a care organization

Cooperation between the Public Dental Health Service (PDHS) and private practitioners (PP)

Objective: About half of Swedish dentists are publicly employed (PDHS) in 21 politically governed counties; the remainder are PPs. By law the PDHS should cooperate with PPs and with each other . The PDHS can be organised in various ways, here we investigated the impact on cooperation from the following factors: 1/ a separate political board governing only the PDHS, 2/ a clear-cut purchase provider split organisation (P/P split), and 3/ the absolute size of the PDHS as measured by the size of county. Materials and Methods: A questionnaire was mailed to the Chief Dental Officer (CDO) in each PDHS. Results: Answers were received from all 21 counties. Four counties reported cooperation on management and policy levels. Cooperation with other PDHS was reported by 65%; usually in emergency care and in specialist dentistry. Cooperation with PPs was stated by 9 CDOs, most frequently out of hours emergency care and care for children. 1. Answers from PDHSs with a separate political board did not covary with any different patterns of cooperation. 2. Seven PDHS stated that they had a fully developed P/P split and four that there was no division of tasks. A clear P/Psplit showed no difference as regards cooperation with other PDHSs; however, these CDOs reported less cooperation with the PPs (rho- 0,45) 3. No correlations were found between the size of the county and the pattern of cooperation. Conclusions: An organisation with a separate political board or with a clear P/Psplit revealed no difference in cooperation between PDHSs. CDOs within a P/P organisation reported less cooperation with PPs. Perhaps the CDOs did not regard the present activities as cooperation or the cooperation might be on the purchaser’s level not the provider’s. There appears to be potential for development of the cooperation between PDHSs and also for more cooperation with PPs

Self-perceived taste disturbance : a 20-year prospective study of a Swedish 1942 birth cohort

Objectives: The aim of this study was to assess the impact of dental care factors, general health factors and socio-economic factors on perceived taste disturbance (PTD) over time and to assess the stability of or change in PTD in a panel of individuals as they progressed from middle age (50 years) to early old age (70 years). Materials and methods: Data collection was conducted from a cohort study beginning in 1992, when the participants were 50 years old, and again 5, 10, 15 and 20 years later. Stability and change in PTD were described using cross-tabulation. Perceived taste disturbance over the 20-year survey period was modelled using the generalised estimating equation (GEE). Results: The prevalence of PTD during a 5-year period found in this study ranged from 2.4 to 2.9%, the latter in individuals between 60 and 70 years of age. Women generally had PTD more often than men. The longitudinal analysis showed that problems with bad breath (OR = 3.6), blisters (OR = 3.4), burning mouth (OR = 3.4) and self-perceived health (OR = 2.7) were the most important factors explaining PTD. Conclusions: This study showed that PTD does not increase between 50 and 70 years of age in ordinary community-living individuals. There were no long-term impacts on PTD over time from socio-economic factors, and over time, there were a limited number of factors contributing to the effect. Bad breath, blisters, burning mouth and self-perceived health are important factors for the dentist to discuss with the patient in the case of PTD

Dental hygienists as primary oral health providers and their degree of professionalism

The number of active dentists in Sweden will fall sharply in the next decade and will partially be countered by an increased number of dental hygienists. The acceptance of this transition to primary oral health care by hygienists will be dependent on many factors; among them will be the perceived service quality offered by the dental hygienists, which may depend on how their professional status is perceived. Aim To find out whether the professional status of Swedish dental hygienists is such that it is possible to meet the demands from the population. Methods The professional status of Swedish dentists and dental hygienists was analysed by the variables suggested by Greenwood (1957). [Greenwood E. Social Work.1957 2: 45-55.] Results The variables used point to shortcomings in the professional status of Swedish dental hygienists. Dentists in Sweden constitute a strong profession, while dental hygienists are emerging as a profession. They lack a coherent and systematic theory in their academic education. Their fields of expertise are not exclusive to their group and that further weakens their professional status. They will probably not meet the service quality that is presently expected by the population. Many factors will have to be combined to make possible the necessary transition from dentists to dental hygienists as primary providers of oral health care. One of them is that the expected level of service must be adjusted to the available personnel. Conclusions The professional status of the dental hygienists needs to be consolidated and strengthened by a more homogenous curriculum. Acknowledgements: This study was supported by the dental commissioning unit in Östergötland County Council

Management structures and beliefs in a professional organisation. an example from Swedish Public Dental Health Services

Work as a dentist is stressful and demanding. In the Public Dental Health Service (PDHS) the heads of clinics' have a great influence on the work environment. In turn the heads have to adapt to the overarching policies on management in each County, which create the environment for the clinics. The aims of this paper were to describe the management structure of the PDHS as described by their Chief Dental Officers (CDOs), and to test hypotheses that the management systems had "a logical administrative structure". A postal questionnaire was mailed to all 21 CDOs,who all responded. Context analysis and bivariate correlations were used. The PDHS employed on average 60% of all dentists in a county. The numbers of clinics for general dentistry in Sweden was 698, and for specialist care 144. The heads of clinics were dentists in 92%. Four hypotheses were tested. 1. separate political board did not lead to closer governance of the PDHS. 2. There was more emphasis on measurable than on qualitative objectives and followup. 3. There was only partial correlation between a larger county and a more formalized management. 4. There was no correlation between size of county and beliefs on advantages of scale. There was a widespread belief in advantages with larger clinics both from administrative, and rather surprisingly, from clinical aspects. Two of the four hypotheses could not be corroborated which indicates that the management structures were more formed by county specific principles. The four hypotheses on administrative behaviour were only partially corroborated. The implications for delivery of care to sparsely populated areas need to be monitored in view of the beliefs in larger clinics. The limits for decisions by management and for professional discretion must be monitored closely considering their effects on work environment and on the quality of care the professionals are able to deliver