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  • 1.
    Axtelius, Björn
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Oral disease and psychosocial risk determinants in relation to self-assessments of general health in persons with chronic whiplash-related disorders2003Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 27, nr 4, s. 185-195Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this study was to analyse how self-assessed general health was related to oral health among persons afflicted with whiplash-associated disorders (WAD), controlling for relevant background factors, confounders and other risk factors. Questionnaires included the SF-36 Health Survey, self-assessed oral health and relevant risk factors, in total 49 questions. Multivariable regression modelling was performed. 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%. A multivariable regression model is presented, with general health as the dependent variable, and the independent variables inserted en-bloc. The model was highly significant with an explained variance of 28%. Among background factors, only older age appeared as significantly and strongly related to poorer general health. The strongest explanatory contributions came from the health related variables. Oral disease and extra-oral body pain were both strongly related to poorer general health, most obviously for the oral disease variable. Oral disease was significantly and to a clinically relevant degree associated with self-assessed general health. Several other psychosocial indicators of stress were also significantly related to the general health. These findings are consistent with the stress-behaviour-immune model for development of disease.

  • 2.
    Axtelius, Björn
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Vad är oral hälsa? Hälso- och sjukdomsbegreppet sett ur teoretisk synvinkel2004Ingår i: Tandläkartidningen, ISSN 0039-6982, Vol. 96, nr 10, s. 50-55Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    Insikten om att vårdens resurser inte kommer att räcka till för att behandla all oral sjukdom i befolkningen har betytt att begreppet oral hälsa allt mer hamnat i fokus. Rent samhällsekonomiskt är det mer fördelaktigt att förebygga än att behandla sjukdom. Det innebär också mindre lidande för patienten. Ett salutogenetiskt perspektiv (se ordförklaring) [1] minskar påfrestningarna på vården och ger ett snabbare och mer komplikationsfritt tillfrisknande [2]. Det är därför viktigt att diskutera begreppen ”oral sjukdom” och ”oral hälsa”: hur de översätts i daglig klinisk praxis, hur de beskrivs i internationella och nationella deklarationer samt i svensk lagstiftning. Författarna föreslår även tre nivåer på utfallsvariabler som bör beaktas vid forskning om oral sjukdom/ohälsa. Artikeln är ett försök att ur teoretisk synvinkel bidra till utvecklingen av hälso- och sjukdömsbegreppet.

  • 3.
    Ayala-Luis, Joselyn
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Johansson, Veronica
    Malmö högskola, Odontologiska fakulteten (OD).
    Sampogna, Francesca
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    A multivariable analysis of patient dental satisfaction and oral health-related quality-of-life: A cross-sectional study based on DVSS and OHIP-142014Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, nr 3, s. 187-193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The aim of this paper was to study the association between dental satisfaction and oral health-related quality-of-life (OHRQoL) when controlling for individual, clinical and psychological factors. Materials. Secondary analysis was conducted using data from a large study carried out in the Swedish region of Varmland in 2004. The questionnaire included demographic variables, clinical assessment and the following instruments: the Dental Visit Satisfaction Scale (DVSS), the short version of Oral Health Impact Profile (OHIP-14) and a modified version of the revised helping alliance questionnaire. Internal consistency analysis was undertaken on the instruments to assess reliability; bivariate comparisons were assessed to compare DVSS scores with individual factors (age, gender and education). In addition, a three step hierarchical multiple regression analysis was performed with DVSS as a dependent variable. Results. Data were completed for 485 randomly selected patients. The mean age of participants was 43.5 years, 54.6% were women, and 41.2% had high education. The median DVSS score was 48 (range 10-50) and the median OHIP was 3.0 (range 0-56). All the instruments showed good reliability. Bivariate analysis showed that females were more satisfied than males (p <= 0.01) and patients of 50 years or older were more satisfied than the younger ones (p <= 0.05). Finally, the following variables explained 31% of the variance of being very satisfied with dental visit: a good OHRQoL and patients' positive perceptions of the relationship with their care provider. Conclusion. This study showed positive associations between dental satisfaction and OHRQoL when controlling for related factors. The result suggests that care providers should take into account the various dimensions of OHRQoL rather than use only clinical measurements when they evaluate patient satisfaction.

  • 4.
    Berthelsen, Hanne
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Lönnblad, Anneli
    Malmö högskola, Odontologiska fakulteten (OD).
    Hakanen, Jari
    Søndergård Kristensen, Tage
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Bjørner, Jakob Bue
    Westerlund, Hugo
    Cognitive interviewing used in the development and validation of Copenhagen Psychosocial Questionnaire in Sweden2014Ingår i: Threats and Possibilities Facing Nordic Working Life: Book of Abstracts and Programme, University of Gothenburg, 2014, s. 232-233Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    The Copenhagen Psychosocial Questionnaire (COPSOQ) has primarily been validated through psychometric methods. Therefore, cognitive interviewing was included as part of the validation project of COPSOQ in Sweden. The aim is to discuss the use of cognitive interviews for development and validation of the Swedish version of COPSOQ. Informants were selected to achieve variation in age, gender, occupation, and region of residence. Individual interviews were performed with 26 informants using a think aloud approach combined with flexible concurrent probing based on an interview guide. The interviews were audio recorded and transcribed verbatim. The interviews were conducted in rounds followed by an initial analysis by the two first authors before adjustments of the questionnaire items were made. Currently, content analysis is ongoing. The cognitive interviews provided insight into what people actually reflected upon while answering the questionnaire. This added new knowledge about how key terms such as ‘work place’ were understood by the respondents and also it helped identifying problems in the interpretation of specific words. The study has been approved by the Regional Ethics Board in Southern Sweden and is funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE).

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  • 5.
    Franzon, Bengt
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Åkerman, Sigvard
    Malmö högskola, Odontologiska fakulteten (OD).
    Klinge, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Dental politics and subsidy systems for adults in Sweden from 1974 until 20162017Ingår i: BDJ Open, E-ISSN 2056-807X, Vol. 3, nr 17007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: The dental health sector, as part of the Swedish welfare system, originated in 1974. Since then, the dental insurance has undergone three major changes. The aim of this archive study was to study where in the legislative process the dental politics concerning national dental insurance and subsidies were formed. Materials and Methods: The material, such as Commission of inquiry proposals and Government Bills from four major dental reforms, was collected from the library at the Sveriges Riksdag (Swedish Parliament) and was analysed and structured using a modified version of the Health Field Model. Results: The views on the fundamental ideas, such as the connection between general and dental health, preventive dentistry, rehabilitation of the mouth and promotion of dental health, were the same over the years. The views on dentistry as a market, when it comes to freedom of prices, have undergone a major change since 1974, but the view on the welfare state remains the same. Conclusions: The Swedish dental subsidy systems and how dentistry has been treated politically are the results of a chain of events ranging from care for the population's dental health, political doctrines, ‘zeitgeist‚, dental policy, to state finances.

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  • 6.
    Franzon, Bengt
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Englander, Magnus
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för socialt arbete (SA).
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Klinge, Björn
    Malmö universitet, Odontologiska fakulteten (OD). Department of Odontology, Division of Oral Diseases, Karolinkska Institutet.
    Dentistry as a free market in the context of leading policymaking2018Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, nr 1, artikel-id 1484218Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to disclose the psychological meaning structure of dentistry as a free market within the context of leading Swedish policymaking. Following the criteria for the descriptive phenomenological psychological method data was collected from leading policy makers about the experiential aspects of dentistry as a free market within the context of a welfare state. The analysis showed that dentistry as a free market was experienced as a complex business relationship between buyers and sellers that transcended the traditional dentist and patient roles. The lived experience of the proposed business transaction was based on two inherently conflicting views: the belief in the individual's ability to make a free choice versus the understanding that all individuals in a society do not have the ability or the means necessary to make a free choice. Dentistry as a free market within a welfare state, such as Sweden, can thus be seen as a persistent attempt to hold on to a compromise between two very distinctive political ideologies.

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  • 7.
    Franzon, Bengt
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Moutakis, Mikael
    Department of Economics, Gothenburg University, Gothenburg, Sweden; The Swedish Dental- and Pharmaceutical Benefits Agency, Stockholm, Sweden.
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Åkerman, Sigvard
    Malmö universitet, Odontologiska fakulteten (OD).
    Klinge, Björn
    Malmö universitet, Odontologiska fakulteten (OD). Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    The relationship between practice ownership and follow-up of comprehensive dental care. A Swedish register study.2024Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, s. 151-159Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aims of this register study were:

    1. To study whether the type of ownership of the dental practice was correlated with the type of dental care provided, that is public versus private ownership and professional (dentist or dental hygienist) versus non-professional ownership.
    2. To study the extent of follow-up of patients who have undergone two types of treatments. 

    MATERIAL & METHODS: Two types of dental care were defined in the two groups studied, periodontitis/peri-implantitis and comprehensive restorative/rehabilitation. All relevant treatment codes that fall under these definitions are noted when they are performed. Also, the follow-up of each treatment code is noted. Differences in dental and socioeconomic status over time and between regions were adjusted for. A drop-out analysis was performed.  Results: Dental practices owned by dentists or dental hygienists schedule follow-up appointments for patients who have undergone comprehensive restorative or rehabilitation dentistry more often than practices with other types of ownership. Dental practices owned by dentists or dental hygienists follow up patients with periodontitis and peri-implantitis less frequently.

    CONCLUSION: Type of ownership of a dental business influences the extent to which periodontal, and comprehensive restorative or rehabilitation dentistry were followed up.

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  • 8.
    Gullberg, Joanna
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Lindh, Christina
    Malmö universitet, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Horner, Keith
    Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK.
    Devlin, Hugh
    Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK.
    Povlsen, Lene
    Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
    Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists2020Ingår i: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 37, nr 2, s. 208-216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. Background Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. Materials and methods A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. Results From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. Conclusion Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.

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  • 9.
    Hjalmers, Karin
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Healthy work for female unpromoted general practice dentists2004Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 62, nr 2, s. 107-110Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    This study describes how female unpromoted general practice dentists (GPDs) in a region in Sweden perceived “healthy work”, i.e. their image of the dimensions that the dentistry profession should contain if it is to be really healthy work. The study also investigates whether there is a gulf between ideal and reality for this group. All unpromoted GPDs within the Public Dental Health Service’s general practice in a region in Sweden received a questionnaire, and 94% responded. The data were collected during July and August 2000 and the question about healthy work was taken from work environment studies. A principal components analysis was performed. Three factors explaining more than half the variance (53%), forming three well defined vector clusters: 1) a factor for moral values and possibilities for skill discretion, i.e. properties specific for human services, 2) a factor for career development and 3) a factor for work environment. We found that factor 1 alone explained a greater proportion of the variance (28%) for the respondents. The main results were that the female unpromoted GPDs emphasized free and intellectually stimulating work and that the gulf between the ideal and the reality was wide, especially concerning the dentist’s influence on important decisions. A salutogenetic approach built on good communication and democracy at work, and based on freedom and the employees’ influence, could bring ideal and reality closer.

  • 10.
    Hjalmers, Karin
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Moral values and career: Factors shaping the image of healthy work for female dentists2006Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, nr 5, s. 255-261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Female unpromoted general practice dentists (GPDs) constitute about one-quarter of all dentists in Sweden. These female dentists suffer from many problems relating to their psychosocial working conditions. There are wide discrepancies between their perception of the ideal job situation and reality. Previously, three factors were found to constitute the ideal job situation. The aim of this study was to analyze patterns in two of these factors, i.e. the moral and the career factors, for understanding how ideal circumstances are conceived, i.e. how ‘‘good work’’ for the dentists could be obtained. Material and Methods. In the year 2000, all female unpromoted GPDs (183 persons) within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire; response rate 94%. Four multiple regression models were constructed for two factors of good work and for the differences between the ideal job situation and reality concerning these factors. Results. In all models, the explained variance was high. Those dentists who were committed to moral issues perceived large differences between the ideal and reality concerning moral values. Dentists committed to career issues experienced large differences between the ideal and reality concerning career development. Those dentists - about 60% - who would not want to be a dentist if they were to choose today, perceived large discrepancies concerning moral and career issues. Conclusions. The PDHS organization has failed to convince or engage those whom it ought to engage, that is those with the highest level of commitment. Dentists’ emphasis on moral values confirms the character of dentistry as primarily a human service work.

  • 11.
    Hjalmers, Karin
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Psychosomatic symptoms among female unpromoted general practice dentists2003Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 27, nr 1, s. 35-41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Unpromoted female general practice dentists have a working situation with hard work conditions. The aim of the present study was to describe the perceived health for unpromoted female general practice dentists in comparison with others laving a somewhat similar working situation. Questionnaires were sent to all unpromoted female general practice dentists (n=183) within the Public Dental Health Service in a region in Sweden. The response rate was 94%. Comparisons have been done with personnel in the Social Insurance Organization in Sweden and Children Clinics in the Public Health Care in a region in Sweden. The dentists in this study suffered from many physical and mental troubles and also linked them to the working situation. They reported high prevalences of tiredness (70%) and back, neck and shoulder pain (76%) and related these symptoms to the job situation in 83% and 95%, respectively. The study showed statistically significant differences (p < 0.0001) in the comparison between all the samples that were investigated. In conclusion, the results show problems concerning self-perceived health for the unpromoted female dentists. We have shown that they are feeling unhealthy, worse than other high-risk-groups in a human service working situation, and they suffer from a multitude of problems also connected to their working environment.

  • 12.
    Hjalmers, Karin
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Kronström, Mats
    Network participation for unpromoted female dentists in relation to psychosocial support2004Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 62, nr 3, s. 158-162Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Studies have shown that female unpromoted general practice (GP) dentists have a taxing work situation with many problems related to their psychosocial work environment. This study aims to describe 1) the participation for this group in organized network activity (support groups) in a region in Sweden, 2) the sense of support with comparison to another organization and to a nationwide sample of GP dentists, and 3) the covariation of network participation with support. All unpromoted female dentists within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire, and 94% re-sponded. Those participating in network activity ≥ 4 times a year constituted 12% of the respondents. The co-operation between colleagues was lower than in the nationwide sample. The experienced support from the organization PDHS was weak. It was not possible to explain why the female unpromoted GP dentists participated ≥ 4 times a year, but the female dentists who felt lonely in their work were to a higher degree participants in a network. Almost nine out of ten reported being strengthened by the network both as a person and in the professional role. The female dentist was three times more likely to participate in a network if she had a male head of the clinic. In conclusion, the main results are the paucity of intercolleague contact and the lack of association between support and network participation. The many affirmative comments indicated though, that network participation might be a good coping strategy for unpromoted female GP dentists.

  • 13.
    Johansson, Gunvi
    et al.
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Gerdin, Elisabeth W
    Centre for Public Health Sciences, Östergötland County Council, Linköping, Sweden.
    Halling, Arne
    Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Östberg, Anna-Lena
    Department of Health and Environmental Sciences, University of Karlstad, Karlstad, Sweden.
    Measuring oral health from a public health perspective2008Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 32, nr 3, s. 125-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The paper aims to analyse measures of oral health-related quality of life (OHQOL) from a Public Health perspective. Twenty-two measures were analysed conceptually as to their mirroring of the Public Health principles: empowerment, participation, holism and equity. Elements of empowerment were found in connection with application of the measures. Participation was found in using lay opinions during development in 12 measures. All measures analysed had elements of a holistic approach so far that they were not wholly biological. Two measures captured positive health effects. Measures were available for all ages, various languages and populations, an element of equity. No measure was wholly compatible with Public Health. They were based on a utilitarian theory not in full accordance with modern health promotion. There is a need to develop measures that more obviously capture the positive aspects of health and health as a process, as well as the personal perspective of oral health

  • 14.
    Johansson, Veronica
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    A path analysis of contract and fee-for-service care2009Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Objectives: In Swedish dentistry, the traditional patient financial system is fee-for-service care (FFS). Since 1999, the public dental health service (PDHS) in the county of Värmland offers an alternative system, contract care (CC). Here, the patient pays a set fee for a fixed period of time, and receives oral health care as specified by a contract, without additional costs. Previously, an association between patient financial system and oral health-related quality of life (OHRQoL) was found. The aim was to model direct and indirect effects with path analysis, to study if there were different underlying mechanisms in the patient financial systems. Material and methods: In 2003, a questionnaire was sent to randomly selected patients enrolled in CC (n=1,200) and FFS (n=1,200) in the PDHS in Värmland. The study was approved by the ethical board in the Southern region of Sweden. Response rate was 57%. Data without internal non-response (n=1,044; CC: 57%, FFS: 43%) were analysed with a multiple group path analysis. The interactions of four variables were of central interest: OHRQoL, the respondents’ perceptions of the dental caregiver’s humanistic (patient-, as opposed to disease-centred) qualities, what the respondents were prepared to pay, and what they had paid for dental care the previous year. Results: The underlying mechanisms in the systems were similar. However, there were differences regarding the central variables: the perceived humanism of the caregiver affected OHRQoL only in FFS, while what the respondents were prepared to pay for dental care was affecting the perception of humanism only in CC. Conclusions: The findings indicated that the perception of the caregiver’s humanistic qualities were important for oral health for respondents in FFS, while financial considerations were important for how the caregiver’s qualities were perceived by respondents in CC. Funding: The study was financed by the Swedish Research Council.

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  • 15.
    Johansson, Veronica
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Sampogna, Francesca
    Malmö högskola, Odontologiska fakulteten (OD).
    Lannerud, Monica
    Malmö högskola, Odontologiska fakulteten (OD).
    Sondell, Katarina
    Department of Odontology, Jönköping, Sweden.
    Financial systems' impact on dental care: a review of fee-for-service and capitation systems2007Ingår i: Community Dental Health, ISSN 0265-539X, Vol. 24, nr 1, s. 12-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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. This review was funded by the Swedish Research Council.

  • 16.
    Johansson, Veronica
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Sampogna, Francesca
    Paulander, Jörgen
    Patients' health in contract and fee-for-service care: a descriptive analysis2006Ingår i: Community Dental Health, ISSN 0265-539X, Vol. 23, nr 3, s. 187-188Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    AIM Fee-for-service, paying afterwards for services provided, is the traditional patient financial system in dentistry in Sweden. The public dental health service (PDHS) in Värmland has since 1999 also an alternative system: contract care, where a fixed sum of money is paid annually for dental care, which is then received without additional cost. This study describes demographic as well as general and oral health-related characteristics among patients in a service study comparing the two patient financial systems, fee-for-service and contract care, in the PDHS in Värmland. METHODS A questionnaire was answered by 1,324 patients (response rate 57%). Of the respondents, 52% were in contract care and 48% in fee-for-service. A non-response analysis and a special study of the non-respondents were undertaken. General health was studied with SF-36, measuring health in eight dimensions: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Oral health was studied with OHIP-14, measuring oral health in seven dimensions (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap) and as an index. The demographic factors included gender, age, birth country, marital status, education, and social affinity with neighbourhood and housing area. The data were analysed with contingency tables, Chi-square tests, t-tests, Mann-Whitney non-parametric tests and logistic regression analyses. RESULTS The non-response analysis revealed that the likelihood for answering the questionnaire was higher for women (OR=1.27), for respondents in contract care (OR=1.43) and for each year of life (OR=1.02). A short telephone interview with 40 non-respondents in each financial system indicated that the non-respondents had better oral health than the respondents. The non-respondents had experienced less pain in the mouth, less difficulties doing their usual jobs and had found life more satisfying than the respondents. There were no significant differences in gender or age. In the study population, differences in health were observed between the financial systems. Respondents in contract care had better oral health than those in fee-for-service (p=0.019). They had also better general health in half of the dimensions of SF-36 (physical functioning: p<0.001; role-physical: p=0.002; general health: p<0.001; social functioning: p=0.045), were younger (p<0.001), better educated (p< 0.001), were born in Sweden more often (p<0.001) and were more often married/living with somebody (p=0.011) than were the fee-for-service respondents. The fee-for-service respondents experienced higher social affinity with their housing area (p=0.049). CONCLUSION There was bias in nonresponse. Contract care patients had better general and oral health than patients in fee-for-service. Acknowledgement: The study was financed by the Swedish Research Council.

  • 17.
    Johansson, Veronica
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Sampogna, Francesca
    Malmö högskola, Odontologiska fakulteten (OD).
    Paulander, Jörgen
    Sondell, Katarina
    Multivariate analyses of patient financial systems and oral health-related quality of life2010Ingår i: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 38, nr 5, s. 436-444Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Since 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, has two co-existing patient financial systems, i.e. ways for the patient to pay for dental care services. Alongside the traditional system of fee-for-service payment, i.e. paying afterwards for provided services, a new system of contract care is offered. In this system, dental care is covered by a contractual agreement, for which the patient pays an annual fee and receives care covered by the contract without additional costs. The aim of this article was to study whether patient financial system was associated with oral health-related quality of life (OHRQoL). Methods: A questionnaire was answered by 1324 randomly selected patients, 52% from contract care and 48% from fee-for-service. The questionnaire contained questions about how much one was prepared to pay for dental care, how much one paid for dental care the previous year, OHIP-14 (measured OHRQoL), dental anxiety, humanism of caregiver, SF-36 (measured general health), multidimensional health locus of control, sense of coherence (SOC), self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The material was analysed with a hierarchical block method of multiple regression analysis. Results: When controlling for all other variables, patient financial system was one of the strongest associations with OHRQoL: patients in fee-for-service had worse OHRQoL than those in contract care. OHRQoL was also associated with general health, SOC and to some extent also with psychological and economic factors. Of the social variables, only being foreign born was significant: it was associated with worse OHRQoL. Conclusions: Patient financial system was associated with OHRQoL when controlling for confounding factors: patients in contract care had better OHRQoL than those in fee-for-service care.

  • 18.
    Johansson, Veronica
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Sampogna, Francesca
    Malmö högskola, Odontologiska fakulteten (OD). Health Services Research Unit, IDI-IRCCS, Rome, Italy.
    Paulander, Jörgen
    Public Dental Health Service in Värmland, Karlstad, Sweden.
    Sondell, Katarina
    Institute for Postgradute Dental Education, Jönköping, Sweden.
    Patients' health in contract and fee-for-service care: I. A descriptive comparison2007Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 31, nr 1, s. 27-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fee-for-service care, paying afterwards for services provided, is the traditional adult patient financial system in dentistry in Sweden. The public dental health service (PDHS) in the county of Värmland has since 1999 also an alternative system, contract care. There, a fixed sum of money is paid annually for dental care, which then is received without additional costs. This study compares the demographics, general health and oral health-related quality of life (OHRQoL) in the patient financial systems fee-for-service and contract care in the PDHS in Värmland. A questionnaire was answered by 1,324 patients, response rate 57%. A non-response analysis was undertaken. The non-response analysis showed that the likelihood for answering the questionnaire was higher for women, for respondents in contract care and for increasing age. Further analyses revealed that the non-respondents were healthier than the respondents and that experience of pain in the mouth was the only variable increasing the likelihood of response. General health was studied with the SF-36 and OHRQoL with the OHIP-14. The demographics studied were gender, age, birth country, marital status, education and social network. The results showed that there were differences in patients' health between the patient financial systems. Respondents in contract care had better OHRQoL than those in fee-for-service care. They also had better general health in four of the dimensions of SF-36, were younger, better educated, born in Sweden and were married/living with somebody to a larger extent than fee-for-service care respondents. Fee-for-service care respondents experienced higher social affinity with their housing area. In conclusion, patients in contract care had better general health and OHRQoL than patients in fee-for-service care. There were social differences in choice of financial system and biased non-response.

  • 19.
    Johansson, Veronica
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Sampogna, Francesca
    Malmö högskola, Odontologiska fakulteten (OD).
    Sondell, Katarina
    Contract and fee-for-service care - regression modelling of oral health-related quality of life2007Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    In 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, implemented contract care alongside the traditional patient financial system of fee-for-service care. In contract care, the patient pays a fixed sum annually for dental care and then receives basic dental care without additional costs. Aim The aim was to study the relation between patient financial system and oral health-related quality of life (OHRQoL). Methods In 2003, a questionnaire was sent to 2,400 consecutively selected patients in the PDHS in Värmland, 1,200 from each patient financial system. The questionnaire was answered by 1,324 participants (57% of those who could be reached). The questionnaire contained questions about willingness to pay for dental care, how much one had paid for dental care the previous year, OHRQoL (measured with the OHIP-14), dental anxiety, humanism of caregiver, general health (measured with the SF-36), multidimensional health locus of control, sense of coherence, self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The data were analysed with a block method of multiple linear regression, adding blocks of variables in six steps: financial system, economic factors, individual factors, social factors, psychological factors and health factors. The threshold for statistical significance was set at p≤0.05. Results OHRQoL was affected by the financial system of the respondent: those in fee-for-service care had a worse OHRQoL than those in contract care. OHRQoL was also affected by health, sense of coherence and to some extent by psychological and economical factors. Of the social variables, only being foreign born had a significant effect on OHRQoL. Conclusions OHRQoL was found to be affected by patient financial system. Acknowledgements The study was financed by the Swedish Research Council.

  • 20.
    Johansson, Veronica
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Oral B's Nordic Report on Oral Health: Caries prevalence among children, adolescents and adults, and periodontal conditions among adults in Denmark, Finland, Norway and Sweden2008Rapport (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this report was to compare the oral health in the Nordic countries of Denmark, Finland, Norway and Sweden, from existing national clinical data. The conditions of interest were caries prevalence and periodontal conditions. The groups of interest were children and adolescents up to the age of 19, and adults up to 60 years old. Further, socio-economic and ethnic differences, as well as differences in relation to living area were also of interest. There are indications of similar trends in caries prevalence among children and adolescents in the Nordic countries, with a continuing decrease in caries prevalence during the past 20-30 years, and tendencies of a levelling out at the turn of the century. The WHO goal of a mean DMFT for 12-year-olds at 1.5 or below before the year 2020 (Petersen 2003), is already fulfilled in all four countries. However, it seems there is still work to do to attain the goal of at least 80% caries free 6-year-olds in 2020. The available data do not distinguish differences between urban and rural areas, nor ethnic and socio-economic differences. The most important finding regarding both caries prevalence and periodontal conditions in adults is that there is a lack of national data from Norway and Sweden. Although interpretations should be cautious, there are indications of slightly higher caries prevalence in Finland, compared to Denmark, among adult men. Data on educational level indicate similar patterns of associations between higher levels of education and lower figures of caries prevalence. There is a lack of data on ethnic differences in caries prevalence in adults. There is also a lack of data regarding differences between urban and rural living areas, which only were available for Denmark. The results regarding periodontal conditions indicate that bleeding is widespread in both Denmark and Finland, while both shallow and deep pockets seem to be more common in Finland. Data on educational level indicate similar patterns of associations between higher levels of education and lower prevalence of shallow and deep pockets. There is a lack of data on ethnic differences in periodontal conditions in adults. There is also a lack of data regarding differences between urban and rural living areas, which only were available for Denmark. From the available data, no interpretations regarding aggressive periodontitis, i.e. rapid deterioration of bone loss and periodontal ligaments, nor probability of developing it, can be made. A recommendation for the future is to conduct more national clinical assessments of oral health in adults. National clinical research is needed in order to estimate what actions need to be taken to improve oral health. Without national assessments, political reforms cannot be evaluated and conclusions regarding their effectiveness cannot be drawn.

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  • 21.
    Leisnert, Leif
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Johansson, Veronica
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Diagnoses and treatment proposals in periodontal treatment: A comparison between dentists, dental hygienists and undergraduate students2015Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 39, nr 2, s. 87-97Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study is to find out how professionals in Swedish dental care perform diagnostic procedures in general. Is there a common ground between dentists and dental hygienists concerning sharing different job assignments in an effective way? Are the methods of treatment used in accordance with degree of severity of the disease and to what extent is proposed treatment in accordance with the National Guidelines? A questionnaire consisting of three different patient cases with periodontal disease was sent to 804 private practitioners, 809 dentists in Dental Public Service, 802 dental hygienists and 40 dental students on their final semester at the Dental School in Malmo.The questionnaire was completed by 1,103 respondents (47%). A majority of all practitioner groups (94%) found that a relatively healthy patient had disease, the risk for developing further disease was deemed none too low by 97%, but 91% wanted to give preventive care. A vast majority suggested more dental care to healthy patients as compared to patients with severe periodontal disease. In Conclusion the two groups, i.e. dentists and dental hygienists, did not to a sufficiently high degree share views on diagnosis and treatment, in order to optimize the resources in dentistry. The delivery of dental care was not in line with the severity of disease and too much attention was paid to the needs of relatively healthy persons.To change this pattern, the incentives in and structure of the national assurance system could be adapted. Furthermore, the knowledge basis for periodontal diagnosis and treatment needs, with special reference to the National Guidelines, should to a higher degree be shared by all caregivers.

  • 22.
    Lira-Junior, Ronaldo
    et al.
    Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Holmström, Sofia Björnfot
    Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Clark, Reuben
    Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Zwicker, Stephanie
    Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Majster, Mirjam
    Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Johannsen, Gunnar
    Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Åkerman, Sigvard
    Malmö universitet, Odontologiska fakulteten (OD).
    Svensson, Mattias
    Department of Medicine, Center for Infectious Medicine, Karolinska Institutet, Huddinge, Sweden.
    Klinge, Björn
    Malmö universitet, Odontologiska fakulteten (OD). Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    Boström, Elisabeth A.
    Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
    S100A12 Expression Is Modulated During Monocyte Differentiation and Reflects Periodontitis Severity2020Ingår i: Frontiers in Immunology, E-ISSN 1664-3224, Vol. 11, artikel-id 86Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    S100A12 is a calcium-binding protein of the S100 subfamily of myeloid-related proteins that acts as an alarmin to induce a pro-inflammatory innate immune response. It has been linked to several chronic inflammatory diseases, however its role in the common oral immunopathology periodontitis is largely unknown. Previous in vitro monoculture experiments indicate that S100A12 production decreases during monocyte differentiation stages, while the regulation within tissue is poorly defined. This study evaluated S100A12 expression in monocyte subsets, during monocyte-to-macrophage differentiation and following polarization, both in monoculture and in a tissue context, utilizing a three-dimensional co-culture oral tissue model. Further, we explored the involvement of S100A12 in periodontitis by analyzing its expression in peripheral circulation and gingival tissue, as well as in saliva. We found that S100A12 expression was higher in classical than in non-classical monocytes. S100A12 expression and protein secretion declined significantly during monocyte-to-macrophage differentiation, while polarization of monocyte-derived macrophages had no effect on either. Peripheral monocytes from periodontitis patients had higher S100A12 expression than monocytes from controls, a difference particularly observed in the intermediate and non-classical monocyte subsets. Further, monocytes from periodontitis patients displayed an increased secretion of S100A12 compared with monocytes from controls. In oral tissue cultures, monocyte differentiation resulted in increased S100A12 secretion over time, which further increased after inflammatory stimuli. Likewise, S100A12 expression was higher in gingival tissue from periodontitis patients where monocyte-derived cells exhibited higher expression of S100A12 in comparison to non-periodontitis tissue. In line with our findings, patients with severe periodontitis had significantly higher levels of S100A12 in saliva compared to non-periodontitis patients, and the levels correlated to clinical periodontal parameters. Taken together, S100A12 is predominantly secreted by monocytes rather than by monocyte-derived cells. Moreover, S100A12 is increased in inflamed tissue cultures, potentially as a result of enhanced production by monocyte-derived cells. This study implicates the involvement of S100A12 in periodontitis pathogenesis, as evidenced by increased S100A12 expression in inflamed gingival tissue, which may be due to altered circulatory monocytes in periodontitis.

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  • 23.
    Lundegren, Nina
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Håkansson, Jan
    Åkerman, Sigvard
    Malmö högskola, Odontologiska fakulteten (OD).
    Dental Treatment Need Among 20 to 25-year-old Swedes: Discrepancy Between subjective and Objective Need2004Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 62, nr 2, s. 91-96Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Our aim was to analyze variables from a questionnaire sent to 20 to 25-year-old Swedes to determine how they perceive their oral treatment need, and to determine which variables affect this perception. The questionnaire was sent to 650 individuals randomly selected from the database of the National Social Insurance Board of Sweden. The response rate was 78%. Another questionnaire was sent to the dentists of these young adults in order to collect clinical information. The response rate was 66%. The respondent's answer to the question 'How do you rate your dental treatment need today?' was dichotomized and used as a dependent variable in a multivariate logistic regression model. Each increase in number of decayed- filled teeth led to a 13% increased treatment need, bad oral hygiene a 2.24-fold increase, and no periodontal disease an 80% reduction in treatment need. A higher education beyond comprehensive school increased the perceived treatment need 7.16 times; a poorer dental health than one's contemporaries led to a 14.47-fold increase. When dentist and patient assessments were combined, variables related to the patients' self-assessments were the only significant contributors to the statistical model. A lack of concordance between patients' and dentists' assessments of treatment need was found which highlighted the differences between patients' and dentists' views on treatment need. This study shows the importance of communication between dentist and patient.

  • 24.
    Lundegren, Nina
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Isberg, Per-Erik
    Åkerman, Sigvard
    Malmö högskola, Odontologiska fakulteten (OD).
    Analysis of the perceived oral treatment need using Andersen's behavioural model2013Ingår i: Community Dental Health, ISSN 0265-539X, Vol. 30, s. 102-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim of this study was to investigate the influence of specific components of Andersen’s behavioural model on adult individuals’ perceived oral treatment need. Methods: A questionnaire was sent to a randomly selected sample of 9,690 individuals, 20 to 89 years old, living in Skåne, Sweden. The 58 questions, some with follow-up questions, were answered by 6,123 individuals; a 63% response rate. Selected for inclusion in the multivariate logistic regression analysis were those questions relating to Andersen’s behavioural model, phase five. Responses to “How do you rate your oral treatment need today?” were used as a dependent variable. The 62 questions chosen as independent variables represented the components: individual characteristics, health behaviour and outcomes in the model. Results: Of the independent variables, 24 were significant at the p≤0.05 level. Low educational level, previously unmet perceived oral treatment need, frequent visiting pattern, perception of worse oral health than one’s peers, an external locus of control, and to have received information from one’s dental caregiver about a need for oral treatment were all highly significant (p<0.001) variables correlating with high self-perceived oral treatment need. Conclusion: The Andersen behavioural model can be a useful theoretical tool for the study of perceived oral treatment need.

  • 25.
    Lundegren, Nina
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Åkerman, Sigvard
    Malmö högskola, Odontologiska fakulteten (OD).
    Oral health in the adult population of Skane, Sweden: a clinical study2012Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, nr 6, s. 511-519Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The aim of this study was to describe the oral health in the adult population of Skåne by clinical factors with special reference to age, gender, ethnicity and education. Materials and methods. Clinical examinations were performed on 451 randomly selected individuals, 20–89 years old, living in Skåne, Sweden. The clinical examination included a radiographic examination and a questionnaire. Clinical variables were put into cross-tabulations along with age, gender, educational level and ethnicity. Results. For all of the described clinical variables, except caries, the frequency increased with age. There were no differences in the clinical variables due to gender. The frequencies of missing teeth, caries, periodontal conditions and DMFT were higher among those with a lower educational level. More missing teeth, worse periodontal conditions, more apical destructions and less dental fillings were found in individuals who were not born in Sweden. Conclusions. The oral health in the adult population of Skåne was overall good, with low frequencies of oral disease and a large number of remaining teeth up to a high age. The patients' oral health status, as determined by a dentist's clinical examination, differed due to age, educational level and ethnicity, but not due to gender.

  • 26.
    Lundegren, Nina
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Åkerman, Sigvard
    Malmö högskola, Odontologiska fakulteten (OD).
    Self perceived oral health, oral treatment need and the use of oral health care of the adult population in Skåne, Sweden2011Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 35, nr 2, s. 89-98Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to describe how the adult population in Skåne, Sweden, perceived their oral health, dental status, oral treatment need and use of oral health care. A questionnaire was sent to a randomly selected sample of 10 000 persons in Skåne, Sweden. The individuals were between 20 and 89 years old and registered as residents of the region during 2006. After excluding those no longer living in the region, 9 690 individuals remained. The response rate to the questionnaire was 63%, of which 57% were women and 43% men. A majority was satisfied with their teeth and with their teeth's appearance, 65% and 62% respectively. Of the respondents, 35% considered their dental health to be better than others in their age group. Symptoms associated with periodontitis were experienced by 40%. 7% were missing more than ten teeth while 7% had no dental fillings. 30% rated their need of dental treatment as high and most expected their treatment need to increase in the future. Most of the respondents, 60%, received their oral care at a private practice, whereas 13% did not see a dentist regularly for check-ups. More women than men perceived a high dental treatment need, 32% compared to 28%. Conclusions: A majority of the adult population in Skåne have a positive attitude towards their oral health. Most individuals had lost few teeth and removable dentures were uncommon. A third rated their dental treatment need as high and most expected their treatment need to increase in the future. 

  • 27. Mårtensson, Carina
    et al.
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Andersson, Pia
    Expectations and satisfaction with care for periodontal specialist patients2012Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 71, nr 3-4, s. 799-806Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Objective. The aim of this study was to investigate expectations on and satisfaction with treatment among patients referred for comprehensive treatment to specialist clinics in periodontology and to explore factors associated with satisfaction in regression analysis. Materials and methods. Patients referred for comprehensive periodontal treatment were sampled for the study. The study was based on a questionnaire in a before-and-after design. The first questionnaire was sent to the patients before their first appointment at the specialist clinic. The second questionnaire was sent after ∼ 6 months. Three questions were used to measure expectations and four questions to measure satisfaction. The first questionnaire was sent to 273 patients with a response rate of 31% and the second questionnaire was sent to 85 patients with a response rate of 73%. In non-response analysis, no difference between respondents and non-respondents were detected as to age and gender. Results. Many of the patients viewed it as important or very important to have healthy teeth (98%) and improved well-being (93%) after periodontal treatment. More than 50% of the patients were satisfied with the relation to the caregiver. When measuring the satisfaction in general, 42% indicated the highest score on the summarized Dental Visit Satisfaction Scale. Having confidence (p ≤ 0.001) and a good relation (p = 0.001) to the caregiver indicated higher satisfaction. Conclusion. Having a good relation to the caregiver and having confidence in the caregiver seems to indicate satisfied patients receiving periodontal treatment at periodontal clinics.

  • 28. Mårtensson, Carina
    et al.
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Andersson, Pia
    Knowledge of periodontitis and self-perceived oral health: a survey of periodontal specialist patients2013Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 37, nr 1, s. 49-58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to investigate changes in knowledge of periodontal disease among patients referred to periodontal specialist clinics. A further aim was to investigate the patients' self- perceived oral health before the treatment. Patients referred to five specialist clinics in periodontology for comprehensive periodontal treatment were consecutive sampled. The study was based on a questionnaire in a before and after design. The first questionnaire was sent to the patients before visiting the specialist clinic and the second was sent after six months. Four questions were analysed, two to measure knowledge about periodontitis and two to measure the patients self- perceived oral health. The first questionnaire was sent by post to 273 patients with a response rate of 31%. The second questionnaire was sent to 85 patients with a response rate of 73%. The results of the study showed a statistically significant improvement of correct answers on the knowledge questions after six months was found for scaling (p = 0.006), X-ray examination (p = 0.001) and increased space between the teeth (p = 0.001). The most frequent self-perceived trouble from the mouth was bleeding gum (70%) and sensitive teeth (51%). In conclusion knowledge of periodontitis improved after visiting the specialist clinic of periodontology. Many of the patients experienced some problems of the mouth

  • 29.
    Persson, Karin
    et al.
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV). Swedish Institute for Health Sciences, Lund, Sweden.
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Östman, Margareta
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för hälso- och välfärdsstudier (HV). Swedish Institute for Health Sciences, Lund, Sweden.
    Association of perceived quality of life and oral health among psychiatric outpatients2009Ingår i: Psychiatric Services, ISSN 1075-2730, E-ISSN 1557-9700, Vol. 60, nr 11, s. 1552-1554Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The relationship between oral health and various aspects of quality of life has gone uninvestigated in psychiatric populations. The aim of this study was to investigate the correlation between the Oral Health Impact Profile-14 and subjective quality of life, perceptions about general health, and self-related variables. METHODS: A structured interview constructed from validated instruments was administered to 113 consumers attending outpatient psychiatric care. RESULTS: A lower perceived oral health-related quality of life had a correlation with decreased ratings of subjective quality of life, general health disabilities, and chance and internal locus of control. CONCLUSIONS: Correlations between subjective and general health-related quality of life and oral health-related quality of life had not been detected in this group before. In order to improve mental health consumers' total perceived quality of life, oral health problems should be regularly addressed in the course of psychiatric care.

  • 30.
    Persson, Karin
    et al.
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Östman, Margareta
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för hälso- och välfärdsstudier (HV).
    Monitoring oral health and dental attendance in an out-patient psychiatric population2009Ingår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, nr 3, s. 263-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 31.
    Persson, Karin
    et al.
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Östman, Margareta
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för hälso- och välfärdsstudier (HV).
    Oral health-related quality of life and dental status in an outpatient psychiatric population: a multivariate approach2010Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 19, nr 1, s. 62-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Research related to oral health in people with mental health problems may deepen our understanding of the quality of life of such individuals. This study aimed to investigate the relationship between oral status, health perceptions and life satisfaction, and their impacts on oral health-related quality of life (OHQoL). Data were collected from 113 patients in outpatient psychiatric care using a structured interview and an oral examination. Six multivariate models (one comprising the total population, three separate diagnostic groups, and two sex groups) investigated the variance in OHQoL. In the total population, the number of teeth, subjective life satisfaction, perception of physical health, sex, and relying on chance accounted for 40% of the variance. In the group consisting of patients diagnosed with schizophrenia 41% of the variance was explained by the variables 'number of teeth' and 'perception of physical health'. In the group diagnosed with mood disorders, the variable 'number of teeth' accounted for 58% of the variance. The variance in the remaining group of diagnoses was explained, up to 38%, by life satisfaction and reliance on chance. The sex models revealed significant differences: men considered the responsibility of caring for their oral health as a health matter, while women saw oral health as a more subjective issue. The perception of OHQoL was found to be dependent on the particular psychiatric diagnosis and sex. Such findings can be of use in the development of rehabilitation, as well as preventive strategies that could be individually tailored to maintain OHQoL and oral health.

  • 32.
    Sampogna, Francesca
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Johansson, Veronica
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Abeni, Damiano
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    A multilevel analysis of factors affecting the difference in dental patients' and caregivers' evaluation of oral quality of life2008Ingår i: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 116, nr 6, s. 531-537Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 33.
    Sampogna, Francesca
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Johansson, Veronica
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Abeni, Damiano
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    A multilevel analysis of factors affecting the difference in patients’ and providers’ evaluation of oral quality of life2008Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background It is important for dentists and hygienists to evaluate the oral health-related quality of life (OHRQoL) of patients, in order to depict with accuracy the burden of the disease on them, and thus to reach their specific needs. In a previous study, we observed that caregivers tended to overestimate the burden of dental conditions on patients’ life. Aim of the study In the present study, we further analysed those data using multilevel analysis, to investigate the possible determinants of the low concordance between patients’ and caregivers’ evaluation of OHRQoL, taking into account the role of the different caregivers and clinics. Methods This study consisted of a simultaneous assessment of patients’ oral quality of life, performed both by patients themselves and by their caregivers. Data were collected in four clinics, and patients were evaluated by 27 caregivers (15 dentists and 12 hygienists). OHRQoL was measured using the OHIP-14, that contains measures of physical, psychological and social abilities, general physical function, ability of speech and eating, symptoms of pain and discomfort, and appearance and social embarrassment. We tested eight multilevel models, using the OHIP difference as the dependent variable. In each model, the variance for the fixed effect (i.e., the levels) and the random effects (i.e., the intercept and other variables) was estimated. Results Data were complete for 432 patients. The mean difference between the caregivers’ OHIP and the patients’ OHIP was 4.4 (SD=8.2). The variance due to patients was partly explained by their age (higher OHIP difference in elderly vs young patients), gender (higher OHIP difference in women vs men), and number of teeth (higher OHIP difference in patients with less teeth). Almost 30% of variance was due to caregivers, while the effect of clinics was not significant. Conclusions The differences in caregivers’ evaluation could depend on the different caregivers’ experience, or their personal ability to empathize with the patient, or at least in part descend from different conceptual models of dental disease among caregivers. 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 of care, and to help patients to reach a well-informed decision about the treatment. Acknowledgement. The study was supported by the Swedish Research Council. DA is supported, in part, by funds from the "Progetto Ricerca Corrente" of the Italian Ministry of Health, Rome, Italy.

  • 34.
    Sampogna, Francesca
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Johansson, Veronica
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Abeni, Damiano
    Health Services Research Unit, Istituto Dermopatico dell’Immacolata IDI-IRCCS, Rome, Italy.
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Quality of life in patients with dental conditions: comparing patients' and providers' evaluation2009Ingår i: Community Dental Health, ISSN 0265-539X, Vol. 26, nr 4, s. 234-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 35.
    Sampogna, Francesca
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Bergamo, Fabio
    Gisondi, Paolo
    Di Pietro, Cristina
    Alessandroni, Livia
    Pagliarello, Calogero
    Zino, Grazia
    Pallotta, Paola
    Tabolli, Stefano
    Abeni, Damiano
    Comparison of patients' and providers' severity evaluation of oral mucosal conditions2011Ingår i: The Journal of American Academy of Dermatology, ISSN 0190-9622, E-ISSN 1097-6787, Vol. 65, nr 1, s. 69-76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In dental diseases, significant discrepancies were observed in the oral health-related quality of life evaluation between patients and providers. Few studies have been performed specifically on the impact of oral mucosal diseases on patients' health. OBJECTIVE: We sought to compare the evaluation of the severity of oral mucosal conditions in providers and patients. METHODS: Patients with an oral mucosal condition were recruited at the oral health care unit of a dermatologic hospital. Severity was evaluated both by the physician and by the patient, using a global severity assessment score on a 5-point scale. The 14-item Oral Health Impact Profile was used to evaluate oral health-related quality of life, the 12-item General Health Questionnaire for psychologic problems, and the 20-item Toronto Alexithymia Scale for alexithymia (ie, the difficulty in identifying and expressing feelings). RESULTS: Data were complete for 206 patients. The agreement between patients' and providers' evaluation was very low (Cohen κ = 0.18). Severity was particularly underestimated by the physician in patients with alexithymia (43% compared with 25% of patients with no alexithymia) and with psychologic problems (44% vs 25%). LIMITATIONS: Because of the high number of different conditions, and thus the small figures in each group, it was not possible to analyze the concordance between patient and provider in each single condition. CONCLUSION: Even in the severity assessment of his or her own disease, it is plausible that a patient does not provide a simple clinical evaluation, but includes subjective aspects. It is important for the physician to take into account the severity the patient perceives in making treatment decisions, and in evaluating clinical improvement

  • 36. Sampogna, Francesca
    et al.
    Tabolli, Stefano
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Aparo, Ugo Luigi
    Abeni, Damiano
    Measuring quality of life of patients with different clinical types of psoriasis using the SF-362006Ingår i: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 154, nr 5, s. 844-849Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 37.
    Senneby, Anna
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Neilands, Jessica
    Malmö universitet, Odontologiska fakulteten (OD).
    Svensäter, Gunnel
    Malmö universitet, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Rohlin, Madeleine
    Malmö universitet, Odontologiska fakulteten (OD).
    Threshold values affect predictive accuracy of caries risk assessment2019Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, nr 4, s. 315-327Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment. Material and methods: Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists’ risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds. Results: Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk. Conclusions: As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

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  • 38.
    Sharma, Sonia
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). University of Buffalo, USA.
    Lövgren, Anna
    Umeå University.
    Åkerman, Sigvard
    Malmö universitet, Odontologiska fakulteten (OD).
    Nilsson, Peter M.
    Lund University.
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    List, Thomas
    Malmö universitet, Odontologiska fakulteten (OD). Skåne University Hospital.
    Häggman-Henrikson, Birgitta
    Malmö universitet, Odontologiska fakulteten (OD). Umeå University.
    Prevalence of Facial Pain and Headache in Sweden2021Ingår i: The Journal of Oral & Facial Pain and Headache, ISSN 2333-0384 , E-ISSN 2333-0376 , Vol. 35, nr 2, s. 139-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To compare the prevalence of facial pain and headache across various regions in Sweden. Methods: This study involved a comparison of cross-sectional questionnaire studies over a period of 10 years including 128,193 individuals and assessed facial pain, pain on function, and headache. Participants included (1) all Public Dental Service patients aged 16 to 90 years in Vasterbotten (n = 57,283) and Gavleborg (n = 60,900); and (2) random samples of residents in Kalmar (n = 3,560) and Skane (n = 6,450). Facial pain and pain on function were assessed for all participants, and headache was also assessed for participants in Kalmar and Skane. Descriptive statistics were used to estimate unadjusted prevalence estimates and demographic characteristics. Prevalence estimates were adjusted for age and sex using weighted distributions from the 2015 data in the Swedish population registry before comparisons across the regions. Results: Overall, the prevalence of facial pain and headache were significantly higher in female than in male participants (P<.01). The standardized prevalence of facial pain was 4.9% in Vasterbotten, 1.4% in Gavleborg, 4.6% in Kalmar, and 7.6% in Skane. For headache, the standardized prevalence was 18.9% in Kalmar and 21.3% in Skane. In Skane, individuals with facial pain had a 15-fold higher odds of headache than those without. Conclusion: In the present Swedish epidemiologic study, the prevalence of facial pain ranged from 1.4% in Gavleborg to 7.6% in Skane. Besides different sampling frames and other population characteristics, the presence of a high number of immigrants in Skane may account for some differences in pain prevalence across the Swedish regions.

  • 39.
    Shmarina, Elena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Reg Kalmar Cty, Publ Dent Serv, Oskarshamn, Sweden..
    Ericson, Dan
    Malmö universitet, Odontologiska fakulteten (OD).
    Åkerman, Sigvard
    Malmö universitet, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Exploring salutogenic factors supporting oral health in the elderly2022Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, nr 4, s. 241-251Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim To explore associations between salutogenic factors and selected clinical outcome variables of oral health in the elderly, combining Antonovsky's salutogenic theory and the Lalonde Health Field concept. Methods The subjects comprised 146 individuals, aged 60 years and older, who had participated in a population-based epidemiological study in Sweden, 2011-2012, using questionnaire and oral examination data. A cross-sectional analysis used the selected outcome variables, such as number of remaining teeth, DMFT-index and risk assessment, and salutogenic factors from the questionnaire, clustered into domains and health fields, as artifactual-material, cognitive-emotional and valuative-attitudinal. This selection was based on findings from our previous analysis using a framework cross-tabulating two health models. The purpose was to facilitate analysis of associations not previously addressed in the literature on oral health. Bivariate and Multiple Linear Regression analyses were used. Results Numerous salutogenic factors were identified. Significant associations between outcome variables and salutogenic factors previously unreported could be added. Regression analysis identified three contributing independent factors for 'low DMFT'. Conclusions This study supports the usefulness of a salutogenic approach for analysing oral health outcomes, identifying university education, the importance of dental health organization recall system and close social network, as important salutogenic factors. The large number of salutogenic factors found supporting oral health among the elderly indicates the complexity of salutogenesis and the need for robust analysing tools. Combining two current health models was considered useful for exploring these covariations. These findings have implications for future investigations, identifying important research questions to be explored in qualitative analyses.

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  • 40.
    Shmarina, Elena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Public Dental Service, Kalmar County Council, Oskarshamn, Sweden.
    Ericson, Dan
    Malmö universitet, Odontologiska fakulteten (OD).
    Åkerman, Sigvard
    Malmö universitet, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde2021Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, nr 3, s. 218-231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde. Material and methods This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated. Results The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m(2)' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors. Conclusions The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

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  • 41.
    Ståhlnacke, Katri
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Unell, Lennart
    Halling, Arne
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Changes over 5 years in utilization of dental care by a Swedish age cohort2005Ingår i: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 33, nr 1, s. 64-73Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to investigate the temporal development of the utilization of dental care, in relation to socio-economic factors and also considering perceived oral health, attitudes to dental care, dental anxiety, care organisation and changes in the way that dental care is paid for. A conflict model was used as a theoretical framework. METHODS: In 1992, a mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergotland, as part of a cross-sectional study. This study group numbered 8888 persons. In 1997, the same population was sent a new questionnaire. There were 5363 persons who completed the questionnaire in both 1992 and 1997. Changes in utilization of dental care were analysed. RESULTS: An increase in personal expenditure for care was obvious, 42% paid more in 1997 compared with 1992. In the study, 7% had prolonged their time since most recent visit and 12% had less frequent visits. In regression models, education, occupation, place of residence, country of birth, marital status, gender, dental anxiety, having poor perceived oral health and poor general health were associated with utilization. Care organisation factors showed there was a greater probability of having higher utilization and higher cost of care when private practitioners provided the care. CONCLUSION: Small changes in the utilization of dental care occurred during this study time. Inequality in utilization existed and socio-economic factors affected utilization as well as health perception and dental anxiety. Changes in the cost of care did not affect utilization appreciably, probably because of a selected population with high price elasticity. Having a private care provider compared with one in the public system affected the probability of having higher utilization and higher cost for care.

  • 42.
    Ståhlnacke, Katri
    et al.
    Örebro County Council, Örebro, Sweden.
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Unell, Lennart
    Örebro County Council, Örebro, Sweden.
    Halling, Arne
    Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Patient satisfaction with dental care in one Swedish age cohort: Part 1 - descriptions and dimensions2007Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 31, nr 2, s. 103-111Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study were to investigate the dimensionality of satisfaction with dental care, to control the reproducibility of the analysis over time, to investigate changes between the two studied years and to relate satisfaction with elapsed time since the most recent visit to dental care. All persons born in 1942 in two counties in Sweden, Orebro and Ostergötland, were surveyed by post in 1992 at the age of 50 and resurveyed at the age of 55. There were 5363 persons responding at both times, constituting the study group. In this study, opinions are analysed about general satisfaction with dental care and about the most recent dental visit. Factor analysis, one-way ANOVA and contingency tables were used. Overall satisfaction was high both as to general satisfaction and as to the most recent dental care visit. Those with their most recent dental visit more than a year ago felt more pain, anxiety and unpleasantness and were also more generally dissatisfied. Of those having experiences of pain, anxiety and unpleasantness at most recent visit, there was an overrepresentation of non regular attenders. Factor analysis showed that the questions used revealed a stable pattern. In conclusion, the overall satisfaction with dental care was high. Differences between the two studied years were small. Persons not visiting dental care within the last year were more dissatisfied both generally and with the most recent visit. A greater number of regular attenders had no feelings of anxiety, pain or unpleasantness at all.

  • 43.
    Ståhlnacke, Katri
    et al.
    Örebro County Council, Sweden.
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Unell, Lennart
    Örebro County Council, Sweden.
    Halling, Arne
    Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Patient satisfaction with dental care in one Swedish age cohort: Part II - What affects satisfaction2007Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 31, nr 3, s. 137-146Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to investigate satisfaction with dental care in relation to dental care factors, recent dental care experiences, past dental care experiences, general health factors, oral health factors and socio-economic factors and all over time. All persons born in 1942 in two counties in Sweden, Örebro and Östergötland, were surveyed by post in 1992 at the age of 50, and resurveyed at the age 55. There were 5363 persons responding at both times, constituting the study group. A conceptual theoretical model was constructed to be used as a framework in the analysis. Multiple regression analysis and contingency tables were used. Factors related to satisfaction with dental care were: care organisation, cost for care, visit to dental specialist, time spent in waiting room, regular attendance, reception at dental clinic, feelings of anxiety, taking part of school dentistry, smoking, oral health factors, dental appearance and being dissatisfied 5 years previously. Change between the two study years was affected by perceived oral health, experiences from the most recent dental visit and care organisation. Oral health related factors and dental care factors like cost for care and care organisation were related to satisfaction with dental care. Likewise were experiences from the most recent dental visit and to some extent past care experiences like school dentistry. Almost no correlation was seen between socio-economic factors and satisfaction.

  • 44.
    Ståhlnacke, Katri
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Söderfeldt, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Unell, Lennart
    Malmö högskola, Odontologiska fakulteten (OD).
    Halling, Arne
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Perceived oral health: changes over 5 years in one Swedish age-cohort2003Ingår i: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 31, nr 4, s. 292-299Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Objectives: The purpose of this study was to investigate if a change in the social gradients in perceived oral health occurred over a 5-year period, 1992-97, using a cohort population from two Swedish counties. Methods: In 1992, a cross-sectional mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Örebro and Östergotland, and altogether there were 8888 persons. In 1997, the same population was sent a new questionnaire. The cohort, comprising the same respondents from 1992 and 1997, was of 5363 persons. An index of perceived oral health was constructed out of three questionnaire variables: satisfaction with teeth, chewing ability and the number of remaining teeth. This index value was set as a dependent variable in a regression model. Reports of toothache were investigated in a separate logistic regression model. Results: There were obvious social gradients in the perceived oral health index both in 1992 and in 1997. Marital status, foreign birth, education and occupation were all substantially related to the perceived oral health. The change in perceived oral health was analyzed. Almost half of the cohort (47.4%) showed no change at all. Those with increased and those with decreased health were rather evenly distributed on both sides, with 22.0% with better health in 1997 and 30.6% with worse health. Gender and education were related to toothache experience. Conclusion: Changes have been moderate in the perceived oral health in this cohort, despite the rather drastic changes in the remuneration of dental care during this study time. On the other hand, this also means that the social differences remain, despite the official goals of increased equity.

  • 45.
    Östergård, Gun-Britt
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Englander, Magnus
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Axtelius, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    A salutogenic patient-centred perspective of improved oral health behaviour: a descriptive phenomenological interview study2016Ingår i: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 14, nr 2, s. 142-150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A salutogenic perspective was applied in the study when investigating the patient's perspective of what it means to move in the direction towards health in the treatment of periodontitis. Objectives The study aimed at describing the lived experience of improved oral health-related behaviour. Method The descriptive phenomenological method was chosen for collection and analysis of data. Patients were selected from a private general dental clinic. Results The results described the patient-centred perspective in the general structure held together by eight constituents: (i) change is increased successively, (ii) a changed view on self-care at the start of change, (iii) improved self-care includes understanding and automatic routine, (iv) motivating challenges and feedback are perceived as strengthening, (v) having good thoughts and being satisfied with one's own capacity, (vi) experiencing trust and participation along with an expert, (vii) negative experiences and limitations precedes the change and (viii) relating yourself to past time, present time, future and other people. Conclusion The complex pattern of interconnected external and internal components in the results calls for the need of a holistic perspective of the change process and for the clinician to practise flexibility.

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