Adolescents' self-reported experiences following a person-centred, theory-based educational intervention versus conventional education for improved oral hygiene: Analysis of secondary outcomes of a randomized field study.

AIM: To analyse adolescents' self-reported experiences and behavioural outcomes of a person-centred, theory-based intervention in comparison with conventional information/instruction for improved oral hygiene. MATERIALS AND METHODS: Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Västra Götaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person-centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three-hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed. RESULTS: The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p < .01). CONCLUSIONS: The person-centred, theory-based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self-reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction.

Impact of Medical and Surgical Obesity Treatment on Dental Caries: A 2-Year Prospective Cohort Study.

The objective was to study the long-term effects on oral health of bariatric surgery compared with medical treatment of obesity. Swedish females with morbid obesity (n = 66; 18-35 years at baseline) were followed prospectively from before obesity treatment until 2 years after treatment. The main response variable was dental caries registered according to the ICDAS-II system. Possible confounding factors, such as sociodemographic characteristics, general health, oral health habits, and oral hygiene, were controlled for. The statistical methods included χ2 tests, Student's t tests, one-way ANOVA, Wilcoxon's nonparametric tests, and linear regression models. In the surgically treated patients (n = 40), a significant increase over time in enamel caries (mean increase 4.13 tooth surfaces ICDAS1-2), dentine caries (mean increase 2.18 tooth surfaces ICDAS3-6), and total caries (mean increase 6.30 tooth surfaces ICDAS1-6) was registered (all p < 0.001), which was not seen in the medically treated patients (n = 26). However, the difference between the treatment groups (surgical or medical) was only statistically significant for enamel caries (crude ß 4.89, p = 0.003) and total caries (crude ß 6.53, p < 0.001). The relationships were stable and independent of differences in confounders as socioeconomy, general health, and oral health behaviors. In conclusion, 2 years after obesity treatment, a significant increase in dental caries was registered in the surgically treated but not in the medically treated women. The dental service should intensify its preventive efforts in individuals undergoing obesity treatment.

Hypertension treatment in the oldest-old: focus group interviews with Swedish general practitioners.

OBJECTIVE: This study explored the considerations and experiences of Swedish General Practitioners (GPs) of hypertension treatment in patients 80 years and above. DESIGN: Qualitative design with focus group interviews. Data were analysed by qualitative content analysis. SETTING: Primary health care centres (PHCCs), both rural and urban, in the Region of Västra Götaland, Sweden. SUBJECTS: GPs and GP trainees working at PHCCs in 2019 and 2020. Five focus group interviews with 24 physicians were performed. MAIN OUTCOME MEASURES: Considerations and experiences of hypertension treatment in the oldest-old. RESULTS: Eighteen GPs and six GP trainees participated in the study. The latent content was formulated in a theme: 'The physician's decision-making in the treatment of hypertension in the oldest-old implies the inclusion of both medical and humanistic considerations.' The manifest content constituted three main categories: 'The patient characteristics' included medical condition, behavioural factors and daily life. 'The physician's role' described the GP as a professional and her/his experienced support. 'The treatment decision' considered these categories and involved risk-benefit balancing and communication. For the future, the participants proposed better guidelines for the oldest-old multimorbid patients, increased teamwork, continuous cooperation with nurses and better cooperation with hospital physicians. CONCLUSION: Hypertension care for the oldest-old was experienced as complicated by GPs, due to the need of balancing medical and humanistic considerations. The GP's clinical experience and the received support were of importance when making the treatment decision based on risk-benefit balancing and communication with the patient.Key pointsGPs experienced the task of caring for the oldest-old patients with hypertension as complicated.Patient factors like multimorbidity, polypharmacy, behavioural factors and the patient's condition of daily life were identified.Clinical experience and the experienced support at the PHCC were discussed as important for the GPs' treatment decision.Treatment decisions for the oldest-old patients with hypertension were based on risk-benefit balancing and communication with the patients.

Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study.

OBJECTIVES: Adequate oral hygiene, that is self-performed infection control, is crucial to prevent periodontal disease. Epidemiological studies reveal poor oral hygiene conditions among Swedish adolescents and indicate a need for more effective prevention programs. The aim of the current study was to analyse adolescents' experiences of a person-centred, theory-based, oral health education program for improved oral hygiene. METHODS: Data were obtained by interviewing 19 adolescents treated by dental hygienists in accord with the person-centred education program in a preceding clinical field study (ClinicalTrials.gov NCT02906098). Study participants were selected to reflect a variation of male and female adolescents, treated at clinics in areas with various socio-demographic profiles within Region Västra Götaland, Sweden. Interviews were audio-taped, transcribed verbatim and analysed with qualitative content analysis. RESULTS: A main theme was identified: 'Adolescents on a guided and challenging journey towards beneficial oral hygiene behavior'. The results elucidate the importance of a person-centred approach in therapy. The adolescents described insight on a personal level about the importance of improved oral hygiene as fundamental for behavioural change. Planning and monitoring of the behaviour, with guidance and support by the dental hygienist, was considered to facilitate change and encouraged further behavioural efforts. However, the adolescents expressed a need of reminders and support to keep up oral hygiene routines over time. CONCLUSIONS: The study brings knowledge on factors of importance in educational interventions to increase beneficial health behaviours among adolescents and emphasize areas for further improvements of such interventions.

Oral health by obesity classification in young obese women - a cross-sectional study.

OBJECTIVE: To explore oral health by increasing degree of obesity and the influence of modifying factors. MATERIALS AND METHODS: A cross-sectional design was used. Swedish females (n = 118; 18-35 years) with morbid obesity were recruited from the BAriatric SUbstitution and Nutrition study (BASUN). Body mass index (BMI) was used as continuous and categorized into 35-39.9 kg/m2/40-44.9 kg/m2/≥45 kg/m2. Oral examinations assessed dental caries using the ICDAS system, periodontal status and saliva characteristics. Information on sociodemographics, oral health behaviour and symptoms was collected via a questionnaire. RESULTS: Mean BMI was 42.2 kg/m3 (SD 4.0; range 35.0-63.7). Significantly higher frequencies of dentine caries (p = .001) and total caries (p = .046) were found with higher BMI with an increase in total caries by 0.59 tooth surface (p = .025) for each increasing BMI degree. There were consistent associations between obesity and dentine caries for the group with the highest BMI (≥45), adjusted RR 2.08 (95% CI 1.20-3.61), and all stages of caries, adjusted RR 1.41 (95% CI 1.02-1.96). High scores were found for dental plaque (50.2%) and gingivitis (34.5%). CONCLUSION: Young obese women exhibited poor oral health with higher caries levels by higher BMI. Dental care should adapt the prevention efforts for obese individuals. Trial Registration: The trial was prospectively registered on March 03; 2015; NCT03152617.

Oral health profile of postbariatric surgery individuals: A case series.

OBJECTIVES: To describe the oral health profile of individuals who had undergone gastric bypass surgery (GBP) or sleeve gastrectomy (SG) to generate hypotheses for further studies. MATERIAL AND METHODS: Fourteen individuals treated with GBP or SG surgery ≥ 2 years ago and with observed and/or perceived oral problems were recruited to a case series. The documentation included clinical and radiographic examinations, biomedical sampling, and self-reported diet and questionnaires. The results are presented descriptively. RESULTS: The age range was 31 to 66 years and all had a BMI > 25 (range 25.4-44.7). Only four participants were fully dentate. Eleven out of 14 individuals exhibited severe decay. A majority had poor oral hygiene and high bacterial counts. The flow rates of unstimulated saliva were extremely low and hyposalivation was present in ten of the fourteen cases. Most perceived several oral health problems, such as chewing difficulty and tooth hypersensitivity. CONCLUSIONS: Individuals who had undergone GBP or SG surgery had poor clinically diagnosed oral health and perceived oral health problems. Longitudinal studies are needed to monitor the patients' oral health, from before bariatric surgery to long-term postoperatively.

Primary care physicians' concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden.

Objective: This study explored the views of primary health care (PHC) physicians on sickness certification after reforms in 2005 prompted by the Swedish government to increase the quality and decrease the inequalities, and costs of sickness certification.Design: Qualitative design with focus group interviews. Data were analysed using qualitative content analysis.Setting: Urban and rural PHC centres in Region Västra Götaland, Sweden.Subjects: GPs, interns, GP trainees and locums working in PHC centres 2015. Six focus group interviews with 28 physicians were performed.Main outcome measures: Experiences and reflections about the sickness certification system.Results: The latent content was formulated in a theme: 'The physicians perceived the sickness certification process as emotive and a challenge to master with differing demands and expectations from authorities, management and patients'. Sickness certification could be easy in clear-cut situations or difficult when other factors besides the pure medical were ruling the decisions. The physicians' coping strategies for the task included both active measures (cooperation with health care staff and social insurance officers) and passive adaptation (giving in or not caring too much) to the circumstances. Proposals for the future were to transfer lengthy sickness certifications and rehabilitation to specialized teams and increase cooperation with rehabilitation coordinators and social insurance officers.Conclusions: Political decisions on laws and regulations for sickness certification impacted the primary health care making the physicians' work difficult and burdensome. Their views and suggestions should be carefully considered in future organization of primary care. KEY POINTSIn 2005 Swedish government introduced reforms to decrease the inequalities and costs of sickness certification and facilitate the physicians' work. Focus group interviews with Swedish primary care physicians revealed that sickness certification was challenging due to differing demands from authorities, management and patients.Coping strategies for the sick-listing task included both active measures and passive adaptation to the circumstances.A proposal for future better working conditions for physicians was to transfer lengthy sickness certifications and rehabilitation to specialized teams.

A longitudinal study of the impact of change in socioeconomic status on dental caries in the permanent dentition of Swedish children and adolescents.

OBJECTIVES: The overall aim was to analyse longitudinally the development of dental caries in the permanent dentition of children and adolescents in a Swedish region, in relation to possible change in socioeconomic status (SES). METHODS: A total of 259 448 individuals in western Sweden were followed over a 3-year period, through dental journal records at baseline (3-19-year-olds) and 1-3 dental check-ups during the follow-up period. Official socioeconomic register information (ethnicity, wealth, parental education and employment) was available at both baseline and follow-up. Data were used both as independent single variables and combined in an index. Gender, age and caries status at baseline and the examination years were included as covariates in the regression models. RESULTS: Associations over time were found between SES and dental caries in young people. A persistently low SES was associated with the greatest risk of both new and accumulated (decayed plus filled teeth/approximal surfaces) caries; however, any change in SES, whether improved or worsened, led to a greater risk. An increased risk of new caries events was identified for those who were older at baseline and by examination year. On average, the increase per year in decayed and/or filled teeth and in approximal surfaces was 0.23 and 0.12, respectively. CONCLUSION: SES was shown to be an important risk factor for dental caries over time in young Swedish people. Prevention programmes should pay particular attention to the needs of socioeconomically vulnerable individuals and groups.

Oral Health-Related Quality of Life After Gastric Bypass Surgery.

OBJECTIVE: The aim was to examine how individuals treated for obesity with gastric bypass (GBP) surgery perceived their oral health and oral health-related quality of life (OHRQoL). METHOD: All individuals in one Swedish region who had undergone GBP surgery (n = 1182) were sent a postal questionnaire 2 years after surgery. The questionnaire comprised items on sociodemographics, oral symptoms and the Oral Health Impact Profile-49 to assess the OHRQoL. RESULTS: The mean age was 47.6 years with 75% females, response rate 55.3%. The self-perceived oral health was rated low by 45% of the respondents. Gender differences were seen, for instance, regarding hypersensitive teeth (men 18.8%, women 30.8%, p = 0.003). Nine out of ten reported at least one oral impact experienced sometimes, fairly or very often, according to the Oral Health Impact Profile-49 (OHIP-49). The mean additive OHIP-49 score was 30.3 (SD 36.1). The associations between self-reported oral health and OHRQoL were consistent throughout. Tooth hypersensitivity generated an OR of 2.28 (95% CI 2.28-8.46) of having ≥ 2 impacts on OHRQoL. CONCLUSION: A large proportion of individuals having undergone GBP surgery reported problems with their oral health and impacts on their OHRQoL, indicating a need for medical and dental staff-surgeons and general practitioners as well as other health professionals-to offer oral health promotion and prevention measures.

Multilevel Analysis of Dental Caries in Swedish Children and Adolescents in Relation to Socioeconomic Status.

The objective was to investigate the variability in dental caries experience in Swedish children and adolescents, at two different area levels: dental clinics and SAMS (small areas for market statistics), with respect to multiple individual socioeconomic factors (SES). Records of manifest caries using the DMFT indices (decayed, missing, filled teeth, dependent variables) were collected from electronic dental records for 300,988 individuals aged 3-19 years (97.3% coverage) from the Region Västra Götaland, Sweden. SES data were obtained from official registers and covered ethnicity, wealth, parental education, and employment. The SES variables were used as an independent aggregated variable - an in dex - categorized in deciles. Age and gender were independently included in the multilevel models. Two-level logistic regression analyses explored the probability of a dental caries experience and the variability (intracluster correlation) within dental clinic areas and SAMS, respectively. The most deprived (10th decile, SAMS level) 3- to 6-year-old children had an OR of 5.00 (95% CI 4.61-5.43) for dental caries experience (deft), compared with children in the 1st to 5th deciles. For older children and adolescents (≥7 years), the corresponding OR (DFT) was 2.25 (95% CI 2.15-2.35). Small geographical areas explained more of the variance in caries experience compared with the more aggregated level dental clinics. SES was more strongly related to the risk of dental caries experience than age and gender. In conclusion, the associations between SES and dental caries experience in Swedish children and adolescents were strong in the study and strongest in young children at a low level.

Socio-economic and demographic determinants affecting participation in the Swedish cervical screening program: A population-based case-control study.

BACKGROUND: Cervical screening programs are highly protective for cervical cancer, but only for women attending screening procedure. OBJECTIVE: Identify socio-economic and demographic determinants for non-attendance in cervical screening. METHODS: Design: Population-based case-control study. Setting: Sweden. Population: Source population was all women eligible for screening. Based on complete screening records, two groups of women aged 30-60 were compared. The case group, non-attending women, (N = 314,302) had no smear registered for 6-8 years. The control group (N = 266,706) attended within 90 days of invitation. Main outcome measures: Risk of non-attendance by 9 groups of socioeconomic and demographic variables. Analysis: Unadjusted odds ratios (OR) and OR after adjustment for all variables in logistic regression models were calculated. RESULTS: Women with low disposable family income (adjOR 2.06; 95% confidence interval (CI) 2.01-2.11), with low education (adjOR 1.77; CI 1.73-1.81) and not cohabiting (adjOR 1.47; CI 1.45-1.50) were more likely to not attend cervical screening. Other important factors for non-attendance were being outside the labour force and receiving welfare benefits. Swedish counties are responsible for running screening programs; adjusted OR for non-participation in counties ranged from OR 4.21 (CI 4.06-4.35) to OR 0.54 (CI 0.52-0.57), compared to the reference county. Being born outside Sweden was a risk factor for non-attendance in the unadjusted analysis but this disappeared in certain large groups after adjustment for socioeconomic factors. CONCLUSION: County of residence and socio-economic factors were strongly associated with lower attendance in cervical screening, while being born in another country was of less importance. This indicates considerable potential for improvement of cervical screening attendance in several areas if best practice of routines is adopted.

Multiple Socioeconomic Factors and Dental Caries in Swedish Children and Adolescents.

The study aimed to explore associations between multiple socioeconomic factors and dental caries experience in Swedish children and adolescents (3-19 years old). Electronic dental records from 300,988, in a Swedish region (97.3% coverage) were collected using the DMFT indices (decayed, missing, filled teeth: dependent variables). Socioeconomic status (SES) data (ethnicity, wealth, parental education, and employment) for individuals, parents, and families were obtained from official registers. Principal component analysis was used to explore SES data. Scores based on the first factor were used as an independent aggregated socioeconomic variable in logistic regression analyses. Dental caries experience was low in the participants: 16% in 3- to 6-year-olds (deft index: decayed, extracted, filled teeth) and 47% in 7- to 19-year-olds (DFT index). Both separate and aggregated socioeconomic variables were consistently associated with the dental caries experience irrespective of the caries index used: the crude odds ratio (OR) for having at least 1 caries lesion in 3- to 6-year-olds (deft index) in the lowest SES quintile was 3.26 (95% confidence interval [CI] 3.09-3.43) and in ≥7-year-olds (DFT index) OR 1.80 (95% CI 1.75-1.84) compared with children in the 4 higher SES quintiles. Overall, associations were stronger in the primary dentition than in the permanent dentition. Large SES models contributed more to explaining the caries experience than slim models including fewer SES indicators. In conclusion, socioeconomic factors were consistently associated with dental caries experience in the children and adolescents both as single factors and as multiple factors combined in an index. Socioeconomic inequalities had stronger associations to caries experience in young children than in older children and adolescents.

Experiences from the Merger of Clinics in the Swedish Public Dental Service - the Employee Perspective.

OBJECTIVES: The purpose of this study was to investigate the experiences of employees regarding the merger of clinics within the Public Dental Service (PDS), Västra Götaland Region, Sweden. METHODS: Employees (dentists, dental hygienists, dental nurses) affected by both administrative and geographical mergers of dental clinics answered a web-based survey about experiences and effects of the merger process (n = 99, 47%). The Swedish short-form version of "The Nordic Questionnaire for Psychological and Social Factors at Work" (QPSNordic), the QPSNordic-34+ was used. Chi-squared tests and logistic regression analyses were used. RESULTS: Two thirds of the participants were aged ≥ 50 years. The respondents stated that the reasons for the merger were often made clear (78%). Satisfaction with and involvement in the merger process received lower scores (45%). Work was often perceived as stressful, irrespective of the merger. Job demands and engagement scored positively, but control at work was given a low score (one fifth stated fairly high or high control). Dentists (OR 5.9; 95%, CI 1.1-32.3), but not dental hygienists (OR 2.8; 95%, CI 0.9-9.0), indicated stress significantly more often than dental nurses (reference) (adjusted for age and gender). CONCLUSION: Employees in the Public Dental Service (PDS) in a Swedish region had mainly positive experiences after the merger of clinics; however, their involvement in the process was low. Work demands were perceived as high. These findings should be considered when planning mergers in dental organizations.

The influence of social deprivation on dental caries in Swedish children and adolescents, as measured by an index for primary health care: The Care Need Index.

OBJECTIVES: The objective was to examine associations between a primary Care Need Index (CNI) and dental caries experience. METHODS: Dental journal records for 300 988 individuals in western Sweden, aged 3-19 years in 2007-09, were completed with official socioeconomic information. The CNI (independent variable), originally developed for assessing primary care need, was calculated for residential areas (small areas, parishes, dental clinics) based on markers of material deprivation, sociodemographic characteristics, social instability and cultural needs. Dental caries (dependent variable) was registered using the decayed, missing, filled teeth (DMFT) system. Multilevel Poisson regression and logistic regression models were used. All analyses were adjusted for age and gender. RESULTS: In the most deprived areas, the incidence rate ratio (IRR) for dental caries was up to five times higher than in the most affluent areas (reference); in small areas, the IRR for decayed teeth (DT) was 3.74 (95% CI: 3.39-4.12) and 5.11 (CI: 4.45-5.87) for decayed surfaces approximally (DSa). Caries indices including fillings (decayed filled teeth [DFT], decayed filled surfaces approximally [DFSa]) produced lower IRRs, with similar pictures at the parish and dental clinic level. The intracluster correlation was low overall, but stronger at lower geographical levels. The odds ratios for ≥3 caries lesions in the two most deprived areas of the CNI deciles were high, with a DT OR of 3.55 in small areas (95% CI: 3.39-3.73), compared with the eight more affluent deciles. CONCLUSIONS: There were strong associations between an index for assessing need in primary care, the CNI and dental caries in Swedish children and adolescents.

Caries increment in young children in Skaraborg, Sweden: associations with parental sociodemography, health habits, and attitudes.

AIM: To explore parental sociodemography, oral health habits, and attitudes in relation to dental caries increment in their children. DESIGN: A longitudinal questionnaire and clinical study. The children were followed annually from age 3 years (n = 271) to 6 years (n = 243). Carious lesions of different depth were registered (initial and manifest) by four calibrated dentists. The parents filled out a questionnaire. Statistics included factor analyses, Cronbach's alpha together with bivariate and multivariate logistic regression analyses. RESULTS: Most of the parents exhibited positive health behaviour and attitudes. 'Late start of toothbrushing of child' was, however, common (≥1 year; 29%) and 'external locus of control' showed a high mean value (10,1; possible range 3-15). In a multivariate model, 'parent born abroad' (OR 3.26, 95% CI 1.85-5.76) and 'parental indulgence' (OR 3.20, 95% CI 1.37-7.51) were the most important for the development of carious lesions in the children. CONCLUSIONS: This study identified 'parent born abroad' and 'parental indulgence' as significant risk factors for caries in the age period 3 to 6 years. Identifying parents with the greatest need should be emphasized, in order to target promotion and prevention activities.

Health investment behaviours and oral/gingival health condition, a cross-sectional study among Swedish 19-year olds.

OBJECTIVES: To test the hypothesis that certain individual, environmental and lifestyle factors are positively associated with beneficial health investment behaviours and oral/periodontal health among adolescents. METHODS: Five hundred and six randomly selected 19-year old subjects living in two different areas (Fyrbodal and Skaraborg) in the county council of Västra Götaland, Sweden participated in a clinical examination and answered questionnaires covering psycho-social and health behavioural issues. Two oral-health models were estimated with gingivitis score as an objective and self-perceived oral health as a subjective indicator. Three health- investment behaviour models were designed with indicators directly related to oral health and two with indicators related to general health as well. The explanatory variables included gender, upper secondary education programme, native country, living area, general self-efficacy and parents' education level. RESULTS: In the objective oral-health model, theoretical studies and living in the Skaraborg area were both positively associated with a lower gingivitis score. For the subjective oral-health indicator, none of the explanatory variables showed statistical significance. In the investment-behaviour model with 'tooth-brushing ≥ 2 times daily' as a health indicator, female gender and theoretical studies showed statistically significant associations. With the indicators 'no/few missed dental appointments', 'no tobacco use' and 'weekly exercise', theoretical studies were statistically significant and positively associated. In the investment model with 'perceived oral health care attention' as an indicator, a high score of general self-efficacy was significantly associated with the feeling of taking good care of the teeth. CONCLUSIONS: Individual, environmental and lifestyle factors are associated with young individuals' oral health investment behaviours and gingival health conditions.

Demographic factors and dental health of Swedish children and adolescents.

OBJECTIVE: To investigate the dental health of Swedish children and adolescents with reference to age, gender and residence. MATERIAL AND METHODS: Electronic dental records from 300,988 3-19-year-olds in one Swedish region were derived in a cross-sectional study in years 2007-2009. The DMFT system was used. Age was categorized into 3-6/7-9/10-12/13-15/16-17/18-19-year-olds and residence into 'metropolitan', 'urban' and 'rural' areas. ANOVA, generalized linear regression models and Fisher's exact test were used. RESULTS: Among 7-9-year-old children, nine out of 10 were free from fillings and manifest caries, while for 18-19-year-olds; this proportion was one third. Girls (18-19-year-olds) had a significantly lower risk of caries compared to boys of the same age, RR for the DT index = 0.83 (95% CI = 0.81-0.85). This pattern was reversed in 7-12-year-old children. Children and adolescents in metropolitan and urban areas had significantly more caries than subjects in rural areas, for instance the RR for the DT index in metropolitan 7-9-year-olds was 2.26 (95% CI = 2.11-2.42) compared to their rural counterparts. CONCLUSIONS: In the permanent dentition, the overall pattern revealed that girls ≤ 12 years had a higher risk of caries, while adolescent girls had a lower risk of caries, both compared with boys of corresponding ages. Living in an urban or metropolitan area entailed a higher risk of caries than living in a rural area. A greater occurrence of dental caries in adolescents than in children was confirmed. The findings should have implications for planning and evaluation of oral health promotion and disease prevention activities.

Oral health-related quality of life in Swedish young adults.

The living conditions of young adults in Sweden have changed during the last decades due to the economic and employment situation in society. Although oral health is mainly considered to be good in this age group, their use of dental care has decreased and their priorities and opportunities regarding oral health are little known. The purpose of this study was to describe the views of Swedish young adults on their oral health and oral health-related quality of life (OHRQoL). The design of the study was qualitative, using content analysis. Sixteen young adults, aged 21-29 years, were interviewed. The findings from the interviews were summarized under the theme "Young adults reflected on their OHRQoL in a time perspective" consisting of three categories: "Past experiences, Present situation, and Future prospects." The OHRQoL of young adults is dependent not only on their own experiences of oral health during childhood and their received dental care but also on their present self-perceived oral health, oral health habits, and social life; together with their expectations of future oral health. The findings in this study indicate that the oral health awareness and needs of young adults, as well as their expectations of oral care, merit further follow-up.

Facing suspected child abuse--what keeps Swedish general practitioners from reporting to child protective services?

OBJECTIVE: The aim of this study was to examine the reporting of suspected child abuse among Swedish general practitioners (GPs), and to investigate factors influencing them in their decision whether or not to report to child protective services (CPS). DESIGN: A cross-sectional questionnaire study. SETTING: Primary health care centres in western Sweden. SUBJECTS: 177 GPs and GP trainees. MAIN OUTCOME MEASURES: Demographic and educational background, education on child abuse, attitudes to reporting and CPS, previous experience of reporting suspected child abuse, and need of support. RESULTS: Despite mandatory reporting, 20% of all physicians had at some point suspected but not reported child abuse. Main reasons for non-reporting were uncertainty about the suspicion and use of alternative strategies; for instance, referral to other health care providers or follow-up of the family by the treating physician. Only 30% of all physicians trusted CPS's methods of investigating and acting in cases of suspected child abuse, and 44% of all physicians would have wanted access to expert consultation. There were no differences in the failure to report suspected child abuse that could be attributed to GP characteristics. However, GPs educated abroad reported less frequently to CPS than GPs educated in Sweden. CONCLUSIONS: This study showed that GPs see a need for support from experts and that the communication and cooperation between GPs and CPS needs to be improved. The low frequency of reporting indicates a need for continued education of GPs and for updated guidelines including practical advice on how to manage child abuse.

A new dental insurance scheme--effects on the treatment provided and costs.

The aim of this study was to investigate whether the revenues cover the costs in a pilot capitation plan, a dental insurance scheme, and to compare this capitation plan (CP) with the original fee-for-service system (FFS), in terms of the amount and type of dental care provided. Data was collected longitudinally over a period of three years from 1,650 CP patients in five risk groups at a test clinic, and from 1,609 (from the test clinic) and 3,434 (from a matched control clinic) FFS patients, in Göteborg, Sweden. The care investigated was the number of total treatments provided and the number of examinations by dentists and dental hygienists, together with preventive, restorative and emergency treatments. The economic outcome was positive from the administrator's perspective, in all risk groups for the three-year period. The amount and type of care provided differed between the payment models, as CP patients received more preventive treatments, less restorative treatments, and more examinations by dental hygienists than the FFS patients. Emergency treatment was performed more often on CP patients, and the difference was due to a higher frequency of such treatments among women in the CP group. The difference between clinics concerning certain treatment measures was sometimes greater than the difference between payment models. The results from this study indicate a net positive economic outcome for the pilot CP system over three years. The payment model and the clinic affiliation had impact on what type and amount of dental care the patients received. This might suggest that the risk of skewed selection and its consequences as well as the influence of clinic-specific practice need further investigation, to ensure economic sustainability in a longer perspective.