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  • 1.
    Gustafsson, Annika
    et al.
    Publ Dent Hlth Serv, Postgrad Dent Educ Ctr, Dept Pedodont, Örebro, Sweden.
    Arnrup, K.
    Publ Dent Hlth Serv, Postgrad Dent Educ Ctr, Dept Pedodont, Örebro, Sweden.
    Broberg, A. G.
    Dept Psychol, Univ Gothenburg, Gothenburg, Sweden.
    Bodin, Lennart
    Örebro University, Swedish Business School at Örebro University. Örebro University Hospital, Örebro, Sweden.
    Berggren, U.
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Unit Dent Behav Sci, Gothenburg, Sweden.
    Child dental fear as measured with the Dental Subscale of the Children's Fear Survey Schedule: the impact of referral status and type of informant (child versus parent)2010In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 38, no 3, p. 256-266Article in journal (Refereed)
    Abstract [en]

    Objectives: The first aim of this methodological study was to investigate the agreement between self-ratings of Children's Fear Survey Schedule (CFSS-DS). The second aim was to explore using differentiated cut-off scores, and to compare these cut-off scores with those commonly used. Methods: Three different data collections included study groups (n = 497) of children and adolescents who had been referred to specialized pediatric dentistry clinics, and reference groups (n = 499) of dental patients and children rating the analyses were limited to the Ostergotland sample (n = 210 + 228). Patients and their accompanying parents (mainly mothers) were asked to fill in the CFSS-DS independently. Cut-off scores on the CFSS-DS scale were determined using receiver-operating characteristic analysis; patient-parent agreement was illustrated with Bland-Altman plots. Results: The patient-parent agreement was modest, particularly among those who were referred because of dental behaviour management problems (DBMP). Cut-off scores differentiated by age and gender, suggested by exploration according to two different methods, were with few exceptions clearly below the standard cut-off score. Conlusion: The validity of parental ratings of their children dental fear should be questioned, particularly in high-fear populations. Self-ratings should, as far as possible, be used to complement parental ratings. One consequence of using the standard cut-off score is the risk of overlooking some patients needs for special attention. Further research is needed to establish and validate age-and gender-differentiated cut-off scores on the CFSS-DS.

  • 2.
    Gülcan, Ferda
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Linkoping Univ, Ostergotland Cty Council, Dent Commissioning Unit, Linkoping, Sweden..
    Lie, Stein Atle
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Åstrøm, Anne Nordrehaug
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Social predictors of less frequent dental attendance over time among older people: population-averaged and person-specific estimates2016In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 44, no 3, p. 263-273Article in journal (Refereed)
    Abstract [en]

    Objectives: Longitudinal studies considering social disparities in the utilization of dental services are scarce. Repeated measures should be accounted for by the use of appropriate statistical methods. The purpose of this study was first to describe the patterns of less frequent dental attendance (less than once a year) over time from the age of 65-70 in Norwegian and Swedish 1942 cohorts. Second, this study estimated the influence of predisposing, enabling and need-related social predictors using marginal model with robust variance estimators and random intercept model, RIM, to account for the clustered structure of the repeated observations. Third, the study aimed to compare the estimates of associations between social predictors and less frequent dental attendance derived from marginal and random intercept models.

    Methods: In 2007 and 2012, all residents born in 1942 in selected counties of Norway and Sweden were invited to participate in a questionnaire survey. In Norway, the response rate was 58.0% (n = 4211) in 2007 and 54.5% (n = 3733) in 2012 with a follow-up rate of 70%. The corresponding figures in Sweden were 73.1% (n = 6078) and 72.2% (n = 5697), with a follow-up rate of 80%. Marginal and random intercept models were fitted for population-averaged and person-specific estimates. Design effects were calculated by comparing the results from ordinary logistic regression analyses and the marginal model with robust variance estimators. The proportion of the total variation due to differences between persons was reported using the intraclass correlation coefficient (ICC).

    Results: Less frequent dental attendance declined from 14.5% to 12.2% in Norway and from 13.6% to 12.9% in Sweden. According to marginal and random intercept models, time-invariant (gender, country of birth, education) and time-variant social predictors (working status, social network, marital status, smoking and perceived health) contributed to less frequent dental attendance. A likelihood ratio test confirmed that adjustment for clustered observations was appropriate. The ICC was 0.90 in Norway and 0.85 in Sweden.

    Conclusions: The prevalence of less frequent dental attendance was low and dropped by increasing age from 65 to 70 years. Both at population and at person-specific levels, being advantaged on social aspects protects against less frequent dental attendance after 65 years of age in the Norwegian and Swedish cohorts investigated.

  • 3.
    Åstrøm, Anne Nordrehaug
    et al.
    Institute of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Institute of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway; Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Factor structure of a conceptual model of oral health tested among 65-year olds in Norway and Sweden2010In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 38, no 2, p. 110-119Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: No studies have tested oral health-related quality of life models in dentate older adults across different populations.

    OBJECTIVES: To test the factor structure of oral health outcomes within Gilbert's conceptual model among 65-year olds in Sweden and Norway. It was hypothesized that responses to 14 observed indicators could be explained by three correlated factors, symptom status, functional limitations and oral disadvantages, that each observed oral health indicator would associate more strongly with the factor it is supposed to measure than with competing factors and that the proposed 3-factor structure would possess satisfactory cross-national stability with 65-year olds in Norway and Sweden.

    METHODS: In 2007, 6078 Swedish- and 4062 Norwegian adults borne in 1942 completed mailed questionnaires including oral symptoms, functional limitations and the eight item Oral Impacts on Daily Performances inventory.

    RESULTS: Model generation analysis was restricted to the Norwegian study group and the model achieved was tested without modifications in Swedish 65-year olds. A modified 3-factor solution with cross-loadings, improved the fit to the data compared with a 2-factor- and the initially proposed 3-factor model among the Norwegian [comparative fit index (CFI) = 0.97] and Swedish (CFI = 0.98) participants. All factor loadings for the modified 3-factor model were in the expected direction and were statistically significant at CR > 1. Multiple group confirmatory factor analyses, with Norwegian and Swedish data simultaneously revealed acceptable fit for the unconstrained model (CFI = 0.97), whereas unconstrained and constrained models were statistically significant different in nested model comparison.

    CONCLUSIONS: Within construct validity of Gilbert's model was supported with Norwegian and Swedish 65-year olds, indicating that the 14-item questionnaire reflected three constructs; symptom status, functional limitation and oral disadvantage. Measurement invariance was confirmed at the level of factor structure, suggesting that the 3-factor model is comparable to some extent across 65-year olds in Norway and Sweden.

  • 4.
    Åstrøm, Anne Nordrehaug
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Östergötland, Sweden.
    Nasir, Elwalid
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Long-term routine dental attendance: influence on tooth loss and oral health-related quality of life in Swedish older adults2014In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 42, no 5, p. 460-469Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Few studies have investigated the effect of long-term routine dental attendance on oral health between middle-aged and older adults, using a prospective cohort design. This study aimed to assess routine dental attendance (attending dentist in the previous 12 months for dental checkups) from age 50 to 65 years. Moreover, this study examined whether long-term routine dental attendance contributes to oral health-related quality of life, OHRQoL, and major tooth loss independent of social factors and the type of treatment sector utilized. Whether oral health impacts of long-term routine attendance varied with type of treatment sector utilized was also investigated.

    METHOD: In 1992, a census of the 1942 cohort in two counties of Sweden participated in a longitudinal questionnaire survey conducted at age 50 and again after 5, 10, and 15 years. Information was collected on a wide range of health- and oral health-related aspects. Of the 6346 subjects who completed the 1992 survey, 4143 (65%) completed postal follow-ups in 1997, 2002, and 2007.

    RESULTS: Routine dental attendance decreased from 69.1% at age 50-64.2% at age 65. Adjusted logistic regression analyses revealed that individuals reporting long-term routine attendance (routine attendance in both 1992 and 2007) were 0.3 (95% CI 0.2-0.5) times less likely than their counterparts who were nonroutine attenders to report oral impacts. According to generalized estimating equations (GEE), individuals who reported long-term routine attendance were 0.6 (95% CI 0.4-0.7) times less likely than nonroutine attenders to have major tooth loss across the survey years. The effect of long-term routine attendance on OHRQoL was stronger in public than in private dental healthcare attenders.

    CONCLUSION: Routine attendance decreased from age 50-65 years. Long-term routine attendance had positive impact on major tooth loss and OHRQoL supporting the principle of encouraging annual dental attendance for preventive checkups among older people.

  • 5.
    Åstrøm, Anne Nordrehaug
    et al.
    Faculty of Medicine and Dentistry, Institute of Clinical Odontology-Community Dentistry, University of Bergen, Bergen, NorwayFaculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit Östergötland County Council, Linköping, Sweden.
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Socio-behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort2011In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 39, no 4, p. 300-310Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Using a prospective cohort design, this study assessed loss of natural teeth between ages 50 and 65. Guided by a conceptual framework grouping variables according to the life-course stage at which they would be expected to operate, this study assessed the impacts of socio-behavioral and disease-related factors on tooth loss between ages 50 and 65.

    METHODS: In 1992, all 50-year-olds in two counties of Sweden were invited to participate in a longitudinal questionnaire survey. Of the total population of 8,888 subjects, 6,346 responded (71.4%). Of the 6346 subjects who completed the 1992 questionnaire, 4,143 (65%) completed postal follow-ups at ages 55, 60 and 65.

    RESULTS: For the total sample, the prevalence of having lost at least some teeth increased from 76% at age 50-85.5% at age 65. A total of 14% women and 13% men changed from having all teeth in 1992 to having tooth loss in 2007. Stepwise logistic regression analyses focused on predictors of tooth loss between 1992 and 2007. The following life-stage predictors achieved or approached statistical significance with respect to overall tooth loss; country of birth and education (early life and young adult life stage), marital status, dental care avoidance because of high cost, smoking and reporting consistent pain (middle-age and early-old-age life stage).

    CONCLUSION: Fewer substantial proportions of the 1942 cohort experienced tooth loss between ages 50 and 65. Tooth loss was highly prevalent from age 50 and increased moderately with increasing age. Oral disease-related factors and socio-behavioral characteristics such as refraining from dental care because of financial limitations, acting at earlier and later life-course stages were major risk factors for having tooth loss. Early primary prevention of smoking and increased equitable access to dental care might improve tooth retention throughout the transition from middle age to early-older age.

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