Björn Axtelius

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

Background  Different specific and generic instruments are used to evaluate quality of life in dermatology, but their interrelationship is not well known.

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

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

Multivariate analyses of patient financial systems and oral health-related quality of life

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.

Moral values and career: Factors shaping the image of healthy work for female dentists

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.

Network participation for unpromoted female dentists in relation to psychosocial support.

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 of this group in organized network activity (support groups) in a region (Scania) in Sweden, 2) the sense of support compared with another organization and with 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 Scania received a questionnaire and 94% responded. Those participating in network activity ≥4 times a year constituted 12% of respondents. Cooperation between colleagues was lower than in the nationwide sample. Support from the PDHS was experienced as weak. It was not possible to explain why female unpromoted GP dentists participated ≥4 times a year, while those who felt lonely in their work were to a higher degree participants in a network. Almost 9 out of 10 reported being strengthened by the network both as a person and in a professional role. The female dentist was three times more likely to participate in a network if she had a male head of clinic. The main findings are a paucity of inter‐colleague contact and a lack of association between support and network participation. The many affirmative comments indicated that network participation might be a good coping strategy for unpromoted female GP dentists.

Expectations and satisfaction with care for periodontal specialist patients

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.

Dentistry as a free market in the context of leading policymaking

ABSTRACT 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.

Dental politics and subsidy systems for adults in Sweden from 1974 until 2016

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 populations dental health, political doctrines, ‘zeitgeist‚, dental policy, to state finances.

A salutogenic patient-centred perspective of improved oral health behaviour – a descriptive phenomenological interview study

UNLABELLED A salutogenic perspective was applied in the study when investigating the patients 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 ones 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.