Karin Wikblad

Type 2 diabetes and oral health: A comparison between diabetic and non-diabetic subjects

A controlled cross-sectional study with the aim of studying oral health in patients with type 2 diabetes was carried out in a health care district in Sweden. The study included 102 randomly sampled diabetic patients and 102 age- and gender-matched non-diabetic subjects from the same geographical area, treated at the same Public Dental Service clinics. Oral conditions were measured at clinical and X-ray examinations. Diabetes-related variables were extracted from medical records. Diabetic patients suffered from xerostomia (dry mouth) to a significantly higher degree than non-diabetic controls did (53.5 vs. 28.4%; P=0.0003). Sites with advanced periodontitis were more frequent in the diabetic group (P=0.006) as were initial caries lesions (P=0.02). Diabetic subjects showed a greater need of periodontal treatment (P=0.05), caries prevention (P=0.002) and prosthetic corrections (P=0.004). Diabetes duration or metabolic control of the disease was not related to periodontal status. However, patients with longer duration of diabetes had more manifest caries lesions (P=0.05) as had those on insulin treatment when compared with patients on oral/diet or combined treatment (P=0.0001). The conclusion is that individuals with type 2 diabetes in some oral conditions exhibited poorer health. Close collaboration between the patient, the primary health care and oral health professionals could be a way of improving the diabetic patients general and oral health.

Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes mellitus

To investigate important factors with respect to health-related quality of life (HRQOL) in patients with longstanding insulin dependent diabetes mellitus, a patient cohort was followed prospectively for 10 years. The degree of metabolic control and the presence of late complications was assessed and HRQOL was measured with a 61-item questionnaire (SWEDQUAL) in which reference values have been obtained in a population sample. The results indicate that diabetic patients (n=108) experienced a quality of life as good as a general population. When patients were divided into four groups based on metabolic control, those with poor control (HbA1c≥9%) rated their physical and emotional functioning significantly lower than those with lower HbA1c values. Nearly 15% of the patients reported 1–5 hypoglycaemic episodes during the latest 6 months. Despite a lower HbA1c they rated their general health as being poorer than patients without severe hypoglycaemia. Of the 108 patients 39% appeared to be free from late complications of diabetes. These patients rated their general health as better than patients who already had developed late complications. We conclude that a satisfactory metabolic control with a minimum of hypoglycaemic episodes is desirable not only to prevent late complications but also because poor metabolic control seems to be one reason why diabetic patients experience a poorer quality of life.

Acute confusional states in patients undergoing hip surgery : a prospective observation study

Background: There is general agreement that acute confusional state (ACS) is common among elderly patients admitted to hospital, although exact figures are difficult to obtain. The objective of the current study was to investigate the onset of ACS during hospital stay and to isolate possible predisposing, facilitating and precipitating factors associated with the onset of ACS. Methods: Non-confused patients, ≥65 years of age, undergoing orthopedic hip surgery, were consecutively included in the study (n = 225). Of these, 149 patients were operated on because of acute hip fracture and 76 underwent elective hip-replacement surgery. ACS was diagnosed by the DSM-IV criteria for delirium. Structured observations of ACS onset were performed every 2nd to every 4th hour during the patients’ entire hospital stay. A protocol was used to document the observations on sleep, activities, well being and behavior. The Mini-Mental State Examination was used to measure cognitive functioning. Results: Of 225 patients 20% were diagnosed with ACS. The incidence of ACS was 24.3% in the group of hip-fractured patients and 11.7% in the hip-replacement surgery patients. The onset of ACS was postoperative (mean 24 ± 21 h after surgery) in all but 8 patients. The duration of ACS among recovered patients was generally less than 48 h (mean 42 ± 43 h). Predisposing factors were older age, cognitive impairment and pre-existing cerebrovascular or other brain diseases. Facilitating factors related to ACS were associated with communication and social isolation, e.g. impaired hearing and sight, reticence and passivity. One precipitating factor, besides surgery, may be the use of psychopharmacological drugs. Conclusion: The incidence of ACS was 20% among hip surgery patients. Older age and social isolation were factors associated with ACS. Increased attention and interaction with older patients could be of value in avoiding ACS during hospitalization.

Patient perspectives of diabetes care and education

Educating and supporting patients in managing their daily life with diabetes mellitus are important goals of diabetes care today These goals demand not only good medical knowledge but also good communication skills in the members of the diabetes care team and in the patients Continuity and accessibility are naturally factors influencing the communication between the patients and the care team This study, based on 55 interviews with well-experienced insulin dependent diabetic patients, shows further that the contacts between the diabetes care system and the patient are often only superficial and in practice mainly related to the patients metabolic control Patients with good or acceptable metabolic control expenence positive feed-back from the care team, while those with unsatisfactory or unacceptable metabolic control do not receive positive response and support to the same degree The patients want to be permitted to be responsible for themselves and need support from the care team in order to accomplish this From the patients perspective, the diabetes education consists of an overwhelming amount of new information which often is presented on only one occasion The patients want the education to be on an acceptable but minimum level and to be a continuous process that is applicable in practice

Self-perceived health in Swedish parents of children with Down's syndrome

In this comparative study, self-perceived health was investigated in 165 parents of 86 children with Downs syndrome (DS), using the Swedish version of the SF-36 questionnaire. Questionnaires were mailed to parents of children with DS in a defined Swedish population. The results were compared with those in a randomised control group of parents from the Swedish SF-36 norm population. Mothers and fathers replied separately. Students t-test with the Bonferroni correction was used for multiple statistical comparisons. The mothers of children with DS (‘DS mothers’) had significantly lower, less favourable scores than did the fathers of DS children (‘DS fathers’) in the Vitality (p < 0.0005) domain. Further, DS mothers spent significantly more time in caring for their child with DS than did the DS fathers (p < 0.0001). DS mothers also had lower scores than the mothers of the control group in the Vitality (p < 0.001) and Mental Health (p < 0.001) domains. DS fathers and control fathers differed significantly in the Mental Health domain (p < 0.002), but not otherwise. In conclusion, DS mothers showed poorer health than their spouses and the control mothers. No differences similar to those found between the DS mothers and DS fathers were observed between control mothers and control fathers.

A controlled study of oral self-care and self-perceived oral health in type 2 diabetic patients.

A controlled study was carried out in mid-Sweden with the aim of comparing oral self-care and selfperceived oral health in 102 randomly sampled type 2 diabetic patients with that of 102 age-and-gendermatched non-diabetic controls. Oral health variables were also related to glycemic control (HbA1c), duration, anti-diabetic treatment, and late complications. Questionnaires were used to collect data on oral self-care and self-perceived oral health. Diabetes-related variables were extracted from medical records. Eighty-five percent of the diabetic subjects had never received information about the relation between diabetes and oral health, and 83% were unaware of the link. Forty-eight percent believed that the dentist/ dental hygienist did not know of their having diabetes. Most individuals, but fewer in the diabetic group, were regular visitors to dental care and the majority felt unaffected when confronted with dental services. More than 90% in both groups brushed their teeth daily and more than half of those with natural teeth did proximal cleaning. Subjects in the diabetic group as well as in the control group were content with their teeth and mouth (83% vs 85%). Those with solely natural teeth and those with complete removable dentures expressed most satisfaction. Sensation of dry mouth was common among diabetic patients (54%) and subjects with hypertension exhibited dry mouth to a greater extent (65%) than those who were normotensive. Our principal conclusion is that efforts should be made to give information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff.

Self-perceived physical, psychologic, and general symptoms in survivors of testicular cancer 3 to 13 years after treatment.

Due to the large group of patients with advanced testicular cancer now being cured, it is important to identify the men who are at risk of deteriorated health. The purposes of this study were: (1) to delineate and compare frequency of self-perceived physical, psychologic, and general symptoms in men treated for testicular cancer with those of a general population sample and (2) to compare self-perceived physical, psychologic, and general symptoms in relation to secondary Raynaud phenomena, sexual dysfunction, infertility, and self-perceived attractiveness in different treatment modalities. The subjects were 277 survivors of testicular cancer (M = 42.2 years) who had completed a self-reported questionnaire (75.5% response rate). A population survey comprising 392 men was used as a comparison group (M = 45 years). The result demonstrated that although survivors of testicular cancer as a group reported significantly less frequency of backache, leg pain, cough, and eye problems than did the general population sample, they described that they significantly more often felt cold. Men reporting secondary Raynaud phenomena, infertility, and/or feeling less attractive had experienced significantly more self-perceived symptoms. Oncologist nurses could play an important role in psychologic counseling for those men.

Health-Related Quality of Life in Survivors of Testicular Cancer 3 to 13 Years After Treatment

Abstract In a retrospective study of 277 survivors of testicular cancer aged 18 to 83, the authors investigated health-related quality of life. A packet including a questionnaire about health-related quality of life, specific questions concerning testicular cancer, and a symptom checklist was sent to 367 men with nonseminomatous and seminomatous tumors who had completed treatment 3 to 13 years before the study; 277 of the men (75.5%) completed the questionnaires. The results were compared with an age-matched group of 122 men in the general population. Overall, the health-related quality of life experienced by the survivors was as good as, or even better than, that of the men in the general population. Men treated with chemotherapy, either as a single therapy or in combination with other treatments, scored less favorably regarding quality of life. Perceived attractiveness, being fertile, having children, and living with a partner were the most important aspects of good health-related quality of life.

Oral health and health-related quality of life in type 2 diabetic patients and non-diabetic controls

The aim of the present study was to identify factors in oral health and also diabetes-related and socio-economic components that could be associated with the subjects health-related quality of life (HRQL). One-hundred-and-two randomly sampled type 2 diabetic and 102 age-matched and gender-matched non-diabetic subjects from the same residential area were studied cross-sectionally using the SF-36 questionnaire. Although the HRQL profiles were similar in nature, the control subjects indicated a more favorable health status in their HRQL scores than did type 2 diabetic subjects. Certain oral health factors contributed to deterioration of the patients HRQL. Multiple regression analyses including both groups were used to determine variables explaining variance in the different HRQL domains. Dissatisfaction with teeth and mouth, feeling of dry mouth and poor financial status contributed to about one-fourth of the explanation of the variance in all health domains. Having diabetes played an important role in the domains Physical Functioning, Role functioning--Physical, General Health, and Social Functioning. Age was important for Physical Functioning and Role functioning--Physical. Our study indicates that different factors may be associated with impaired HRQL, especially among type 2 diabetic subjects, although only a partial understanding of its relation to oral health could be demonstrated.

Side effects after surgical treatment of snoring.

In a questionnaire study detailed side effects after snoring surgery were examined in 415 individuals 2–8 years after surgery. Three years later a new questionnaire was answered by those with side effects affecting taste, smell and voice (n = 74). At the first follow-up 255 had side effects of globus, regurgitation, taste, smell and voice. The globus was the most common (40%). In all spheres except the globus, a significant improvement was seen 3 years later. However, pharyngeal dryness and phlegm had a reported frequency of nearly 60%. No significant differences were seen between the uvulopalatopharyngoplasty and laser uvulopalatoplasty methods. Taste disturbances might be due to surgical damage to the nerves or oral dryness. The olfactory impairment present in 7 patients still needs to be explained.