The primary aim was to compare the effectiveness of smoking cessation interventions of different ... more The primary aim was to compare the effectiveness of smoking cessation interventions of different intensities in a clinical dental and a telephone setting in Sweden. Methods: A total of 300 smokers were randomized to High or Low Intensity Treatment (HIT or LIT) at the Public Dental Service, County Council of Västmanland. Effectiveness (abstinence rate) was measured after 1yr (paper I) and 5-8yrs (paper III). A cost-effectiveness analysis was conducted, based on intervention costs, number of abstinent participants after 1yr, and a Markov modelling of future costs and health (in QALYs) consequences (paper II). In paper IV, 586 callers to the Swedish National Tobacco Quitline (SNTQ) were randomized to highintensity proactive or low-intensity reactive service, and effectiveness was measured after 1 yr. Effectiveness measures were self-reported point prevalence, 6-month continuous abstinence, and sustained abstinence. Results: Absolute quit rates were 7% higher with HIT than with LIT on all measures and increased by 8% from 1yr to 5-8yrs. Point prevalence was 23% vs. 16% (p=.11) after 1yr and 31% vs. 24% (p=.16) after 5-8yrs. Six-month continuous abstinence was 18% vs. 9% (p =.02) after 1yr and 26% vs.19% (p=.18) after 5-8yrs. Sustained abstinence was 12% vs. 5% (p =.03) after 5-8yrs. Nicotine dependence was a strong predictor for abstinence at 1yr and achieved abstinence at 1yr was a strong predictor for abstinence at long-term follow-up. The cost-effectiveness analysis showed that both HIT and LIT were cost-effective, and LIT was even cost-saving compared with doing nothing. HIT was more costly and more effective than LIT, and the cost of each extra QALY gained by HIT was 100,000SEK, which is considered very cost-effective in Sweden. Proactice and reactive services were equally effective at the SNTQ. Point prevalence was 27% and 6-month continuous abstinence was 21% after 1yr. Being smokefree at baseline was the strongest predictor for abstinence at 1yr. Conclusion: Support at high as well as low intensity in a clinical dental setting in Sweden and at the SNTQ was effective in achieving smoking cessation. Both high-and low-intensity interventions were very cost-effective in a clinical dental setting.
Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disor... more Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) and acceptance or nonacceptance of such disorders in adult patients attending all public dental health services in the County of S€ ormland, Sweden, during a 3-year period, 2011-2013. Methods: Two questions were asked about TMD and the voluntary mouth-opening capacity was measured. The results were registered in a score 0-3. The registration was completed with a question about each patient's acceptance or nonacceptance of their condition. Results: More than 73,000 registrations of the TMD condition were performed in general dental clinics from 2011 to 2013. The mean prevalence of a TMD score of 1-3 was 5% and was consistent over these years. Seventy percent of these patients were women. The peak prevalence of TMD was registered in patients aged 30-45 years (38%), and the frequency declined in older age groups. Reduced voluntary mouth-opening capacity (35 mm) was found in less than 2% of the participants. About one-fifth of the patients with a TMD-score of 1-3 did not accept their condition and wanted professional care. The frequency of nonacceptance of the condition increased with the severity of symptom score: 15%, 27%, and 49% for scores 1, 2, and 3, respectively. Conclusions: This study shows that the prevalence of self-reported TMD in adult patients was consistent from 2011 to 2013 and should be considered as a public health issue in Sweden. Patients with more severe TMD pain symptoms wanted care more frequent. The annual clinical calibrations should be continued to achieve an acceptable level of registration.
The purpose of the study was to evaluate bed-partners' and patients' self-reports of general well... more The purpose of the study was to evaluate bed-partners' and patients' self-reports of general well-being, physical strength and mental energy after treatment for obstructive sleep apnoea (OSA) with a mandibular advancement oral appliance (OA). Patients (N = 134) referred from medical physicians diagnosed with true OSA, i.e. an apnoea-hypopnoea index of > 10, were treated with an OA for more than one year. The somnographic evaluations were undertaken in a patient's home before the start of, and six months after, treatment. An individually designed monobloc OA was manufactured by a dental technician for nightly use. After one year of treatment, a follow-up questionnaire was sent to patients whose sleep disorder was reduced > 50% from baseline values and to their bed partners. The questionnaire consisted of 15 questions or statements with multi-answer alternatives concerning well-being, physical strength, mental energy, sleep, day and night symptoms, and the Epworth Sleepiness Scale (ESS: eight questions). The questionnaire was answered by 82% (110/134) of the patients and 85 bed partners. Both patients and bed partners reported improvement in general well-being, physical strength and mental energy, between 70-80% for patients and 55-68% for bed partners sharing the same bed-room. Similar results were found for concentration ability, joyfulness and strength of effort in social intercourse, as well as decreased daytime sleepiness, improvement in the feeling of getting enough sleep and reduced nocturia. Conclusions: In all dimensions, the treatment effect had a great influence, not only on patients but on bed partners as well.
The aims of the present study were to explore the level of knowledge and attitudes among dentists... more The aims of the present study were to explore the level of knowledge and attitudes among dentists in relation to patients with eating disorders (ED) and evaluate the extent to which patients with ED are identified and/or treated in the dental setting. A postal questionnaire was constructed and sent to all dentists (n = 367) in two Swedish counties during November 2005. The questionnaire comprised 29 questions or statements in the following categories: demographics, general knowledge of ED and its oral consequences, experience of and attitudes towards patients with ED and interaction within the health care system, for example, referrals and treatment options regarding this patient group. The response rate was 70% (n = 258). Perceived knowledge about ED was most commonly obtained from media sources, namely newspapers, television, etc. Few dentists knew that there existed specialized referral units for ED patients in their county. The majority of dentists stated that they had seen only a few such patients during their practice. Even though the perceived level of general knowledge about ED among female dentists appeared to be better than among male dentists, they also found it more difficult to inform the patient/relatives about their suspicion of the condition. Female dentists referred to specialists significantly more frequently than did males. Eighty-six percent of responders reported that they needed more training in dental management of patients with ED. Knowledge and clinical experience of dentists as regards patients with ED were found to be low. The level of education in this area needs to be improved, which would have the potential to encourage dentists to become more involved in secondary and tertiary prevention and management of ED.
Background: Tobacco is still the number one life style risk factor for ill health and premature d... more Background: Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting. Methods: 300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (≥ 183 days) at the 12-month follow-up. Results: Follow-up questionnaires were returned from 86% of the participants. People in the HITarm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LITarm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support. Conclusion: Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.
Scandinavian Journal of Public Health, Aug 12, 2017
Aims: Parental separations have become more frequent in recent decades. In Western countries, abo... more Aims: Parental separations have become more frequent in recent decades. In Western countries, about 25% of children experience parental separation. There is a need to explore the risk factors for separation to give children an optimal childhood. The objective of the present study was to examine parental stress and depressive symptoms during early parenthood and their association with parental separation. Methods: Four hundred and seven couples completed questionnaires on depressive symptoms for 3 months and parental stress for 18 months after childbirth. Total parental stress and five subareas were investigated. To study the separation rate, parents' addresses were recorded 9 to 11 years after childbirth. Results: Twenty-nine percent of the parents were separated 9 to 11 years after childbirth. Separation was associated with depressive symptoms at 3 months (mothers p = .002, fathers p = .025) and total parental stress at 18 months after childbirth (mothers p = .010, fathers p = .005). The sub-areas of parental stress, Spouse relationship problems (mothers p = <.001, fathers p = .001) and fathers' Social isolation (p = .005), were associated with separation. In multivariable regression analyses of the parents' separation rate 9 to 11 years after childbirth, the only significant predictor was mothers' Spouse relationship problems (p < .001). Conclusions: The knowledge that parental stress and depressive symptoms are risk factors for separation may simplify professional support for parents in early parenting. Courses for new and expectant parents can use this knowledge to increase parents' awareness.
Background: The purpose of this study was to investigate knowledge, attitudes and clinical experi... more Background: The purpose of this study was to investigate knowledge, attitudes and clinical experience with regard to patients with eating disorders (ED) among Norwegian dentists. Methods: In 2010, a questionnaire was sent to all dentists in Norway (N = 4282) comprising 33 questions related to demographics of the participating dentists, their knowledge of ED (general and oral health aspects), clinical experience, attitudes and perceived management preferences. Results: The participation rate was 40 % (47 % women and 53 % men). Their knowledge about ED was often retrieved from common media sources and the greater part of the participants reported they had seen very few patients with ED during their professional career. Female dentists reported superior knowledge about ED compared to males, but the former experienced greater difficulties to inform about the condition. Referrals of the patient to other health facilities were significantly more common among female compared to male dentists. The majority of dentists (76 %) reported a need of more education related to ED management. Conclusions: The Norwegian dentists in this study reported limited clinical experience and insufficient knowledge regarding ED. There is therefore a need to increase both undergraduate and continuing education in this field, which can improve preventive and management measures that a dentist can provide for ED patients.
et al. Cost-effectiveness of a high-intensity versus a lowintensity smoking cessation interventio... more et al. Cost-effectiveness of a high-intensity versus a lowintensity smoking cessation intervention in a dental setting: long-term follow-up. BMJ Open 2019;9:e030934.
Background: Telephone-based smoking cessation services ('quitlines') are both effective and cost-... more Background: Telephone-based smoking cessation services ('quitlines') are both effective and cost-effective. Knowledge of modifiable baseline factors in real-life settings with heterogeneous participants is essential for the development and improvement of treatment protocols to assist in telephone-based smoking cessation. The aim was to assess if self-perceived abilities to cope measured at baseline, would predict abstinence at the 12-month follow-up at the Swedish National Tobacco Quitline (SNTQ). Methods: The data were retrieved from a previous randomized controlled trial comparing the effectiveness of proactive and reactive service at the SNTQ. Included were 612 clients calling the SNTQ between February 2009 and September 2010. Outcome measures were self-reported point prevalence and 6-month continuous abstinence at the 12-month follow-up. Plausible predictors of smoking cessation were assessed at the first call and in a baseline questionnaire. Self-perceived abilities at baseline were measured by two questions: (1) How likely is it that you will be smoke-free in one year? and (2) How likely are you to be able to handle stress and depressive mood without smoking? The associations between potential predictors and outcome (smoke-free at 12-month follow-up) were assessed by logistic regression analysis. Results: Of the two potential predictors for abstinence at 12-month follow-up, only the perceived ability to handle stress and depressive mood without smoking remained significant in the adjusted analyses (Odds Ratio, OR 1.13, 95% CI 1.00-1.27 for point prevalence and OR 1.16, 95% CI 1.01-1.33 for 6-month continuous abstinence according to intention-to-treat). The overall strongest predictor in the adjusted analyses was smoking status in the week before baseline (OR 3.30, 95% CI 1.79-6.09 for point prevalence and OR 3.97, 95% CI 2.01-7.83 for 6-month continuous abstinence). Conclusions: The perceived ability to handle stress and depressive mood without smoking at baseline predicted the subjects' abstinence at the 12-month follow-up. An assessment of/adjustment for stress and depressive mood coping skills may be appropriate in future smoking cessation treatment and research. The treatment protocol can be tailored to individual differences and needs for optimal support. Trial registration: ClinicalTrials.gov: NCT02085616. Registered March 10, 2014, 'retrospectively registered'.
Aim To determine whether there is an association between depressive symptoms and parental stress ... more Aim To determine whether there is an association between depressive symptoms and parental stress among mothers and fathers during early parenthood in Sweden. Methods In this study, 401 mothers and 396 fathers (393 couples) were included; the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale were measured 3 months after childbirth, and the Swedish Parenthood Stress Questionnaire and the Sense of Coherence Scale after 18 months. Complete data for multivariable analysis were available for 264 mothers and 252 fathers. Results The mothers estimated greater total depressive symptoms and parental stress than the fathers did. Both the mothers and the fathers had the greatest level of stress in the sub-area 'Role restriction'. The mothers had the lowest level of stress in the sub-area 'Social isolation' and the fathers in the subarea 'Incompetence'. The mothers perceived greater levels of stress than the fathers did in all sub-areas except for 'Social isolation', where the fathers perceived higher stress. There was an association between the parents' depressive symptoms and parental stress. The parents' own depressive symptoms at 3 months and sense of coherence and the partners' parental stress at 18 months were positively associated with the parental stress at 18 months in univariable and multivariable analyses. Conclusions Understanding the relationship between depressive symptoms and parental stress is important for health professionals so they can offer parents adequate support in early parenthood to optimize the conditions for raising a child. This knowledge should also be communicated to the parents.
This study evaluated the use of bioactive glass, PerioGlas, after retrograde filling with Super E... more This study evaluated the use of bioactive glass, PerioGlas, after retrograde filling with Super EBA cement in the treatment of periapical bone destruction. Healing outcomes were followed up after endodontic surgery in 186 teeth. Outcomes were divided into two groups according to follow-up time: short- and long-term. The EBA group (n = 110) underwent endodontic surgery and retrograde filling with EBA cement. In the EBA + PerioGlas group (n = 76), PerioGlas was embedded in the bone cavity after retrograde filling. The success rate in the EBA + PerioGlas group was 72% compared with 56% in the Super EBA group at the short-term follow-up and 74% and 84%, respectively, at the long-term follow-up. Healing of periapical bone destruction classified as uncertain at the short-term follow-up was considered successful in two out of three cases at the long-term follow-up. This study found that PerioGlas as bone substitute did not significantly improve endodontic healing outcome.
Background: Achieving lifelong tobacco abstinence is an important public health goal. Most studie... more Background: Achieving lifelong tobacco abstinence is an important public health goal. Most studies use 1-year follow-ups, but little is known about how good these are as proxies for long-term and lifelong abstinence. Also, intervention intensity is an important issue for development of efficient and cost-effective cessation treatment protocols. The study aims were to assess the long-term effectiveness of a high-and a low-intensity treatment (HIT and LIT) for smoking cessation and to analyze to what extent 12-month abstinence predicted long-term abstinence. Methods: 300 smokers attending dental or general health care were randomly assigned to HIT or LIT at the public dental clinic. Main outcome measures were self-reported point prevalence, continuous abstinence (≥6 months), and sustained abstinence. The study was a follow-up after 5-8 years of a previously performed 12-month follow-up, both by postal questionnaires. Results: Response rate was 85% (n=241) of those still alive and living in Sweden. Abstinence rates were 8% higher in both programs at the long-term than at the 12-month follow-up. The difference of 7% between HIT and LIT had not change, being 31% vs. 24% for point prevalence and 26% vs. 19% for 6-month continuous abstinence, respectively. Significantly more participants in HIT (12%) than in LIT (5%) had been sustained abstinent (p=0.03). Logistic regression analyses showed that abstinence at 12-month follow-up was a strong predictor for abstinence at long-term follow-up. Conclusions: Abstinence at 12-month follow-up is a good predictor for long-term abstinence. The difference in outcome between HIT and LIT for smoking cessation remains at least 5-8 years after the intervention.
This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc... more This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Objective: The benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (O... more Objective: The benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that these types of appliances would be equally effective. Material and methods: In this multicentre, randomized equivalence trial, patients with OSA received one type of bibloc or one type of monobloc treatment. At baseline, a 1-night polygraphy study was done, and this was repeated after 1 year. The outcome was any change in the apnoea-hypopnoea index (AHI) and the limits of equivalence between the two devices were set at ±5 AHI units. Results: Of 302 patients, 146 were randomly assigned to bibloc and 156 to monobloc appliances. In 88 and 104 patients, respectively, there were significant reductions in the AHI (p < .001) with a mean change of À16.7 (95% CI À19.4 to À14.1) in the bibloc and À11.8 (À14.9 to À8.7) in the monobloc groups. The proportions of responders defined as having an AHI <10 were 68% and 65% for the bibloc and monobloc groups, respectively. Treatment-related adverse events were mild, transient and the dropouts were more frequent in the bibloc group. Conclusions: Both types of treatments positively and significantly reduced respiratory disturbances, but at the 1-year follow-up, they were not significantly different in treating OSA, with a numerically greater reduction of the AHI value with the bibloc appliance. However, the higher proportion of treatment-related adverse events and higher proportion of dropouts among bibloc users should be balanced against the advantage of a greater reduction in the AHI.
Aim To determine whether there is an association between depressive symptoms and parental stress ... more Aim To determine whether there is an association between depressive symptoms and parental stress among mothers and fathers during early parenthood in Sweden. Methods In this study, 401 mothers and 396 fathers (393 couples) were included; the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale were measured 3 months after childbirth, and the Swedish Parenthood Stress Questionnaire and the Sense of Coherence Scale after 18 months. Complete data for multivariable analysis were available for 264 mothers and 252 fathers. Results The mothers estimated greater total depressive symptoms and parental stress than the fathers did. Both the mothers and the fathers had the greatest level of stress in the sub-area 'Role restriction'. The mothers had the lowest level of stress in the sub-area 'Social isolation' and the fathers in the sub-area 'Incompetence'. The mothers perceived greater levels of stress than the fathers did in all sub-areas except for ...
The primary aim was to compare the effectiveness of smoking cessation interventions of different ... more The primary aim was to compare the effectiveness of smoking cessation interventions of different intensities in a clinical dental and a telephone setting in Sweden. Methods: A total of 300 smokers were randomized to High or Low Intensity Treatment (HIT or LIT) at the Public Dental Service, County Council of Västmanland. Effectiveness (abstinence rate) was measured after 1yr (paper I) and 5-8yrs (paper III). A cost-effectiveness analysis was conducted, based on intervention costs, number of abstinent participants after 1yr, and a Markov modelling of future costs and health (in QALYs) consequences (paper II). In paper IV, 586 callers to the Swedish National Tobacco Quitline (SNTQ) were randomized to highintensity proactive or low-intensity reactive service, and effectiveness was measured after 1 yr. Effectiveness measures were self-reported point prevalence, 6-month continuous abstinence, and sustained abstinence. Results: Absolute quit rates were 7% higher with HIT than with LIT on all measures and increased by 8% from 1yr to 5-8yrs. Point prevalence was 23% vs. 16% (p=.11) after 1yr and 31% vs. 24% (p=.16) after 5-8yrs. Six-month continuous abstinence was 18% vs. 9% (p =.02) after 1yr and 26% vs.19% (p=.18) after 5-8yrs. Sustained abstinence was 12% vs. 5% (p =.03) after 5-8yrs. Nicotine dependence was a strong predictor for abstinence at 1yr and achieved abstinence at 1yr was a strong predictor for abstinence at long-term follow-up. The cost-effectiveness analysis showed that both HIT and LIT were cost-effective, and LIT was even cost-saving compared with doing nothing. HIT was more costly and more effective than LIT, and the cost of each extra QALY gained by HIT was 100,000SEK, which is considered very cost-effective in Sweden. Proactice and reactive services were equally effective at the SNTQ. Point prevalence was 27% and 6-month continuous abstinence was 21% after 1yr. Being smokefree at baseline was the strongest predictor for abstinence at 1yr. Conclusion: Support at high as well as low intensity in a clinical dental setting in Sweden and at the SNTQ was effective in achieving smoking cessation. Both high-and low-intensity interventions were very cost-effective in a clinical dental setting.
Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disor... more Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) and acceptance or nonacceptance of such disorders in adult patients attending all public dental health services in the County of S€ ormland, Sweden, during a 3-year period, 2011-2013. Methods: Two questions were asked about TMD and the voluntary mouth-opening capacity was measured. The results were registered in a score 0-3. The registration was completed with a question about each patient's acceptance or nonacceptance of their condition. Results: More than 73,000 registrations of the TMD condition were performed in general dental clinics from 2011 to 2013. The mean prevalence of a TMD score of 1-3 was 5% and was consistent over these years. Seventy percent of these patients were women. The peak prevalence of TMD was registered in patients aged 30-45 years (38%), and the frequency declined in older age groups. Reduced voluntary mouth-opening capacity (35 mm) was found in less than 2% of the participants. About one-fifth of the patients with a TMD-score of 1-3 did not accept their condition and wanted professional care. The frequency of nonacceptance of the condition increased with the severity of symptom score: 15%, 27%, and 49% for scores 1, 2, and 3, respectively. Conclusions: This study shows that the prevalence of self-reported TMD in adult patients was consistent from 2011 to 2013 and should be considered as a public health issue in Sweden. Patients with more severe TMD pain symptoms wanted care more frequent. The annual clinical calibrations should be continued to achieve an acceptable level of registration.
The purpose of the study was to evaluate bed-partners' and patients' self-reports of general well... more The purpose of the study was to evaluate bed-partners' and patients' self-reports of general well-being, physical strength and mental energy after treatment for obstructive sleep apnoea (OSA) with a mandibular advancement oral appliance (OA). Patients (N = 134) referred from medical physicians diagnosed with true OSA, i.e. an apnoea-hypopnoea index of > 10, were treated with an OA for more than one year. The somnographic evaluations were undertaken in a patient's home before the start of, and six months after, treatment. An individually designed monobloc OA was manufactured by a dental technician for nightly use. After one year of treatment, a follow-up questionnaire was sent to patients whose sleep disorder was reduced > 50% from baseline values and to their bed partners. The questionnaire consisted of 15 questions or statements with multi-answer alternatives concerning well-being, physical strength, mental energy, sleep, day and night symptoms, and the Epworth Sleepiness Scale (ESS: eight questions). The questionnaire was answered by 82% (110/134) of the patients and 85 bed partners. Both patients and bed partners reported improvement in general well-being, physical strength and mental energy, between 70-80% for patients and 55-68% for bed partners sharing the same bed-room. Similar results were found for concentration ability, joyfulness and strength of effort in social intercourse, as well as decreased daytime sleepiness, improvement in the feeling of getting enough sleep and reduced nocturia. Conclusions: In all dimensions, the treatment effect had a great influence, not only on patients but on bed partners as well.
The aims of the present study were to explore the level of knowledge and attitudes among dentists... more The aims of the present study were to explore the level of knowledge and attitudes among dentists in relation to patients with eating disorders (ED) and evaluate the extent to which patients with ED are identified and/or treated in the dental setting. A postal questionnaire was constructed and sent to all dentists (n = 367) in two Swedish counties during November 2005. The questionnaire comprised 29 questions or statements in the following categories: demographics, general knowledge of ED and its oral consequences, experience of and attitudes towards patients with ED and interaction within the health care system, for example, referrals and treatment options regarding this patient group. The response rate was 70% (n = 258). Perceived knowledge about ED was most commonly obtained from media sources, namely newspapers, television, etc. Few dentists knew that there existed specialized referral units for ED patients in their county. The majority of dentists stated that they had seen only a few such patients during their practice. Even though the perceived level of general knowledge about ED among female dentists appeared to be better than among male dentists, they also found it more difficult to inform the patient/relatives about their suspicion of the condition. Female dentists referred to specialists significantly more frequently than did males. Eighty-six percent of responders reported that they needed more training in dental management of patients with ED. Knowledge and clinical experience of dentists as regards patients with ED were found to be low. The level of education in this area needs to be improved, which would have the potential to encourage dentists to become more involved in secondary and tertiary prevention and management of ED.
Background: Tobacco is still the number one life style risk factor for ill health and premature d... more Background: Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting. Methods: 300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (≥ 183 days) at the 12-month follow-up. Results: Follow-up questionnaires were returned from 86% of the participants. People in the HITarm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LITarm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support. Conclusion: Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.
Scandinavian Journal of Public Health, Aug 12, 2017
Aims: Parental separations have become more frequent in recent decades. In Western countries, abo... more Aims: Parental separations have become more frequent in recent decades. In Western countries, about 25% of children experience parental separation. There is a need to explore the risk factors for separation to give children an optimal childhood. The objective of the present study was to examine parental stress and depressive symptoms during early parenthood and their association with parental separation. Methods: Four hundred and seven couples completed questionnaires on depressive symptoms for 3 months and parental stress for 18 months after childbirth. Total parental stress and five subareas were investigated. To study the separation rate, parents' addresses were recorded 9 to 11 years after childbirth. Results: Twenty-nine percent of the parents were separated 9 to 11 years after childbirth. Separation was associated with depressive symptoms at 3 months (mothers p = .002, fathers p = .025) and total parental stress at 18 months after childbirth (mothers p = .010, fathers p = .005). The sub-areas of parental stress, Spouse relationship problems (mothers p = <.001, fathers p = .001) and fathers' Social isolation (p = .005), were associated with separation. In multivariable regression analyses of the parents' separation rate 9 to 11 years after childbirth, the only significant predictor was mothers' Spouse relationship problems (p < .001). Conclusions: The knowledge that parental stress and depressive symptoms are risk factors for separation may simplify professional support for parents in early parenting. Courses for new and expectant parents can use this knowledge to increase parents' awareness.
Background: The purpose of this study was to investigate knowledge, attitudes and clinical experi... more Background: The purpose of this study was to investigate knowledge, attitudes and clinical experience with regard to patients with eating disorders (ED) among Norwegian dentists. Methods: In 2010, a questionnaire was sent to all dentists in Norway (N = 4282) comprising 33 questions related to demographics of the participating dentists, their knowledge of ED (general and oral health aspects), clinical experience, attitudes and perceived management preferences. Results: The participation rate was 40 % (47 % women and 53 % men). Their knowledge about ED was often retrieved from common media sources and the greater part of the participants reported they had seen very few patients with ED during their professional career. Female dentists reported superior knowledge about ED compared to males, but the former experienced greater difficulties to inform about the condition. Referrals of the patient to other health facilities were significantly more common among female compared to male dentists. The majority of dentists (76 %) reported a need of more education related to ED management. Conclusions: The Norwegian dentists in this study reported limited clinical experience and insufficient knowledge regarding ED. There is therefore a need to increase both undergraduate and continuing education in this field, which can improve preventive and management measures that a dentist can provide for ED patients.
et al. Cost-effectiveness of a high-intensity versus a lowintensity smoking cessation interventio... more et al. Cost-effectiveness of a high-intensity versus a lowintensity smoking cessation intervention in a dental setting: long-term follow-up. BMJ Open 2019;9:e030934.
Background: Telephone-based smoking cessation services ('quitlines') are both effective and cost-... more Background: Telephone-based smoking cessation services ('quitlines') are both effective and cost-effective. Knowledge of modifiable baseline factors in real-life settings with heterogeneous participants is essential for the development and improvement of treatment protocols to assist in telephone-based smoking cessation. The aim was to assess if self-perceived abilities to cope measured at baseline, would predict abstinence at the 12-month follow-up at the Swedish National Tobacco Quitline (SNTQ). Methods: The data were retrieved from a previous randomized controlled trial comparing the effectiveness of proactive and reactive service at the SNTQ. Included were 612 clients calling the SNTQ between February 2009 and September 2010. Outcome measures were self-reported point prevalence and 6-month continuous abstinence at the 12-month follow-up. Plausible predictors of smoking cessation were assessed at the first call and in a baseline questionnaire. Self-perceived abilities at baseline were measured by two questions: (1) How likely is it that you will be smoke-free in one year? and (2) How likely are you to be able to handle stress and depressive mood without smoking? The associations between potential predictors and outcome (smoke-free at 12-month follow-up) were assessed by logistic regression analysis. Results: Of the two potential predictors for abstinence at 12-month follow-up, only the perceived ability to handle stress and depressive mood without smoking remained significant in the adjusted analyses (Odds Ratio, OR 1.13, 95% CI 1.00-1.27 for point prevalence and OR 1.16, 95% CI 1.01-1.33 for 6-month continuous abstinence according to intention-to-treat). The overall strongest predictor in the adjusted analyses was smoking status in the week before baseline (OR 3.30, 95% CI 1.79-6.09 for point prevalence and OR 3.97, 95% CI 2.01-7.83 for 6-month continuous abstinence). Conclusions: The perceived ability to handle stress and depressive mood without smoking at baseline predicted the subjects' abstinence at the 12-month follow-up. An assessment of/adjustment for stress and depressive mood coping skills may be appropriate in future smoking cessation treatment and research. The treatment protocol can be tailored to individual differences and needs for optimal support. Trial registration: ClinicalTrials.gov: NCT02085616. Registered March 10, 2014, 'retrospectively registered'.
Aim To determine whether there is an association between depressive symptoms and parental stress ... more Aim To determine whether there is an association between depressive symptoms and parental stress among mothers and fathers during early parenthood in Sweden. Methods In this study, 401 mothers and 396 fathers (393 couples) were included; the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale were measured 3 months after childbirth, and the Swedish Parenthood Stress Questionnaire and the Sense of Coherence Scale after 18 months. Complete data for multivariable analysis were available for 264 mothers and 252 fathers. Results The mothers estimated greater total depressive symptoms and parental stress than the fathers did. Both the mothers and the fathers had the greatest level of stress in the sub-area 'Role restriction'. The mothers had the lowest level of stress in the sub-area 'Social isolation' and the fathers in the subarea 'Incompetence'. The mothers perceived greater levels of stress than the fathers did in all sub-areas except for 'Social isolation', where the fathers perceived higher stress. There was an association between the parents' depressive symptoms and parental stress. The parents' own depressive symptoms at 3 months and sense of coherence and the partners' parental stress at 18 months were positively associated with the parental stress at 18 months in univariable and multivariable analyses. Conclusions Understanding the relationship between depressive symptoms and parental stress is important for health professionals so they can offer parents adequate support in early parenthood to optimize the conditions for raising a child. This knowledge should also be communicated to the parents.
This study evaluated the use of bioactive glass, PerioGlas, after retrograde filling with Super E... more This study evaluated the use of bioactive glass, PerioGlas, after retrograde filling with Super EBA cement in the treatment of periapical bone destruction. Healing outcomes were followed up after endodontic surgery in 186 teeth. Outcomes were divided into two groups according to follow-up time: short- and long-term. The EBA group (n = 110) underwent endodontic surgery and retrograde filling with EBA cement. In the EBA + PerioGlas group (n = 76), PerioGlas was embedded in the bone cavity after retrograde filling. The success rate in the EBA + PerioGlas group was 72% compared with 56% in the Super EBA group at the short-term follow-up and 74% and 84%, respectively, at the long-term follow-up. Healing of periapical bone destruction classified as uncertain at the short-term follow-up was considered successful in two out of three cases at the long-term follow-up. This study found that PerioGlas as bone substitute did not significantly improve endodontic healing outcome.
Background: Achieving lifelong tobacco abstinence is an important public health goal. Most studie... more Background: Achieving lifelong tobacco abstinence is an important public health goal. Most studies use 1-year follow-ups, but little is known about how good these are as proxies for long-term and lifelong abstinence. Also, intervention intensity is an important issue for development of efficient and cost-effective cessation treatment protocols. The study aims were to assess the long-term effectiveness of a high-and a low-intensity treatment (HIT and LIT) for smoking cessation and to analyze to what extent 12-month abstinence predicted long-term abstinence. Methods: 300 smokers attending dental or general health care were randomly assigned to HIT or LIT at the public dental clinic. Main outcome measures were self-reported point prevalence, continuous abstinence (≥6 months), and sustained abstinence. The study was a follow-up after 5-8 years of a previously performed 12-month follow-up, both by postal questionnaires. Results: Response rate was 85% (n=241) of those still alive and living in Sweden. Abstinence rates were 8% higher in both programs at the long-term than at the 12-month follow-up. The difference of 7% between HIT and LIT had not change, being 31% vs. 24% for point prevalence and 26% vs. 19% for 6-month continuous abstinence, respectively. Significantly more participants in HIT (12%) than in LIT (5%) had been sustained abstinent (p=0.03). Logistic regression analyses showed that abstinence at 12-month follow-up was a strong predictor for abstinence at long-term follow-up. Conclusions: Abstinence at 12-month follow-up is a good predictor for long-term abstinence. The difference in outcome between HIT and LIT for smoking cessation remains at least 5-8 years after the intervention.
This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc... more This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Objective: The benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (O... more Objective: The benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that these types of appliances would be equally effective. Material and methods: In this multicentre, randomized equivalence trial, patients with OSA received one type of bibloc or one type of monobloc treatment. At baseline, a 1-night polygraphy study was done, and this was repeated after 1 year. The outcome was any change in the apnoea-hypopnoea index (AHI) and the limits of equivalence between the two devices were set at ±5 AHI units. Results: Of 302 patients, 146 were randomly assigned to bibloc and 156 to monobloc appliances. In 88 and 104 patients, respectively, there were significant reductions in the AHI (p < .001) with a mean change of À16.7 (95% CI À19.4 to À14.1) in the bibloc and À11.8 (À14.9 to À8.7) in the monobloc groups. The proportions of responders defined as having an AHI <10 were 68% and 65% for the bibloc and monobloc groups, respectively. Treatment-related adverse events were mild, transient and the dropouts were more frequent in the bibloc group. Conclusions: Both types of treatments positively and significantly reduced respiratory disturbances, but at the 1-year follow-up, they were not significantly different in treating OSA, with a numerically greater reduction of the AHI value with the bibloc appliance. However, the higher proportion of treatment-related adverse events and higher proportion of dropouts among bibloc users should be balanced against the advantage of a greater reduction in the AHI.
Aim To determine whether there is an association between depressive symptoms and parental stress ... more Aim To determine whether there is an association between depressive symptoms and parental stress among mothers and fathers during early parenthood in Sweden. Methods In this study, 401 mothers and 396 fathers (393 couples) were included; the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale were measured 3 months after childbirth, and the Swedish Parenthood Stress Questionnaire and the Sense of Coherence Scale after 18 months. Complete data for multivariable analysis were available for 264 mothers and 252 fathers. Results The mothers estimated greater total depressive symptoms and parental stress than the fathers did. Both the mothers and the fathers had the greatest level of stress in the sub-area 'Role restriction'. The mothers had the lowest level of stress in the sub-area 'Social isolation' and the fathers in the sub-area 'Incompetence'. The mothers perceived greater levels of stress than the fathers did in all sub-areas except for ...
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