A study of socio-economic inequalities in self-reported oral and general health in South-East Norway

Worries and information seeking during pregnancy: a cross-sectional study among 1402 expectant Norwegian women active on social media platforms

BACKGROUND

Pregnant women often navigate extensive information from healthcare professionals, social networks and online sources, which can increase anxiety. Understanding their concerns and preferred information sources is crucial for effective antenatal care.

OBJECTIVE

To explore worries and information-seeking behaviour among pregnant women in Norway using social media.

METHODS

An anonymous, web-based survey was conducted among 1402 pregnant women in Norway from January to March 2022, distributed via Facebook and Instagram. The survey covered 11 pregnancy worries, eight postpartum worries, information sources and thoughts regarding childbirth.

RESULTS

Nearly, all participants had concerns, mainly about foetal anomalies (99%, n = 1381), miscarriage (95%, n = 1332) and childbirth (85%, n = 1195). Postpartum worries included physical changes (90%, n = 1266), breastfeeding (85%, n = 1187) and financial situation (74%, n = 1030). Major worries were more common among first-time mothers and women with financial insecurity. Most women sought information from quality-assured public health websites (74%, n = 1042) and healthcare personnel (56%, n = 775), with only 2% (n = 32) turning to influencers or bloggers.

CONCLUSIONS

Pregnancy and postpartum worries are widespread among pregnant women using social media, especially among first-time mothers and those with financial insecurity. Most pregnant women prefer quality-assured websites and healthcare personnel for information. Antenatal care could benefit from offering more tailored information and follow-up, particularly for first-time mothers and financially insecure women.

Oral health status of individuals with eating disorders: Systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis evaluates the oral health status of individuals diagnosed with eating disorders (EDs) compared to healthy controls.

DATA & SOURCES

Electronic database search was conducted in five databases. Two independent reviewers carried out screening, data extraction, risk of bias assessment, sensitivity analysis, subgroup analysis (by type of eating disorder), and certainty of evidence grading with Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Assessed oral health outcomes included dental caries, erosion, oral hygiene, periodontal status, salivary flow, pH and composition, myofascial pain, bruxism, malocclusion, oral lesions, dentine hypersensitivity, and oral health-related quality of life (OHRQoL).

STUDY SELECTION

The literature search yielded 2,322 articles. Thirty-three articles were included in the present review.

CONCLUSION

Individuals with EDs had poorer oral health outcomes compared to healthy controls, although the effect estimates are uncertain due to very low certainty of evidence. Dental caries and gingival inflammation severity, and prevalence of dental erosion, myofascial pain, malocclusion, oral lesions, and dentine sensitivity were higher amongst individuals with EDs compared to healthy controls. They also had lower salivary flow and pH, which are risk factors for oral diseases. No significant difference in bruxism was noted and inconclusive results were obtained for oral hygiene and periodontal status. Dental professionals may identify signs of EDs during routine appointments and may play an important role in the early referral and prompt management of patients with EDs. Clinical Significance With growing awareness of the interconnectedness between oral and psychological health, this article reviews various oral health outcomes in individuals with eating disorders compared to controls. The findings highlight the importance of interdisciplinary collaboration as dentists may be among the first to detect these issues during routine appointments.

Is Poor Self-Rated Health Associated with Higher Caries Experience in Adults? The HUNT4 Oral Health Study

INTRODUCTION

The association between lower socioeconomic status and a higher risk of dental caries is well established, but the independent association between general health status and dental caries on a population level is less investigated. The aim of this study was to assess the association between self-rated general health and caries experience in an adult Norwegian population and to assess if the associations were modified by age and sex.

METHODS

Data were collected as part of the Trøndelag Health Study (HUNT4) conducted 2017-2019 and a randomly selected subsample (20%) were invited for the HUNT4 Oral Health Study. This cross-sectional study included 4,880 dentate participants aged 19-94 years (response rate 67%). Participants underwent clinical and radiographic oral examinations and caries experience was measured by numbers of decayed (DT), missing (MT), and filled teeth (FT), DMFT index. The DT component consisted of primary and secondary caries in dentine, cavitated root caries, and remaining roots. Questionnaires were used to assess self-rated general health and socioeconomic position, denoted by education, household income, and employment status. Associations between self-rated health and caries experience (DMFT) and components (DT, MT, and FT) were assessed using negative binomial regression models. Ratios of means (RMs) with 95% confidence intervals (CI) for the associations were estimated, adjusting for socioeconomic position.

RESULTS

Individuals with poor self-rated general health had a 29% higher mean number of MT (RM: 1.29 [95% CI: 1.13-1.46]), a 22% higher mean number of DT (RM: 1.22 [95% CI: 1.07-1.39]), and a 7% higher mean number of DMFT (RM: 1.07 [95% CI: 1.04-1.11]) than individuals reporting very good health. Age-stratified analyses presented a more pronounced association between self-rated health and caries experience for individuals below the age of 55 years than for those 55 years or older. Similarly, the association was more evident in women, with significantly higher mean values for DMFT, MT, and FT among women reporting poor health.

CONCLUSIONS

The present study demonstrated an independent association between poor self-rated health and a higher burden of caries experience, adjusted for education, income, and employment status. The association was stronger in women and individuals below the age of 55 years. These findings add new evidence in understanding caries inequalities through self-rated health.

The Norwegian Counties Public Health Survey (NCPHS): a design study

BACKGROUND

Effective public health initiatives should be founded on a comprehensive and robust understanding of health-related factors including societal and community contexts. The Norwegian Counties Public Health Survey (NCPHS) aims for insights into the adult population on topics relevant for planning public health practices at county and municipality levels.

METHODS

The NCPHS includes a core questionnaire on public health-related topics and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register and 'washed' against the Common Contact Register to retrieve digital contact information and exclude those who cannot be contacted electronically. NCPHS was piloted in 2015 and 2018 (four counties). After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400,000.

RESULTS

Expedient data analysis has enabled the Norwegian Institute of Public Health to present comprehensive reports within 6 weeks of completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment and self-reported sufficiency of household income. Tables are also made available at the municipality level.

CONCLUSIONS

The NCPHS represents a valuable addition to existing data sources, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions and for evaluation of policies and interventions. The value of such a system during times of crisis was demonstrated during the COVID-19 pandemic.

Exploring socioeconomic inequality in caries experience in an adult Norwegian population; the HUNT4 Oral Health Study

OBJECTIVES

To investigate socioeconomic inequality in caries experience in an adult Norwegian population.

METHODS

This population-based study included 4549 dentate participants aged 25-94 years from the cross-sectional HUNT4 Oral Health Study conducted in Central Norway in 2017-2019. Participants were randomly sampled from the larger HUNT4 Survey and answered questionnaires and underwent clinical and radiographic examinations. Caries experience was measured as numbers of decayed, missing and filled teeth (DMFT index) and socioeconomic position was denoted by education and household income. Negative binomial regression models were used to estimate associations between caries experience and socioeconomic position.

RESULTS

Lower levels of both education and income were associated with higher caries experience, particularly pronounced for missing teeth. Socioeconomic gradients were observed for all outcomes DMFT, DT, MT and FT (p-value linear trends <.001). Gradients were similar for both income and education and were apparent for all age groups but were most evident in middle-aged and older individuals. High level of education was associated with a 50% lower mean number of missing teeth compared with basic level education, whereas high income was associated with a 24% lower mean number of decayed teeth and a 15% higher mean number of filled teeth than low income.

CONCLUSIONS

There was a socioeconomic gradient for caries experience in the study population that was present from early adulthood and increased with age. The gradient was particularly pronounced for missing teeth. Findings indicate that inequality was more associated with treatment given than with untreated disease.

The mediating effect of social support on the association between socioeconomic status and self-reported oral health status among the migrant elderly following children in Weifang, China: a cross-sectional study

BACKGROUND

Driven by population aging and the rapid urbanization in China, many migrant elderly following children (MEFC) moved to big cities to care for their grandchildren. The purpose of this study is to clarify the mediating effect of social support on the relationship between socioeconomic status (SES) and self-reported oral health status among the MEFC in Weifang, China.

METHODS

Multistage cluster random sampling was used to select the participants and finally 613 MEFC were included in the survey. The Social Support Rating Scale (SSRS) and the Chinese version of the Geriatric Oral Health Assessment Index (GOHAI) scale were used for data collection. Descriptive analysis, Rao-Scott test, t-test and structural equation modeling (SEM) were conducted in this study.

RESULTS

Mean score of GOHAI of the MEFC was 54.95 ± 6.47. The SES of MEFC exerted positive direct effect both on social support (standardized coefficient = 0.15) and self-reported oral health status (standardized coefficient = 0.22); social support exerted positive direct effect on self-reported oral health status (standardized coefficient = 0.17). Social support partially mediated the association between SES and self-reported oral health status [95% confidence interval (CI) 0.003-0.064, P < 0.05], and the mediating effect of social support accounted for 12.0% of the total effect.

CONCLUSIONS

Higher GOHAI score of MEFC indicated their better self-reported oral health status. MEFCs' SES could exert positive effect both on social support and self-reported oral health status, while the mediating effect of social support between SES and self-reported oral health status of MEFC was established.