Bronchial responsiveness to methacholine was examined in a Norwegian general population sample (n = 490) 18 to 73 yr of age. Altogether, 20 and 6% of the sample had PC20 less than or equal to 32 mg/ml and PC20 less than or equal to 8 mg/ml, respectively. The relationship of bronchial responsiveness to the following potential predictors were examined: sex, age, smoking habits, airway caliber (FEV1), FEV1 percent predicted (%FEV1), urban-rural area of residence, occupational airborne exposure in present job, and total serum IgE. After adjusting for age and FEV1, the odds ratio for PC20 less than or equal to 32 mg/ml was higher for men than for women in smokers and in ex-smokers, but did not vary by sex in nonsmokers, the adjusted odds ratio for PC20 less than or equal to 32 mg/ml in male compared with female smokers being 8.4 (95% Cl: 2.5-37.4). Irrespective of smoking status the sex- and FEV1-adjusted odds ratio for PC20 less than or equal to 32 mg/ml fell with increasing age. For every 10-yr increase in age the adjusted odds ratio for PC20 less than or equal to 32 mg/ml methacholine in nonsmokers decreased by 2.0 (95% Cl: 1.3-3.3). Also FEV1 and %FEV1 were predictors of PC20 less than or equal to 32 mg/ml after adjusting for sex and age irrespective of smoking status. Bronchial responsiveness (PC20 less than or equal to 8 mg/ml) was more prevalent in rural than in urban areas, the adjusted odds ratio being 2.5 (95% Cl: 1.1-5.9) for bronchial responsiveness in rural compared with urban residents after adjusting for sex, age, smoking habits, and FEV1.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper describes the burden of oral disorders in a population of adults aged 50 years and over living independently in the community. In so doing it uses clinical, functional, experiential and psychosocial impact measures to document the oral health status of this section of the population. The data reveal that substantial proportions of subjects report that their quality of life was compromised in some way by oral problems. Although only 24.1 per cent were edentulous, 30.5 per cent were unable to chew one or more foods; 37.2 per cent reported oral or facial pain in the previous four weeks and 67.5 per cent experienced one or more other oral symptoms. One third reported problems with eating and communication--social interaction, 18.7 per cent worried a great deal about their oral health and 30.8 per cent were dissatisfied with some aspect of their oral health status. Income was consistently associated with all health status measures examined, demonstrating the scope of inequalities in oral health. In addition, regression analysis showed that low income groups had higher scores on a psychosocial impact scale after controlling for clinical, functional and experiential oral health indicators. The paper illustrates the utility of a model of disease and its consequences derived from the international classification of impairments, disabilities and handicaps in exploring oral health.
This paper reports on a study of dental anxiety among adults aged 50 years and over living independently in two communities in Ontario, Canada. Subjects were identified by means of a telephone survey based on random-digit dialing. Data on dental anxiety were collected from 580 subjects by means of a self-completed questionnaire and were measured by the Dental Anxiety Scale (DAS) (Corah, 1969). The mean DAS score was 7.8, and 8.4% of subjects were classified as dentally anxious. Age was the only demographic factor associated with dental anxiety. Older individuals had lower DAS scores than younger individuals (p less than 0.0001). There was also a significant association between dental anxiety and general fearfulness measured by the Fear Survey Schedule II (Geer, 1965) (r = 0.31; p less than 0.001). A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioral and oral health outcomes. While these results confirm that dental anxiety is less prevalent among older adults than in younger populations, it has a number of important consequences with respect to dental care provision.
The purpose of this survey was to evaluate the effects of smoking and occupational exposures on the decline in forced expiratory volume in one second (FEV1), and the presence of airflow limitation (FEV1 x100/forced vital capacity (FVC) being
Comment In: Eur Respir J. 1993 Sep;6(8):1088-98224120
We aimed to investigate whether dietary vitamin C intake, an important antioxidant, is inversely related to self-reported respiratory symptoms in young adults of a community. A random sample of 4300 subjects, aged 20-44 years, living in Bergen, Norway, received a postal questionnaire on respiratory symptoms; 80% responded. Vitamin C intake (mg per week) was estimated from a food-frequency questionnaire asking how often the subject, during the last year, had consumed units of orange juice, oranges, potatoes, carrots and tomatoes. Significant differences in the intake of vitamin C were observed across smoking categories with current smokers having the lowest intake, while there was no variation by gender, age or occupational dust exposure. Dietary vitamin C intake was in univariate analyses inversely related to "morning cough", "chronic cough", "wheeze" and "wheeze ever". After adjusting for gender, age, body mass index, "occupational exposure" pack-years as well as having and stratified on smoking habits in multiple logistic regression analyses, the relationship between dietary vitamin C intake and "cough" and "wheeze" tended to be associated to smoking. The odds ratio (OR) for "morning cough" was 0.68 (95% CI: 0.35-0.95), "chronic cough" OR 0.69 (95% CI: 0.47-1.04) and "wheeze ever" OR 0.75 (95% CI: 0.56-1.01) in current-smokers with dietary vitamin C intake in the upper (> or =395 mg/ week) vs. the lower (
The relation of educational level to obstructive lung disease, spirometric airflow limitation, and respiratory symptoms was examined in a two-phase cross-sectional study of a Norwegian general population aged 18-73 years in 1985-1988. The first phase was a questionnaire survey. In the second phase, a stratified sample of those who responded in the first phase was invited to a clinical and respiratory physiologic examination. Altogether, 714 subjects attended, representing 84% of those invited. The prevalences of obstructive lung disease and spirometric airflow limitation were 7.8% and 4.5%, respectively. A total of 18% of the population had completed college, a further 60% had completed secondary school, and 21% had obtained a primary school education alone. The prevalence of both smoking and occupational airborne exposure decreased with increasing educational level. The sex-, age-, smoking-, and occupational exposure-adjusted odds ratio of obstructive lung disease in primary-versus university-educated subjects was 2.9 (95% confidence interval (CI) 1.3-6.5); in secondary- versus university-educated subjects it was 1.4 (95% CI 0.7-2.8). The corresponding values for spirometric airflow limitations were 5.2 (95% CI 2.0-13.4) and 1.8 (95% CI 1.2-2.7). All of the respiratory symptoms except breathlessness grade 2 were significantly associated with educational level after allowing for sex, age, smoking, and occupational airborne exposure. The survey indicates that educational level is a risk factor for airway disorders independent of smoking and occupational airborne exposure.
The literature on inequalities in health provides convincing evidence that lower socioeconomic groups have poor oral health when compared to higher socioeconomic groups. Since conventional measures of socioeconomic status such as occupation, income and education have a number of weaknesses which may limit their ability to describe and explain health inequalities, alternatives in the form of area-based measures are increasingly being used. In this paper, a conventional measure, household income, and an area-based measure of socioeconomic status are compared in terms of their ability to identify inequalities in oral health. The data used in the analysis were taken from a telephone interview survey of the oral health of older adults in the province of Ontario, Canada. While household income proved to be a marginally better predictor of these inequalities than the area-based measure, the latter had a number of distinct advantages from an epidemiological and planning perspective. Moreover, it identified variations in measures of oral health that were independent of household income, and the region of the province in which subjects lived.
We examined the effects from subjects, technicians and spirometers on within-session variability in successful recordings of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in 4989 asymptomatic never-smoking men. All eligible men aged 30-46 years living in western Norway (n = 45,380) were invited to a cross-sectional community survey. Information on respiratory symptoms, smoking habits and occupational exposures was obtained from a self-administered questionnaire. Three successful FEV1 and FVC recordings were obtained in 26,368 attendants using three dry-wedge bellow spirometers operated by 10 different technicians. Within-subject standard deviation (SD) from three recordings of FEV1 and FVC was on average 102 and 106 ml, respectively, and increased with height (14 and 17 ml, respectively, per 10 cm) and body mass index (BMI) (11 and 14 ml, respectively, per 5 kg m-2). Between-subject SD of the mean of three FEV1 and FVC recordings was 591 and 754 ml, respectively, and increased in groups of increasing height (43 and 40 ml, respectively, per 10 cm). Small, but significant, differences were observed between technicians in within-subject SD and in levels of FEV1 and FVC. Homogeneity of between-subject variability, necessary for linear regression analysis, was obtained using FEV1 and FVC divided by height squared. In conclusion, within-subject variability in three successful spirometric recordings was small, but dependent on height and BMI of the subjects as well as technician performance. The observed heterogeneity in between-subject variation in FEV1 and FVC levels disappeared when each variable was divided by height squared. Novel multiple linear regression equations for FEV1/height2 and FVC/height2 were developed to be used in evaluating the effects from occupational airborne exposures in Nordic men aged 30-46 years.
In the literature, it is usual to find women and younger subjects reporting higher levels of dental anxiety than men and older subjects. Fear of pain was found to be the most important predictor of dental anxiety and issues of control were also related to such anxiety. Therefore, it was predicted that gender and age differences would be reflected in attitudes to pain and control. Subjects were randomly selected from the voters' list in metropolitan Toronto and mailed a questionnaire with a request for cooperation in a study of their thoughts, feelings, and behaviour regarding dental treatment. The questionnaire included demographic data, measures of dental anxiety and painful experiences as well as the Pain Anxiety Symptoms Scale and the Iowa Dental Control Index. The results supported the main predictions. In addition, attitudes to pain and control were found to be complex phenomena with characteristic gender differences.
Longitudinal studies have reported an association between early childhood lung disease and adult respiratory disease. This issue has not been addressed in the Nordic countries. We studied the association between hospitalization for lung disease in early childhood and asthma in young adulthood in a Norwegian population sample, while estimating the attributable fraction of childhood hospitalization. A population-based survey in Bergen, Norway included a random sample of 4300 subjects aged 20-44 years, of whom 80% responded. The effect of hospitalization for lung disease before the age of 2 years on asthma in adulthood was analysed by logistic and polytomous logistic regressions, adjusting for related variables. Adjusted attributable fractions were estimated from these models. The risk for different measures of asthma was significantly increased in the 103 persons reporting childhood hospitalization (airways symptoms: OR from 1.9 to 2.9; asthma medication: OR = 2.8). The associations with airways symptoms were stronger in women (OR from 2.6 to 5.3) than in men (OR from 1.4 to 2.4). Given a causal association, adjusted attributable fractions showed that childhood lung disease causing hospitalization explained 4% of asthma symptoms. Early childhood hospitalization for lung disease was related to asthma symptoms in young Norwegian adults, more strongly in women than in men. Only a minor proportion of asthma symptoms in this age group could be related to hospitalization for lung disease in early childhood.