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    ABSTRACT: To investigate changes in the patient population and treatment case-mix within an expanded primary care dental training facility in Southern England. Cross-sectional analysis of patient management system data. Electronic data for patients with a closed/completed treatment plan in the 12-month period prior to, and following, dental service expansion were extracted for analysis (n = 4343). Descriptive analysis involved age, sex, payment status, deprivation status and treatment activity. Logistic regression was used to model the likelihood of treatment involving laboratory constructed devices (crowns, bridges, dentures), in relation to demography and deprivation in each time period. The volume of patients using the service increased by 48.3% (1749 cf 2594). The average age increased from 31.97 (95%CI: 30.8, 32.5) to 36.4 years (95%CI: 35.6, 37.1); greatest increase was in the over 75 years age-group (96%). The patient base became less deprived: patients exempt from payment reduced from 43.2% (n = 755) to 28.6% (n = 741) (P = 0.001) and the mean population deprivation score (IMD) reduced from 24.5 (95%CI: 23.8, 25.2) to 22.3 (95%CI: 21.7, 22.8). The volume and proportion of care involving laboratory constructed devices increased from 8.3% (n = 145) to 15.8% (n = 411) whilst assessments without interventive care decreased (34.5%-26.3%). On a logistic regression, the odds of having treatment involving laboratory constructed devices, increased with increasing age in both time periods 7% (95% CI: 1.06-1.08) and 6% (95% CI: 1.05-1.07) respectively. Furthermore, the odds increased by 38% OR: 1.38 (95% CI: 1.01-1.89) in period 2, for white patients. After adjusting for these effects, the odds of having care that involved laboratory constructed devices were less in period 2 than period 1 (100% cf 43%) for those who were technically exempt from payment (OR = 2.0; 95% CI 1.34 to 2.90 cf, OR = 1.43; 95% CI 1.13-1.81). The patient population altered in relation to age and socio-economic status. The expanded service had greater uptake by older people while users were less likely to be deprived. The expanded service, free at the point of delivery, attracted a higher proportion of patients who would normally have to pay health service charges. The service also showed an increase in treatment case-mix that involved laboratory constructed dental devices.
    Public health 10/2013; 127(11). DOI:10.1016/j.puhe.2013.08.010
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    ABSTRACT: The number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. We investigated the prevalence and correlates of dependence among older people from middle income countries. A one-phase cross-sectional survey was carried out at 11 sites in seven countries (urban sites in Cuba, Venezuela, and Dominican Republic, urban and rural sites in Peru, Mexico, China and India). All those aged 65 years and over living in geographically defined catchment areas were eligible. In all, 15,022 interviews were completed with an informant interview for each participant. The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, dementia, physical impairments and self-reported diagnoses. Dependence was interviewer-rated based on a key informant's responses to a set of open-ended questions on the participant's needs for care. We estimated the prevalence of dependence and the independent contribution of underlying health conditions. Site-specific prevalence ratios were meta-analysed, and population attributable prevalence fractions (PAPF) calculated. The prevalence of dependence increased with age at all sites, with a tendency for the prevalence to be lower in men than in women. Age-standardised prevalence was lower in all sites than in the USA. Other than in rural China, dementia made the largest independent contribution to dependence, with a median PAPF of 34% (range 23%-59%). Other substantial contributors were limb impairment (9%, 1%-46%), stroke (8%, 2%-17%), and depression (8%, 1%-27%). The demographic and health transitions will lead to large and rapid increases in the numbers of dependent older people particularly in middle income countries (MIC). The prevention and control of chronic neurological and neuropsychiatric diseases and the development of long-term care policies and plans should be urgent priorities.
    BMC Geriatrics 08/2010; 10(1):53. DOI:10.1186/1471-2318-10-53
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    ABSTRACT: To investigate the motivations for, and perceived benefits of, undertaking senior house officer (SHO) posts, and to explore the career pathways of those who do, examining trends in successive cohorts. Postal cross-sectional questionnaire survey of all dental and maxillofacial SHOs (DF2s) who had worked for two South London hospitals within the previous nine years (n=137). Respondents were grouped into three cohorts to enable responses to be examined in relation to respondents' entry to their first SHO post. There were responses from 83 (61%) potential participants. The most frequent motivation for carrying out SHO posts from 79 (95%) of the respondents was the desire to 'learn from experienced clinicians'. The most common perceived benefit reported by those who had completed posts at the time of the survey was 'an improved understanding of the role of the hospital dental service' from 68 (97%) of those who answered this question. Difficulty in securing a job in general dental practice was not reported as a notable motivating factor, either before or after the implementation of the new dental contract. 'Fulfil approved training post requirements for postgraduate examinations' reduced as a motivator from 28 (88%) for the earlier cohort of SHOs to nine (36%) for the more recent cohort. Fifty-four of 78 (69%) respondents declared a definite plan to seek admission to the General Dental Council Specialist Lists in future, 24 (83%) in the first cohort, compared with 11 (46%) in the last (P=0.05). Of the males, 13 (52%) were significantly more likely to report that they were currently working in general practice compared with 15 (27%) females (P=0.028). The findings suggest that multiple benefits are identified from undertaking SHO posts. However, some of the motivations for undertaking SHO posts may have changed over the nine-year period investigated. Possible influences are discussed. This paper highlights the perceived benefits of junior training posts at a time of significant transition within the profession.
    Primary Dental Journal 07/2010; 17(3):115-22. DOI:10.1308/135576110791654937
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    ABSTRACT: Professionalism has been identified as a core component of revalidation by the General Dental Council. However, analysis and debate over what it means to be a professional dentist is lacking in modern dentistry in the United Kingdom. The aim of this article is to open a debate on concepts of professionalism within dentistry, drawing on established thoughts in medicine and more limited material from the dental domain. The scope of discussion will extend to include definitions of professionalism, ethical issues within professionalism, professionalism in relation to revalidation and where all of these issues relate to dentistry perceived as a business. We can learn much from the medical community who have been driven to consider 'medical professionalism in a changing world', and in support of 'better patient care'. However, we can also contribute to the wider debate on professionalism by tackling the business angle, which has been largely ignored by our medical counterparts, and adding greater weight to the ethical implications of being a professional.
    British dental journal official journal of the British Dental Association: BDJ online 04/2009; 206(5):249-53. DOI:10.1038/sj.bdj.2009.164
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    ABSTRACT: Well-designed epidemiological research is relatively lacking in low and middle income countries where two-thirds of the world's estimated 24 million people with dementia live. The 10/66 Dementia Research Group has sought since 1998 to redress this imbalance. Pilot studies to develop and validate dementia diagnostic measures and study care arrangements in 26 centers worldwide were followed by one phase cross-sectional catchment area surveys in eight Latin American countries, China, India, Nigeria and South Africa. The protocol includes assessment of sociodemographics, disability, care arrangements, physical and mental health, and dementia diagnosis with (more restrictive) DSM-IV and (less restrictive) 10/66 dementia criteria. An incidence phase is underway in eight countries. 10/66 dementia prevalence is generally double that of DSM-IV dementia. DSM-IV dementia is particularly rare in India, attributable to the small proportion of family informants confirming cognitive decline and social impairment. Carer psychological and economic strain is as high as in the developed world, despite traditional family care arrangements. A significant minority of people with dementia are vulnerable due to lack of family support and economic resources. Earlier studies probably underestimated dementia prevalence in regions with very low awareness of this emerging public health problem. More research is needed to delineate the impact of dementia relative to other chronic diseases, and secular trends in countries experiencing rapid demographic ageing and health transition. Packages of care are also a priority - healthcare services and governments have not responded to families' complex needs for support in their long-term care role.
    Indian Journal of Psychiatry 01/2009; 51 Suppl 1(Suppl1):S8-S15.
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    ABSTRACT: The Baron Doctor Cornelius Ver Heyden De Lancey is one of the few persons to qualify in dental surgery, medicine and the law. He was an author and art historian and spoke five languages and he was an important benefactor for students and practitioners of the three professions and for others through the De Lancey and De La Hanty Foundation Limited, which he established in 1971. This paper follows the Baron's professional progress from his birth in Holland to his death in Jersey. He gained a plethora of qualifications. His professional activities explain why certain organizations gained from his philanthropy.
    Journal of Medical Biography 03/2006; 14(1):54-61. DOI:10.1258/j.jmb.2006.04-13
  • Journal of the American Dietetic Association 12/2001; 101(11):1354-7. DOI:10.1016/S0002-8223(01)00324-8
  • Journal of Medical Biography 09/2000; 8(3):177-82.
  • Community dental health 01/1999; 15 Suppl 1:306-11.
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    ABSTRACT: This paper reviews the prevalence and possible changes in prevalence of periodontal disease from epidemiological investigations carried out within the previous two decades. Although many older studies used unreliable indices, there is some evidence that clinically significant periodontitis is now restricted to between 15 and 20% of the population with certain groups, such as smokers and diabetics, at particular risk. The outlook for general dental practice in the future is also considered. As elderly people will form a greater proportion of the future population, and are more likely to remain dentate, more periodontal treatment may be required. To identify individuals and communities at risk, high-quality periodontal epidemiological information is of more importance than ever before.
    Dental update 12/1998; 25(9):435-40.
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