[Show abstract][Hide abstract] ABSTRACT: Background
Dentists report facing difficulties and experiencing frustrations with people on social assistance, one of the social groups with the most dental needs. Scientists ignore how they deal with these difficulties and whether they are able to overcome them. Our objective was to understand how dentists deal with critical issues encountered with people on social assistance.
We conducted in-depth, semi-structured interviews with 33 dentists practicing in Montreal, Canada. The interview guides included questions on dentists’ experiences with people on social assistance and potential strategies developed for this group of people. Analyses consisted of interview debriefing, transcript coding, and data interpretation.
Dentists described strategies to resolve three critical issues: missed appointments (organisational issue); difficulty in performing non-covered treatments (biomedical issue); and low government fees (financial issue). With respect to missed appointments, dentists developed strategies to maximise attendance, such as motivating their patients, and to minimise the impact of non-attendance, like booking two people at the same time. With respect to biomedical and financial issues, dentists did not find any satisfactory solutions and considered that it was the government’s duty to resolve them. Overall, dentists seem reluctant to exclude people on social assistance but develop solutions that may discriminate against them.
The efforts and failures experienced by dentists with people on social assistance should encourage us to rethink how dental services are provided and financed.
BMC Health Services Research 10/2014; 14(1):472. DOI:10.1186/1472-6963-14-472 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: to understand the social dynamics of living with cleft lip and palate (CLP) and its determinants over the life course.
Methods: Qualitative in-depth semi-structured interviews with 11 individuals with repaired complete CLP from 3 Canadian cities. Sample size was determined by the principle of theoretical saturation.
Results: The data gathered and analyzed in this project were used to generate a model illustrating several components of the social dynamic of living with CLP. Childhood stigmatization can play a big role in shaping social relationships of affected individuals. By causing persistent feelings of difference, “defectiveness” and “unworthiness”, stigmatization can lead to social passivity and/or hostility, posing obstacles for sustaining healthy relationships. When healthy relationships with "key-figures" are present, they can play a pivotal role in protecting and supporting affected individuals against the harm of stigmatization. They do this through reinforcing positive self-perception. Such beneficial effects on self-perception were consistently reported by participants to be the most influential factor in shaping their judgment of what constitutes a supportive versus a non-supportive relationship. Our results show how a vicious cycle may manifest itself, where childhood stigmatization leads to social dysfunction, which consequently impairs relationships with others, preventing the potential positive effects of these relationships on the stigma, the initiator of this cycle.
Conclusion: Early intervention in children with CLP to prevent childhood stigmatization and its repercussions may be crucial in leading affected individuals down a positive life-trajectory where healthy self-perception and social functioning is maintained. A way of achieving this goal is through preparing and supporting the key-figures in affected individuals lives.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to systematically review the available literature on the levels, causes, and impact of stress among dental students. The investigators searched eight electronic databases: Medline, Medline in process, Psychinfo, ERIC, Embase, Cochrane Library, Web of Science, and SCOPUS. Two independent reviewers conducted the selection, data extraction, and quality appraisal for included studies. The investigators then coded both quantitative and qualitative studies using similar codes and pooled results from studies that used the Dental Environment Stress questionnaire to demonstrate dental students' stress levels. The search initially identified 4,720 studies, of which 124 studies were included in the final qualitative synthesis and twenty-one were included in the meta-analysis. Evidence from this research showed that dental students experience considerable amounts of stress during their training. This stress is mainly due to the demanding nature of the training. In addition, studies suggest adverse effects of elevated stress on students' health and well-being. Most of the available literature is based on cross-sectional studies; thus, future longitudinal studies are needed to follow students throughout their curriculum. In addition, further research needs to explore and test stress management interventions.
Journal of dental education 02/2014; 78(2):226-42. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Unlabelled:
The aim of this study was to evaluate the reproducibility and differences in diagnostic outcomes by practicing dental clinicians previously inexperienced in using the Nyvad criteria and the ICDAS II criteria with the Lesion Activity Assessment system (ICDAS II + LAA). Four volunteer dentists were randomly allocated to one of two groups. Both groups of dentists examined the same voluntary sample (n = 140) of caries active young adults using Nyvad and ICDAS II + LAA criteria in different sequences. The first group used the Nyvad criteria during period 1, followed by ICDAS II + LAA during period 2; the second group did the examinations in the opposite sequence. Before the period 1 and 2 examinations, dentists from both groups were trained with the Nyvad or ICDAS II + LAA criteria, depending on the group to which they were assigned. Intra-examiner agreement for lesion severity was high for both diagnostic instruments (weighted kappa 0.62-0.80). For lesion activity the intra-examiner unweighted kappa values ranged from 0.31 to 0.61 for ICDAS II + LAA and from 0.36 to 0.51 for Nyvad. The mean number of active non-cavitated caries lesions was significantly higher for ICDAS II + LAA (6.14 ± 5.4) than for Nyvad (3.90 ± 3.9) (p < 0.001). Active cavitated/dentinal caries lesions were significantly higher for ICDAS II + LAA (4.14 ± 4.1) than for Nyvad (2.13 ± 3.1) (p < 0.001). Both the Nyvad and ICDAS II + LAA diagnostic criteria showed high reproducibility for lesion severity assessment. The mean number of active caries lesions among high caries risk subjects was significantly higher using the ICDAS II + LAA criteria, which may subsequently lead to more caries treatment.
Caries Research 12/2013; 48(2):126-136. DOI:10.1159/000353094 · 2.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In Canada, the prevalence of oral diseases is very high among people on social assistance. Despite great need for dental treatment, many are reluctant to consult dental professionals, arguing that dentists do not welcome or value poor patients. The objective of this research was thus to better understand how dentists perceived and experienced treating people on social assistance.
This descriptive qualitative research was based on in-depth semi-structured interviews with 33 dentists practicing in Montreal, Canada. Generally organized in dentists' offices, the interviews lasted 60 to 120 minutes; they were digitally recorded and later transcribed verbatim. The interview transcripts were coded with NVivo software, and data was displayed in analytic matrices. Three members of the research team interpreted the data displayed and wrote the results of this study.
Dentists express high levels of frustration with people on social assistance as a consequence of negative experiences that fall into 3 categories: 1) Organizational issues (people on social assistance ostensibly make the organization of appointments and scheduling difficult); 2) Biomedical issues (dentists feel unable to provide them with adequate treatment and fail to improve their oral health); 3) Financial issues (they are not lucrative patients). To explain their stance, dentists blame people on social assistance for neglecting themselves, and the health care system for not providing adequate coverage and fees. Despite dentists' willingness to treat all members of society, an accumulation of frustration leads to feelings of powerlessness and discouragement.
The current situation is unacceptable; we urge public health planners and governmental health agencies to ally themselves with the dental profession in order to implement concrete solutions.
BMC Health Services Research 11/2013; 13(1):464. DOI:10.1186/1472-6963-13-464 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to describe sources of stress in predoctoral dental students and first-year residents at one dental school and to understand how these sources evolved during the four-year curriculum and in the first year after graduation. The study used a mixed methods design. Quantitative data were collected from subjects in each of the five cohorts of students and residents, every month for a period of one year (other than the summer holiday period; N varied each month from 77 to 127). Sources of stress were measured using the Dental Environment Stress questionnaire (DES). The investigators administered the DES twice, once at the end of each academic semester, and used DES categories that emerged from factor analysis to assess monthly sources of stress. Qualitative data collected through individual interviews (N=6) were aimed at understanding the main sources of stress in each year of the curriculum. Results from both quantitative and qualitative phases demonstrated that the main stressors for all dental students throughout the year were examinations and grades as well as workload. Students in the clinical years were also concerned about patient treatment. The residents and final-year students reported future plans as an additional stressor. Over the year, there was a significant increase for workload stress in the fourth year (p<0.05); in the third year there was a significant increase in patient treatment stress (p<0.05) with a significant decrease for personal factors (p<0.05). The study demonstrated that sources of stress in these students and first-year residents varied according to their stage in the program and the period of the year.
Journal of dental education 11/2013; 77(11):1488-97. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to measure and compare the magnitude of income-related inequalities for oral and general health outcomes in Canada.
Data for this study were from the 2007/09 Canadian Health Measures Survey (CHMS). The sample size consisted of 3,413 Canadians aged 18-79 (1,601 men and 1,812 women). Oral health indicators were the total number of decayed and missing teeth. General health was measured as obesity and high blood pressure. Socio-economic status was measured as equivalized household income. We used the concentration index (CI) to quantify income-related inequalities in these outcomes. Values for the concentration index range from -1 to +1 with negative (or positive) concentration indices showing that the outcome is more concentrated among the less well off (or among the better off). All statistical analyses were weight-adjusted for the complex survey design and standardized for age.
The concentration indices for oral health outcomes (decayed teeth = -0.25, missing teeth = -0.15) were greater than for general health outcomes (obesity = -0.05, high blood pressure = -0.04). The concentration indices for oral health outcomes, in contrast to general health outcomes, were statistically significant.
There were income-related inequalities for oral health outcomes with the disease concentrated more among the poor. Inequalities in oral health were greater than inequalities in general health. The variation in the funding of oral health care and general health care is likely to explain the differences in the magnitude of income-related inequalities for oral and general health.
[Show abstract][Hide abstract] ABSTRACT: Objective : To better understand how individuals with cleft lip and palate (CLP) perceive and experience their treatment process and how these perceptions and experiences change over the life course. Design : Qualitative in-depth semistructured interviews with 11 adults with nonsyndromal complete CLP. Participants/Setting : Individuals from three Canadian cities were recruited by convenience and theoretical sampling through AboutFace International. The number of participants was determined by the principle of theoretical saturation. Results : The experience of individuals with CLP through the treatment process changes over the life course. In childhood and early adolescence, most individuals had experienced stigma, had negative self-perception, and as a result were more prone to perceiving the treatment process as not only unbearably burdensome but also as fueling their feeling of "defectiveness." In adulthood, participants' self-perception improved, partly because of definitive surgical correction, leading them to realize benefits of the process and reappraise the treatment process as satisfactory and beneficial rather than burdensome. Subsequently, some individuals pursued further surgeries hoping for additional similar psychological gains, in lieu of psychosocial interventions addressing the underpinnings of residual feelings of defectiveness. This led to dissatisfaction and frustration when the procedures did not lead to the hoped-for psychological gains. Conclusions : The results emphasize the importance of self-perception in determining how participants perceive several important aspects of the treatment experience throughout the life course. Further studies should focus on how to incorporate self-perception as an important variable and outcome in the treatment process.
[Show abstract][Hide abstract] ABSTRACT: To investigate the impact of a Multimode Comprehensive Tailored Information Package (MCTIP) on Head and Neck (H&N) cancer patients' knowledge and satisfaction.
A non-randomized controlled trial was conducted at two participating hospitals. One hospital delivered the MCTIP and the second hospital provided normal care. The study was approved by local ethical committees. Patients with Stage III and IV cancer in the H&N region were recruited between their diagnosis and treatment. All participants were evaluated at baseline, 3 and 6months later using the Satisfaction with Cancer Information Profile (SCIP) and a Cancer Knowledge questionnaire. Data were analyzed using descriptive statistics, T tests, chi square tests and finally linear mixed model analyses to test the potential impact of the intervention.
A total of 103 participants participated in this study and complete data at all time points were collected for 96. The Test group reported higher levels of Cancer Knowledge and Satisfaction at all time points (p<0.001 with all comparisons) compared to the Control group.
Our study demonstrated an association between receiving the multimedia based tailored information and higher levels of satisfaction and cancer knowledge compared to those who receive information in ad hoc manner. Implications: Exploring patients' informational needs is necessary before planning information services to them.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To describe the prevalence of oral pain in Canada and to identify its covariates.
Data were derived from the 2007-2009 Canadian Health Measures Survey. Data were analyzed for a total of 5284 respondents (2558 males, 2726 females) aged 6-79 years. The outcome variable was self-reported pain in the mouth in the past 12 months. Bivariate and multivariate analyses were used to investigate the relationship between oral pain and 4 sets of covariates: socio-demographic factors, dental service utilization, oral health behaviours and clinical oral health.
Oral pain in the past 12 months was reported by 11.7% of respondents. Oral pain was slightly, but not significantly, more prevalent among females than males (13.6% vs. 10.0%). The lowest and highest prevalence of oral pain were reported by children and young adults, respectively. Multivariate analyses suggested that oral pain was significantly more prevalent among adolescents and adults, those in the lowest income groups, those who avoided a dental professional because of the cost and those with untreated decayed teeth.
Canadians with financial barriers to accessing dental care and those with untreated dental decay were at risk of having dental pain. These findings have important implications for the provision of dental care in Canada.
[Show abstract][Hide abstract] ABSTRACT: Objective: This project aimed to: 1) describe the relationship between age and caries prevalence, and age and caries experience in the Canadian population; and 2) describe the differences in those relationships in males and females.
Method: We used data from the 2007-09 Canadian Health Measures Survey, which gathered multiple socio-demographic, economic, behavioural, health and health care indicators in a representative sample of the Canadian population aged 6 to 79 years. Relevant variables for this project were the age as a continuous variable, sex, and total number of decayed, missing and filled teeth, and the composite DMFT. The sample used for our analyses comprised 4,214 dentate 12-79 year olds. Six to eleven year olds were excluded because of their mixed dentition. Data analyses were performed using STATA 11.1. For testing the shape of the relationship between age and decay indicators, we employed nonparametric (locally weighted ordinary least squares regression-LOWESS) and parametric statistical methods (spline analyses for negative binomial regression).
Result: The relationship between age and prevalence of decay was curvilinear. The risk for decay increased strongly between 12-30yrs (Coefficient 0.042; p=0.006), decreased between 30-62 years (Coefficient -0.030; p=0.003) and then increased slightly again between 62-79 years (coefficient 0.016; p=0.492). These relationships were the same in males and females but the risk for decay was constantly higher in males and the difference between the sexes became greater with increasing age. The relationship between age and all other caries experience indicators was simply cumulative with age and did not differ by sex.
Conclusion: While the cross-sectional nature of this study design strongly limits the conclusions of these analyses, they suggest strong roles for age and gender in risk for caries. This has important implications for policy.
IADR/AADR/CADR General Session and Exhibition 2013; 03/2013
[Show abstract][Hide abstract] ABSTRACT: Objectives:
This study aimed to measure the magnitude of income-related inequality for four oral health outcomes in Canada. The degree of oral health inequality according to sex was also compared.
Data for this study are from the year 2007 to 2009 Canadian Health Measure Survey (CHMS). The sample size consisted of 4951 Canadians aged 6-79 (2409 men and 2542 women). The oral health indicators used were the number of decayed teeth, number of missing teeth, number of filled teeth, and oral pain in the past year. Socioeconomic status was measured as equivalized household income. We used the relative concentration index to quantify health inequalities. Data analyses were performed using STATA 11.1 and ADePT (4.0).
The number of decayed teeth, the number of missing teeth and the prevalence of oral pain decreased with increasing income, while the number of filled teeth increased with increasing income. The relative concentration indices for decayed teeth, missing teeth, filled teeth and for oral pain were -0.264, -0.157, 0.085, and -0.120, respectively. There was a statistically significant deviation from equality for the four oral health outcomes and this was generally present for both sexes. The relative concentration indices for decayed teeth were statistically significantly larger than other oral health outcomes. The relative concentration indices for women were greater than those of males indicating a greater magnitude of inequality among women.
There was a higher concentration of decayed teeth, missing teeth and oral pain in the worse off, while the more affluent had a greater concentration of filled teeth. The numbers of decayed teeth was the most unequal aspect of oral health comparatively. There was a sex difference in the pattern of oral health inequalities with greater magnitude of inequality present among women in terms of the number of decayed and missing teeth. Health policymakers should consider the magnitude of health inequalities according to outcome and between sexes in their decision to tackle oral health inequalities.
Community Dentistry And Oral Epidemiology 02/2013; 41(6). DOI:10.1111/cdoe.12043 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
An instrument was developed in Canada to assess impairments related to oral functioning of individuals with four years of age or older with Down syndrome (DS). The present study attempted to carry out the cross-cultural adaptation and validation of the instrument for the Brazilian Portuguese language and to test its reliability and validity.
After translation and cross-cultural adaptation, the instrument was tested on caregivers of people with DS. Clinical examination for malocclusion was carried out in people with DS by two calibrated examiners. Inter and Intra examiner agreement was assessed by Intraclass Correlation Coefficient (ICC) and ranged from 0.92 to 0.97 respectively. Total of 157 people with DS and their caregivers were able to compose the sample. They were selected from eight institutions for people with DS in five cities of southeastern Brazil. The mean age of people with DS was 20.7 [±13.1] and for caregivers was 53.1 [±13.7]. The mean instrument score was 18.6 [±9.0]. Internal reliability ranged from 0.49 to 0.80 and external reliability ranged from 0.78 to 0.88. Construct validity was verified by significant correlations identified between malocclusion and the total instrument; and caregivers’ educational level and the instrument (p<0.05). Discriminant validity was proved as the instrument presented different mean comparing people with DS and non-DS (p<0.05).
Initial validity tests indicated that the instrument related to the oral health for people with DS may be a valid instrument to this segment of the population in Brazil.
Health and Quality of Life Outcomes 01/2013; 11(1):4. DOI:10.1186/1477-7525-11-4 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To investigate if tailored information provision decreases symptoms of anxiety and depression in late stage Head and Neck (H&N) cancer patients. METHODS: This non-randomized, controlled trial was conducted with stage III or IV H&N cancer patients. Subjects were recruited at two academic health centers in Montreal. At the test center, subjects received the Multimode Comprehensive Tailored Information Package (MCTIP), while at the control center, they received normal information provision. Participants were evaluated using the Hospital Anxiety and Depression Scale (HADS) at baseline and 3 and 6month later. Data were analyzed using descriptive statistics then T tests and chi square tests to compare group differences and finally mixed model analysis to test differences in outcome variables. RESULTS: A total of 103 subjects were recruited and of them 96 (47 tests and 49 controls) participants completed baseline, 3 and 6month evaluations. The test group experienced lower levels of anxiety (p=0.001) and depression (p=0.089) than the control group. CONCLUSION: The subjects receiving tailored information had lower levels of anxiety than their counterparts. In addition, depression showed a reduction in the expected direction in the test group. Practice implications: Our results need to be further confirmed using a randomized approach in different samples but they suggest benefits for stage III and IV H&N cancer patients receiving tailored, multi-modal information concerning their cancer.
[Show abstract][Hide abstract] ABSTRACT: This paper describes and compares the magnitude of socio-economic inequalities in oral health among adults in Canada and the US over the past 35 years. We analyzed data from nationally representative examination surveys in Canada and the US: Nutrition Canada National Survey (1970-1972, N = 11,546), Canadian Health Measures Survey (2007-2009, N = 3,508), The First National Health and Nutrition Examination Survey (1971-1974, N = 13,131), and National Health and Nutrition Examination Survey (2007-2008, N = 5,707). Oral health outcomes examined were prevalence of edentulism, proportion of individuals having at least 1 untreated decayed tooth, and proportion of individuals having at least 1 filled tooth. Sociodemographic indicators included in our analysis were place of birth, education, and income. Data were age-adjusted, and survey weights were used to account for the complex survey design in making population inferences. Our findings demonstrate that oral health outcomes have improved for adults in both countries. In the 1970s, Canada had a higher prevalence of edentulism and dental decay and lower prevalence of filled teeth. This was also combined with a more pronounced social inequality gradient among place of birth, education, and income groups. Over time, both countries demonstrated a decline in absolute socio-economic inequalities in oral health.
Journal of dental research 07/2012; 91(9):865-70. DOI:10.1177/0022034512455062 · 4.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite significant needs, people on social assistance are sometimes reluctant to consult dentists because of previous negative experience and communication barriers. They feel poorly understood by oral health professionals and sometimes complain of being stigmatized. It is thus important to know how dentists perceive poverty and this group of patients. The aim of this study was to understand how dentists perceive poverty and people on social assistance. To investigate this largely unexplored question, a qualitative study was conducted based on in-depth interviews with thirty-three dentists practicing in Montreal, Canada. Interviews were audiotaped and transcribed for qualitative analysis. The study revealed two perspectives on poverty: 1) the individualistic-deficit perspective and 2) the socio-lifecourse perspective. In the individualistic-deficit perspective, which predominated among these participants, dentists explained poverty by individual factors and emphasized individuals' negative attitudes toward work and lack of capabilities. Conversely, dentists with a socio-lifecourse perspective described poverty as a structural rather than an individual process. Acknowledging individuals' distress and powerlessness, these dentists expressed more empathy toward people on social assistance. The results suggest the individualistic-deficit perspective impedes the care relationship between dentists and poor patients as well as highlighting the need to better prepare dentists for addressing issues of poverty and social inequities in clinical practice.
Journal of dental education 05/2012; 76(5):545-52. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: To describe and compare stress levels over a one-year period among cohorts of 1st, 2nd, 3rd and 4th year dental students and dental residents, and to describe sources of stress.
Methods: Data were collected once per month for a full academic year from 1st, 2nd, 3rd and 4th year dental students and 1st year residents. We used a visual analogue scale (VAS) to monitor stress levels through the year. The scale consists of 100-millimeter horizontal line with both ends describing the extremes of stress levels as “Not at all stressed” and “Extremely stressed”. Other variables included in the questionnaire were sources of stress and sociodemographic information.
Results: Apart from the very low summer holiday period response rates were 50-82%. There was a gradual increase in dental students’ stress levels throughout the 4-year curriculum with a decline after their graduation. The lowest mean stress point score, on VAS from 0-100, was reported by 2nd year students in December (25.5) and highest was reported by 4th year students (84.4) in February, 2-3 months prior to graduation. Peak stress periods during the academic year were related to most frequently reported sources of stress. These were “pressure to perform well” and “personal issues”, which were cited respectively by 25-50% and 5.6-50% of participants. Students also often mentioned “exams and grades” (11.5-44.4%). Residents, 3rd and 4th year students’ added “patient treatment” (3.9-22.2%). Third year students, transitioning from preclinical to clinical training, stated “learning clinical skills” (3.9%) as another reason. “Workload”(10.5%) and “relationship with professors and staff” (5.3%) were factors mostly reported by residents.
Conclusions: Stress levels vary a lot among dental students depending on their year of study and the time during the academic year. Overall, 1st year students and residents reported lowest levels of stress and 4th year students had the highest peak.
[Show abstract][Hide abstract] ABSTRACT: Information Provision in Head and Neck Cancer Care – a Qualitative Study
Patient information is considered both as a resource and a means of empowerment. Studies conducted with cancer patients show that good quality information can improve patient outcomes such as adherence to treatments, lower levels of anxiety and satisfaction with care. However, very little research has been done with Head and Neck (H&N) cancer patients. Our aim was to describe and compare the experiences of H&N cancer patients receiving information concerning their cancer and treatment at two hospitals with different approaches to information delivery. A total of 11 H&N cancer patients and 2 Nurse Coordinators (NC) participated in this study that used qualitative methods. One hospital provided the Multimode Comprehensive Tailored Information Package (MCTIP), whereas the other hospital used a normal care approach for information provision. Data were gathered by semi‐structured interviews with subjects and by observing information provision at both centers. Interviews and information deliveries were audio taped. Our study findings show that the subjects who received the MCTIP perceived the information that they received was timely, understandable, contained the details they needed, and helped them in preparing them for the treatment. And the subjects who did not receive the MCTIP expressed that they proceeded towards the treatment with no clear idea about various steps in cancer care and they felt confused and lost. The results suggest that subjects who received the information through MCTIP had better information provision experience, while peers receiving a normal care approach expressed dissatisfaction with elements of their information provision experience
International Qualitative Health Research Conference, Montreal, October, 2012., Montreal; 01/2012