Publications by authors named "David Brennan"

193 Publications

Stepping Stones or Second Class Donors?: a qualitative analysis of gay, bisexual, and queer men's perspectives on plasma donation policy in Canada.

BMC Public Health 2021 Mar 5;21(1):444. Epub 2021 Mar 5.

Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.

Background: Men who have sex with men (MSM) are not eligible to donate blood or plasma in Canada if they have had sex with another man in the last 3 months. This time-based deferment has reduced since 2013; from an initial lifetime ban, to five-years, one-year, and now three-months. Our previous research revealed that gay, bisexual, queer, and other MSM (GBM) supported making blood donation policies gender-neutral and behaviour-based. In this analysis, we explored the willingness of Canadian GBM to donate plasma, even if they were not eligible to donate blood.

Methods: We conducted in-depth interviews with 39 HIV-negative GBM in Vancouver (n = 15), Toronto (n = 13), and Montreal (n = 11), recruited from a large respondent-driven sampling study called Engage. Men received some basic information on plasma donation prior to answering questions. Transcripts were coded in NVivo following inductive thematic analysis.

Results: Many GBM expressed a general willingness to donate plasma if they became eligible; like with whole blood donation, GBM conveyed a strong desire to help others in need. However, this willingness was complicated by the fact that most participants had limited knowledge of plasma donation and were unsure of its medical importance. Participants' perspectives on a policy that enabled MSM to donate plasma varied, with some viewing this change as a "stepping stone" to a reformed blood donation policy and others regarding it as insufficient and constructing GBM as "second-class" donors. When discussing plasma, many men reflected on the legacy of blood donor policy-related discrimination. Our data reveal a significant plasma policy disjuncture-a gulf between the critical importance of plasma donation from the perspective of Canada's blood operators and patients and the feelings of many GBM who understood this form of donation as less important.

Conclusions: Plasma donor policies must be considered in relation to MSM blood donation policies to understand how donor eligibility practices are made meaningful by GBM in the context of historical disenfranchisement. Successful establishment of a MSM plasma donor policy will require extensive education, explicit communication of how this new policy contributes to continued/stepwise reform of blood donor policies, and considerable reconciliation with diverse GBM communities.
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http://dx.doi.org/10.1186/s12889-021-10480-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932904PMC
March 2021

Association of periodontitis with oral malodor in Korean adults.

PLoS One 2021 4;16(3):e0247947. Epub 2021 Mar 4.

Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.

This study aimed to evaluate the association of periodontitis with the organoleptic score (OLS)-defined oral malodor after validating OLS with odoriferous sulfur compounds in mouth air among Korean adults. A total of 330 adults aged 47-86 years were recruited from the Yangpyeong health cohort, South Korea, in 2015. Oral malodor was assessed using a 6-point OLS by a trained dentist and validated with the concentrations of hydrogen sulfide (HS) and methyl mercaptan (MM) using a gas chromatographer. Periodontitis was measured by assessing the radiographic alveolar bone loss on digital orthopantomography. Statistical analyses including descriptive statistics, partial correlation, ANOVA, and multivariable logistic regression with putative confounders were applied. OLS was significantly correlated with the concentrations of HS and MM (partial r = 0.401 and 0.392, respectively; both p<0.001) after controlling for confounders. Individuals with periodontitis had 1.8 times the risk of OLS-defined oral malodor in multivariable models (adjusted odds ratio = 1.77 in the model with the number of teeth and 1.82 in the model with denture wearing; p = 0.047 and 0.035, respectively). Periodontitis was associated with OLS-defined oral malodor among Korean adults independent of known confounders. Periodontal conditions should be considered for clinical practice and research of oral malodor.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247947PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932065PMC
March 2021

'I was just doing what a normal gay man would do, right?': The biopolitics of substance use and the mental health of sexual minority men.

Health (London) 2021 Feb 25:1363459321996753. Epub 2021 Feb 25.

University of Toronto, Canada.

Drawing on 24 interviews conducted with gay, bisexual, queer and other men who have sex with men (GBM) living in Toronto, Canada, we examined how they are making sense of the relationship between their mental health and substance use. We draw from the literature on the biopolitics of substance use to document how GBM self-regulate and use alcohol and other drugs (AODC) as . Despite cultural understandings of substance use as integral to GBM communities and subjectivity, GBM can be ambivalent about their AODC. Participants discussed taking substances positively as a therapeutic mental health aid and negatively as being corrosive to their mental wellbeing. A fine line was communicated between substance use being self-productive or self-destructive. Some discussed having made 'problematic' or 'unhealthy' drug-taking decisions, while others presented themselves as self-controlled, responsible neoliberal actors doing 'what a normal gay man would do'. This ambivalence is related to the polarizing binary community and scientific discourses on substances (i.e. addiction/healthy use, irrational/rational, uncontrolled/controlled). Our findings add to the critical drug literature by demonstrating how reifying and/or dismantling the coherency of such substance use binaries can serve as a biopolitical site for some GBM to construct their identities and demonstrate healthy, 'responsible' subjectivity.
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http://dx.doi.org/10.1177/1363459321996753DOI Listing
February 2021

The Practice of Dentistry by Australian- and Overseas-Trained Dentists in Australia: Discriminant Analysis of key Predictors.

Int Dent J 2021 Feb 17. Epub 2021 Feb 17.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide, Australia.

Introduction: Overseas-trained dentists comprise at least one-fourth of the overall Australian dental workforce. This study examined characteristics and practice differences between Australian- and overseas-trained dentists to identify key predictors that best differentiate their dentistry practices.

Methods: Data for the study were from the Longitudinal Study of Dentist Practice Activity (LSDPA), a survey of a nationally representative random sample of dentists in Australia commencing in 1983-1984 and repeated every 5 years. Dentists were surveyed on a wide range of items including participant characteristics, practice patterns, practice inputs, direct demand, and productivity measures. Data were weighted to provide national estimates by age, sex, and practice type. Discriminant function analysis was used to examine the predictor variables that best distinguished between the two groups. Analysis was limited to the most recent wave of the study.

Results: A total of 1148 dentists (response rate = 67%) responded to the survey in 2009-2010; 648 cases were available for the discriminant analysis. The discriminant functions for the full sample and each of the 3 age groups (<35 years; 35-50 years; and 50+ years) were found effective to separate dentists into 2 groups (Australian and overseas), with the proportion of cases correctly classified being highest for the oldest age group (89.7% for 50+ years). Female gender, type of practice (working in public sector), and working in disadvantaged areas were significant predictors, with more prominence in the 35- to 50-year age group. Practice inputs, demand, and productivity measures offered less discriminative capacity between the dentists.

Conclusion: Overseas-trained dentists contribute towards providing dental care to underserved populations, the public sector, and in rural and remote locations. This study provided basis to argue that policies to encourage overseas-trained dentists to contribute towards areas of need locations have been successful, and key productivity measures were also similar to Australian-trained dentists.
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http://dx.doi.org/10.1016/j.identj.2021.01.002DOI Listing
February 2021

Predictors for oral and general health outcomes and quality of life among older people attending general practice clinics in South Australia.

Gerodontology 2021 Jan 21. Epub 2021 Jan 21.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia.

Background: As the proportion and number of older people in Australia continue to grow, innovative means to tackle primary care and prevention are necessary to combat the individual, social and economic challenges of non-communicable diseases.

Objective: To assess risk factors (or predictors) for oral and general health outcomes and quality of life of older people (75+ years.) attending general practice (GP) clinics in South Australia.

Methods: Data were collected from older people attending 48 GP clinics in metropolitan South Australia. Age, sex, education, living arrangement, material standards, chronic conditions and nutrition were assessed as risk factors. Global self-rated oral and general health and quality of life (OHIP Severity and EQ-5D Utility) were included as outcome measures.

Results: A total of 459 participants completed the study; response rate was 78%. In the adjusted models, high satisfaction with material standards and good nutritional health were positively associated with all four oral and general health measures. Sex (β = -0.08), age (β = -0.09) and number of chronic conditions (β = -0.12) were negatively associated with EQ-5D, while living arrangement (β = 0.07) was positively associated. Further, having four or more chronic conditions (RR:1.47) was significantly associated with self-rated general health.

Conclusion: Satisfaction with material standards and nutritional risk were consistent predictors for oral and general health outcomes and quality of life of older people visiting GP clinics.
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http://dx.doi.org/10.1111/ger.12534DOI Listing
January 2021

The long-term influence of orthodontic treatment on adults' psychosocial outcomes: Reflections and critique on a recent commentary.

Orthod Craniofac Res 2020 Oct 26. Epub 2020 Oct 26.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

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http://dx.doi.org/10.1111/ocr.12432DOI Listing
October 2020

Evaluation of the ECOHIS and the CARIES-QC among an Australian "Aboriginal" population.

Qual Life Res 2021 Feb 24;30(2):531-542. Epub 2020 Sep 24.

Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia.

Purpose: An evaluation of the reliability and validity of two child oral health-related quality of life (COHRQoL) measures among Australian Aboriginal children who participated in a randomised trial was undertaken.

Methods: Study participants completed the Early Childhood Oral Health Impact Scale (ECOHIS) and the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The questionnaires were completed a second time to test the scales' test-retest reliability. Internal consistency, convergent and discriminant validity were evaluated through Cronbach's alpha, correlation of the scale scores with the global oral health evaluation, and comparison of scale scores among children with varying levels of caries experience, respectively.

Results: Worse COHRQoL was reported by parents who rated their child's oral health as poor and by children who rated their teeth as being a lot of problem. Cronbach's alpha for the child impact section (CIS), family impact section (FIS), total ECOHIS score and the total CARIES-QC scale were 0.88, 0.81, 0.91 and 0.84, respectively. Spearman's correlations between scale scores and global oral health ratings of the CIS, FIS, total ECOHIS and the CARIES-QC were 0.42, 0.34, 0.45 and 0.70, respectively, p < 0.001. The Kruskal-Wallis test of scale scores with grouped caries experience was statistically significant, p < 0.005. Test-retest reliabilities for the ECOHIS were CIS ICC = 0.91, FIS ICC = 0.89, total ECOHIS ICC = 0.93 and for the CARIES-QC, ICC = 0.61.

Conclusions: Both the ECOHIS and the CARIES-QC were reliable and valid scales for use among an Australian Aboriginal population for assessing COHRQoL of preschool children.

Trial Registration: ACTRN12616001537448, date of registration-08 November 2016.
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http://dx.doi.org/10.1007/s11136-020-02646-8DOI Listing
February 2021

: Canadian Gay, Bisexual, and Queer Men's Willingness to Donate Blood If Eligible Despite Feelings of Policy Discrimination.

Qual Health Res 2020 12 4;30(14):2234-2247. Epub 2020 Sep 4.

Ryerson University, Toronto, Ontario, Canada.

Blood donation policies governing men who have sex with men have shifted significantly over time in Canada-from an initial lifetime ban in the wake of the AIDS crisis to successive phases of time-based deferment requiring periods of sexual abstinence (5 years to 1 year to 3 months). We interviewed 39 HIV-negative gay, bisexual, queer, and other sexual minority men (GBM) in Vancouver, Toronto, and Montreal to understand their willingness to donate blood if eligible. Transcripts were coded following inductive thematic analysis. We found interrelated and competing expressions of and . Most participants said they were "safe"/"low risk" and "willing" donors and would gain satisfaction and civic pride from donation. Conversely, a smaller group neither prioritized the collectivizing biological citizenship goals associated with expanding blood donation access nor saw this as part of sexual citizenship priorities. Considerable repair work is required by Canada's blood operators to build trust with diverse GBM communities.
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http://dx.doi.org/10.1177/1049732320952314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649935PMC
December 2020

: Canadian Gay, Bisexual, and Queer Men's Willingness to Donate Blood If Eligible Despite Feelings of Policy Discrimination.

Qual Health Res 2020 12 4;30(14):2234-2247. Epub 2020 Sep 4.

Ryerson University, Toronto, Ontario, Canada.

Blood donation policies governing men who have sex with men have shifted significantly over time in Canada-from an initial lifetime ban in the wake of the AIDS crisis to successive phases of time-based deferment requiring periods of sexual abstinence (5 years to 1 year to 3 months). We interviewed 39 HIV-negative gay, bisexual, queer, and other sexual minority men (GBM) in Vancouver, Toronto, and Montreal to understand their willingness to donate blood if eligible. Transcripts were coded following inductive thematic analysis. We found interrelated and competing expressions of and . Most participants said they were "safe"/"low risk" and "willing" donors and would gain satisfaction and civic pride from donation. Conversely, a smaller group neither prioritized the collectivizing biological citizenship goals associated with expanding blood donation access nor saw this as part of sexual citizenship priorities. Considerable repair work is required by Canada's blood operators to build trust with diverse GBM communities.
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http://dx.doi.org/10.1177/1049732320952314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649935PMC
December 2020

A descriptive analysis of an on-demand telehealth approach for remote COVID-19 patient screening.

J Telemed Telecare 2020 Jul 23:1357633X20943339. Epub 2020 Jul 23.

Georgetown University School of Medicine, Washington, D.C., USA.

COVID-19 requires methods for screening patients that adhere to physical distancing and other Centers for Disease Control and Prevention guidelines. There is little data on the use of on-demand telehealth to meet this need. The functional performance of on-demand telehealth as a COVID-19 remote patient screening approach was conducted by analysing 9270 patient requests. Most on-demand telehealth requests (5712 of 9270 total requests; 61.6%) had a visit reason that was likely COVID-19 related. Of these, 79.1% (4518 of 5712) resulted in a completed encounter and 20.9% (1194 of 5712) resulted in left without being seen. Of the 4518 completed encounters, 19.1% were referred to an urgent care centre, emergency department or COVID-19 testing centre. The average completed encounter wait time was 26.5 min and the mean visit length was 8.8 min. For patients that completed an encounter 42.8% (1935 of 4518) stated they would have sought in-person care and 9.1% stated they would have done nothing if on-demand telehealth was unavailable. On-demand telehealth can serve as a low-barrier approach to screen patients for COVID-19. This approach can prevent patients from visiting healthcare facilities, which reduces physical contact and reduces healthcare worker use of personal protective equipment.
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http://dx.doi.org/10.1177/1357633X20943339DOI Listing
July 2020

Are trust and satisfaction similar in dental care settings?

Community Dent Oral Epidemiol 2020 Dec 26;48(6):480-486. Epub 2020 Jun 26.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Objectives: Trust and satisfaction in dental care settings are salient constructs to operationalize the concept of dentist-patient relationships (DPR). This study aimed to compare the similarity of both constructs with regard to factor structure and revise the scales for better psychometric properties.

Methods: Data analysed in the study were collected in self-complete questionnaires from a random sample of 4011 adults living in South Australia. Trust and satisfaction were assessed using the Dentist Trust Scale and the Dental Care Satisfaction scale. Items in the scales were initially examined with a split-half sample in exploratory factor analysis and cluster analysis. Factor structures of different model designs were tested on the other half sample in confirmatory factor analysis. The final model was cross-validated on the first half sample for structural invariance.

Results: Exploratory factor analysis revealed a three-factor structure consisting of 'trust', 'satisfaction' and 'distrust/dissatisfaction' (60.2% of the variance explained; Cronbach's α = 0.94, 0.81, 0.73, respectively). Cluster analysis supported the factor solution with the same three major clusters except for a single-item independent branch of the 'cost' domain from the satisfaction scale. The final model was designed with two correlated but distinct factors, 'trust' and 'satisfaction', with the modification of one inter-item covariance and deleting the least associated item (GFI = 0.96, CFI = 0.98, RMSEA = 0.06). The stability of the final model was achieved through cross-validation (P = .143, ∆CFI < 0.001).

Conclusions: Trust and satisfaction in dental care settings are unidimensionally different yet highly correlated factors concurrently. Demonstrating the discriminant and complementary functions of both constructs can justify the rationale to apply them together in further studies for DPR.
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http://dx.doi.org/10.1111/cdoe.12559DOI Listing
December 2020

Oral hygiene behaviours among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

Aust Dent J 2020 06;65 Suppl 1:S79-S84

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, SA, Australia.

Background: This paper examines oral hygiene behaviours (tooth brushing, mouthwash use and dental floss) by a range of explanatory variables.

Methods: Explanatory variables included age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data reported were collected in the interview survey in NSAOH 2017-18.

Results: A higher percentage of females brushed with toothpaste at least daily (98.0%) and used floss in the last week (62.6%) than males (94.6% and 48.5% respectively). There was an income gradient in tooth brushing. Higher percentages brushed in the high income (96.8%) than middle (96.2%) and low-income tertiles (93.6%). A higher percentage of the high-income tertile (58.2%) flossed than the lower tertile (53.3%). Those with unfavourable visit patterns had lower percentages who brushed daily (92.7%) than the intermediate (96.7%) or favourable (98.2%) groups. There was a gradient in flossing by visiting, with a lower percentage flossing for the unfavourable visiting group (38.5%) than for the intermediate (52.8%) or favourable groups (67.6%).

Conclusions: Oral hygiene behaviours were associated with gender, socioeconomic status and dental visiting. A higher percentage of women brushed and flossed than men. Lower socioeconomic status and those with unfavourable visiting patterns had lower frequencies of brushing and flossing.
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http://dx.doi.org/10.1111/adj.12769DOI Listing
June 2020

Oral health impacts among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

Aust Dent J 2020 06;65 Suppl 1:S59-S66

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Background: This paper examines oral health impacts of toothache experience, self-rated oral health (SROH), being uncomfortable with dental appearance, and avoiding foods in the Australian adult population.

Methods: The explanatory variables include age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data were collected in the interview in NSAOH 2017-18.

Results: There were lower percentages with: toothache in the highest (14.8%) than middle (21.2%) and lower income tertiles (25.2%); fair/poor SROH in the highest (15.8%) than middle (24.1%) and lower tertiles (34.8%); uncomfortable with appearance in the highest (29.1%) than middle (35.3%) and lower tertiles (42.2%); and food avoidance in the higher (15.3%) than middle (22.9%) and lower tertiles (34.4%). There were higher percentages with: toothache in the unfavourable (32.2%) than intermediate (23.1%) and favourable (11.7%) visiting groups; fair/poor SROH in the unfavourable (44.0%) than intermediate (27.4%) or favourable (10.2%) groups; being uncomfortable about appearance in the unfavourable (47.6%) than intermediate (39.5%) or favourable (25.8%) groups; and avoiding foods in the unfavourable (34.8%) than intermediate (26.0%) or favourable (14.5%) groups.

Conclusions: Socioeconomic status and dental visiting were associated with oral health impacts. Oral health impacts were worse for those with lower income and unfavourable visiting patterns.
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http://dx.doi.org/10.1111/adj.12766DOI Listing
June 2020

Guest Editorial.

Aust Dent J 2020 06;65 Suppl 1:S3-S4

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http://dx.doi.org/10.1111/adj.12770DOI Listing
June 2020

Use of dental services among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

Aust Dent J 2020 06;65 Suppl 1:S71-S78

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Background: This study examines last dental visit (visiting within the last 12 months, having a last visit 5 or more years ago, attending a private dental practice) and usual visit (usually visiting for a check-up, having a dentist they usually attend).

Methods: Explanatory variables include age, gender, region, income, area-based SES and dental insurance. The data were collected in the Interview in NSAOH 2017-18.

Results: There was a dental visiting gradient by region, with lower percentages visiting in the last 12 months in remote (44.9%) and regional areas (50.8%) than major cities (58.7%). A higher percentage of the higher-income tertile made visits (63.8%) than the middle (53.7%) and lower tertiles (49.9%). There was a visiting gradient by area-based SES, with higher percentages in the higher (63.8%) and middle SES tertiles (55.2%) than the lower tertile (50.2%). Uninsured persons had lower percentages visiting (43.3%) than insured (69.7%).

Conclusions: Persons in remote locations, those with low socioeconomic status and those uninsured were disadvantaged in terms of access. They had lower percentages visiting in the last 12 months, usually visiting for a check-up, having a dentist they usually attend and higher percentages visiting 5 or more years ago.
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http://dx.doi.org/10.1111/adj.12768DOI Listing
June 2020

Oral health policymaking challenges in Iran: a qualitative approach.

BMC Oral Health 2020 06 1;20(1):158. Epub 2020 Jun 1.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: As the strategies proposed for oral health improvement in developed countries are not adapted for developing ones, this study aimed to identify the challenges of oral health policy implementation in Iran as a low-income developing country.

Methods: This qualitative study was conducted in 2019 in Iran as a middle-eastern developing country. The study population consisted of experts who had experience in oral health and were willing to participate in the study. Snowball sampling was used to select 12 participants for semi-structured interviews and saturation was achieved after 16 interviews. Guba and Lincoln criteria including credibility, transferability, confirmability and dependability were used to determine reliability and transparency, and finally a five-step framework analysis method was used to analyze the data.

Results: The analysis of the interviews resulted in identification of 7 main themes that were categorized into 5 problems of policy implementation as proposed by the Matus framework. The main themes of executive and preventive challenges to implement oral health policies were categorized as organizational problems, the main themes of educational and resource challenges were situated as material problems, and the main themes of insurance, policy making and trusteeship challenges were considered as legal, policymaking and perspective.

Conclusion: The implementation of oral health policies has faced some challenges. It seems that the national coverage of oral health and integration of these services in prevention and serious attention to the private sector can be considered as the most important strategies for achieving improved oral health in Iran.
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http://dx.doi.org/10.1186/s12903-020-01148-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268740PMC
June 2020

A real-time measurement of general practice workload in the Republic of Ireland: a prospective study.

Br J Gen Pract 2020 Jul 25;70(696):e489-e496. Epub 2020 Jun 25.

Trinity College Dublin GP Training Scheme, Dublin.

Background: Demand for GP services in the Republic of Ireland (RoI) is increasing, and the resultant escalation in workload demands is an issue of growing concern. Accordingly, the accurate measurement and description of GP workload is essential to inform future healthcare planning.

Aim: To provide a real-time measurement of GP workload with respect to hours worked and of proportional time expenditure on typical workload activities.

Design And Setting: A prospective study among GPs in the RoI that took place from January 2019 to March 2019.

Method: Participants were invited to enrol in the study by direct email invitation and via notifications posted within GP-specific monthly journals; online forums; and a social media platform. Participants used a time-management software program to self-record workload activity in real time over 6 weeks.

Results: In total, 123 GPs were included for final analyses with a total of 8930 hours of activity recorded. The mean duration of a two-session day (excluding break-time) was 9.9 hours (95% confidence interval [CI] = 9.7 to 10.0; interquartile range [IQR] 7.9 to 13.9). Of this time, 64% was spent on clinical consultations. In total, 25.4% of activity was recorded outside the hours of 9.00 am and 5.00 pm. An average of 12.4 face-to-face consultations were completed per session of activity. The mean duration of a 10-session week was greatest for the partner (50.8 hours; 95% CI = 49.8 to 51.9) and >55-year-old (50.8 hours; 95% CI = 49.3 to 52.2) demographics, relative to their respective colleagues.

Conclusion: To the authors' knowledge, this is the first study to provide an objective, accurate, and granular real-time measurement of GP workload in the RoI, demonstrating the significant volume and variety of work undertaken by GPs in the RoI.
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http://dx.doi.org/10.3399/bjgp20X710429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274543PMC
July 2020

Measuring Adverse Childhood Experiences: Comparing Individual, Composite, Score-based and Latent Profile-based Scoring Schemas Among Gay, Bisexual, and Other Men Who Have Sex with Men.

Arch Sex Behav 2020 07 8;49(5):1741-1754. Epub 2020 May 8.

Department of Psychology, Ryerson University, Toronto, ON, M5B 2K3, Canada.

Adverse childhood experiences (ACEs; e.g., neglect, sexual abuse) among gay, bisexual, and other men who have sex with men (GBM) may not occur in isolation, but may be connected and occur in clusters. Most studies have measured ACEs individually, hierarchically, additively, or in a binary fashion (presence or absence of ACEs), rather than treating them as connected and clustered. This study examined these competing approaches of scoring ACEs and their relative power at predicting health outcomes. We examined abuse (sexual, physical, and emotional) and neglect (physical and emotional) experiences among a non-random sample of 470 Toronto GBM using the Childhood Trauma Questionnaire Short Form subscales. We compared five scoring schemas: (1) five individual scores for each form of maltreatment; (2) a composite score summing all of the maltreatment scores; (3) a hierarchical regression model with sexual abuse entered first then followed by physical abuse, emotional abuse, physical neglect, and emotional neglect; (4) a severity-based categorization; and (5) a latent profile-based categorization. Experiences of abuse and neglect were not uncommon (22-33%) and some participants experienced multiple forms of abuse and neglect (r = .33-.65, df = 464-467; p < .001; shared variance, r = 11-43%). Results show the dose-response effects of ACEs and highlight the importance of examining ACEs in clusters rather than individually. Latent profile analysis identified GBM who experienced multiple and frequent ACEs, and also identified the types of ACEs they experienced: crucial information that was obscured in score-based or severity-based approaches.
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http://dx.doi.org/10.1007/s10508-020-01719-6DOI Listing
July 2020

The long-term influence of orthodontic treatment on dental knowledge and behaviour: An Australian cohort study.

J Dent 2020 09 24;100:103345. Epub 2020 Apr 24.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Corner North Terrace and George Street, Adelaide, SA 5000, Australia. Electronic address:

Objectives: Fixed orthodontic treatment (FOT) typically lasts 14-33 months, with regular appointments at short intervals to monitor changes, adjust appliances, and remotivate patients to maintain excellent oral hygiene standards to prevent dental disease. Past experiences are important influencers of dental attitudes and self-care dental behaviours in adulthood. Since FOT comprises a high frequency of appointments compared to other dental visiting, we hypothesised that previous FOT enhances dental knowledge and behaviour in later life.

Methods: This cohort study followed-up 30-year-old participants who originally took part in an oral epidemiological study when aged 13-years. Participants completed a questionnaire regarding sociodemographics, dental health behaviours, dental knowledge (prevention of caries and periodontal disease, including questions about popular myths) and FOT. Data analysis comprised un/adjusted binomial logistic regression and multivariate generalised linear regression.

Results: Data for 448 participants (56 % female, 35 % received FOT) were analysed; adjusted models controlled for sociodemographics and baseline malocclusion severity. There was no association between FOT and regular toothbrushing (Exp B: 1.35, 95% CI: 0.87-2.10), flossing (Exp B: 1.18, 95 % CI: 0.48-2.90), dental attendance within last 2 years (Exp B: 0.96, 95 % CI: 0.62-1.49) or a non-emergency dental visit (Exp B: 1.01, 95 % CI: 0.51-1.99). Non-FOT participants placed importance on a calcium-rich diet preventing caries (Exp B: 1.99, 95 % CI: 1.14-3.50, P < 0.05), while those with a baseline definite malocclusion had higher levels of knowledge about dental visiting compared to those with minimal or more severe malocclusions (P < 0.05).

Conclusion: Previous FOT appears to have limited impact on dental knowledge and may not affect long-term dental behaviours.

Clinical Significance: This 17-year follow-up study examined the influence of previous fixed orthodontic treatment on dental knowledge and behaviour later in life. Although patients have numerous and regular appointments during the course of orthodontic treatment, this does not seem to impact on either dental knowledge or behaviour in adulthood.
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http://dx.doi.org/10.1016/j.jdent.2020.103345DOI Listing
September 2020

Dentist-patient relationships and oral health impact in Australian adults.

Community Dent Oral Epidemiol 2020 08 13;48(4):309-316. Epub 2020 Apr 13.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Objectives: Dentist-patient relationships (DPRs) are a key component in clinical encounters with potential benefits for oral health outcomes. This study aimed to investigate whether better DPR variables are associated with higher oral health-related quality of life (OHRQoL).

Methods: A total of 12 245 adults aged 18 years or over were randomly sampled from South Australia in 2015-2016. Data were collected from self-complete questionnaires and analysed as a cross-sectional design. The outcome variable was the Oral Health Impact Profile (OHIP-14). Explanatory DPR variables included trust in dentists, satisfaction with dental care, and dental fear. Covariates comprising oral health behaviours, dental services, demographics, and socioeconomic status were included as potential confounding variables. Bivariate correlation analyses and multivariable linear regression were performed for the associations among explanatory, outcome variables and other covariates.

Results: Response data were analysed from 4220 participants (response rate = 41.9%). Unadjusted mean total scores of DPR variables and OHIP-14 were associated with most of the study participants' characteristics (P < .05). Bivariate correlations among DPR variables and OHIP-14 showed a diverse range of coefficients (|r| or |ρ|=0.22-0.67). Multivariable regression analyses in both individual/clustered block entry and full model indicated that higher satisfaction and less dental fear (B = -0.039 and 0.316, respectively in the full model) were associated with lower OHIP-14 after adjusting for possible confounders (P < .01).

Conclusions: This study found that favourable DPR variables, mainly greater satisfaction and less dental fear are positively associated with better OHRQoL. Further studies are warranted to investigate the causality and mediation/moderation of DPR variables on oral health outcomes.
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http://dx.doi.org/10.1111/cdoe.12534DOI Listing
August 2020

Trust in dentist-patient relationships: mapping the relevant concepts.

Eur J Oral Sci 2020 04 10;128(2):110-119. Epub 2020 Mar 10.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Trust has a central role in healthcare encounters. This review explored concepts relevant to trust in dentist-patient relationships. The findings were demonstrated by drawing visual system maps for better understanding of the inherent complexity. A pragmatic approach was employed to search for evidence. The approach was initiated with a systematised searching protocol and followed by an iterative process of drawing maps and complementing references. The analysis-synthesis process found relevant key concepts and sub-concepts presented within three frameworks: the continuum of studying trust (utilisation, measurement, and establishment); beneficiaries of trust utilisation (patients, dentists, and oral health system); and a transformational model of trust development (identification-based, knowledge-based, and deterrence/calculus-based trust). Trust in dentist-patient relationships needs to be assessed in a multidisciplinary approach for interconnectedness among relevant concepts. The findings are represented in patient-centred care and quality of care with common underlying values. Despite the centrality of trust in medical/dental contexts, empirical evidence is insufficient beyond normative suggestions from previous studies. Based on the implications of thematic analysis and interpretation of the system maps, this paper can serve as a guide and source of information for further research of trust in dentist-patient relationships.
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http://dx.doi.org/10.1111/eos.12686DOI Listing
April 2020

Mental health and structural harm: a qualitative study of sexual minority men's experiences of mental healthcare in Toronto, Canada.

Cult Health Sex 2021 Jan 3;23(1):98-114. Epub 2019 Dec 3.

Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Compared to the general population, sexual minority men report poorer mental health outcomes and higher mental healthcare utilisation. However, they also report more unmet mental health needs. To better understand this phenomenon, we conducted qualitative interviews with 24 sexual minority men to explore the structural factors shaping their encounters with mental healthcare in Toronto, Canada. Interviews were analysed using grounded theory. Many participants struggled to access mental healthcare and felt more marginalised and distressed because of two interrelated sets of barriers. The first were , hurdles to mental healthcare not exclusive to sexual minorities. These included financial and logistical obstacles, the prominence of psychiatry and the biomedical model, and unsatisfactory provider encounters. The second were , obstacles explicitly rooted in heterosexism and homophobia sometimes intersecting with other forms of marginality. These included experiencing discrimination and distrust, and limited sexual minority affirming options. Discussions of general barriers outweighed those of sexual minority barriers, demonstrating the health consequences of structural harms in the absence of overt structural stigma. Healthcare inaccessibility, income insecurity and the high cost of living are fostering poor mental health among sexual minority men. Research must consider the upstream policy changes necessary to counteract these harms.
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http://dx.doi.org/10.1080/13691058.2019.1692074DOI Listing
January 2021

Validation of the Health Literacy in Dentistry scale in Brazilian adults.

Int Dent J 2020 Apr 2;70(2):116-126. Epub 2019 Dec 2.

Adelaide Dental School, Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia.

Objectives: To perform cross-cultural adaptation and validation of the Health Literacy Dental scale (HeLD) in Brazilian adults.

Methods: The HeLD instrument was translated and cross-culturally adapted to the Brazilian Portuguese language to create longer (HeLD-29) and shorter (HeLD-14) versions. The reliability and validity of these versions were assessed in a sample of 603 adults living near six primary care units in the city of Piracicaba, São Paulo, Brazil.

Results: Both versions of HeLD demonstrated high internal reliability, acceptable convergent validity and discriminant validity. However, the confirmatory factor analysis showed that only HeLD-14 demonstrated satisfactory goodness of fit. There were associations between HeLD-14 scores and social demographic characteristics, general and oral health and oral health-related behaviours. Higher scores were observed for the total HeLD-14 and/or individual components of HeLD-14 among women, ethnic white subjects, those with high educational attainment, those with higher income, those reporting toothbrushing twice or more daily, regular dental attenders, those who usually attended for dental care for a check-up, those with excellent or very good self-ratings of general health, those with excellent or very good self-ratings of oral health, and those without tooth extraction and oral health impact.

Conclusion: The Brazilian version of HeLD-14 was demonstrated to be a reliable and valid instrument for measuring broad aspects of oral health literacy in the adult Brazilian population.
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http://dx.doi.org/10.1111/idj.12531DOI Listing
April 2020

A characterization of ABL-101 as a potential tracer for clinical fluorine-19 MRI.

NMR Biomed 2020 01 13;33(1):e4212. Epub 2019 Nov 13.

Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.

The two main challenges that prevent the translation of fluorine-19 ( F) MRI for inflammation monitoring or cell tracking into clinical practice are (i) the relatively low signal-to-noise ratio generated by the injected perfluorocarbon (PFC), which necessitates long scan times, and (ii) the need for regulatory approval and a high biocompatibility of PFCs that are also suitable for MRI. ABL-101, an emulsion of perfluoro(t-butylcyclohexane), is a third-generation PFC that is already used in clinical trials, but has not yet been used for F MRI. The objective of this study was therefore to assess the performance of ABL-101 as a F MRI tracer. At magnetic field strengths of 3, 9.4 and 14.1 T, the CF groups of ABL-101 generated a large well-separated singlet with T /T ratios of >0.27, >0.14 and > 0.05, respectively. All relaxation times decreased with the increase in magnetic field strength. The detection limit of ABL-101 in a 0.25 mm voxel at 3 T, 37°C and with a 3-minute acquisition time was 7.21mM. After intravenous injection, the clearance half-lives of the ABL-101 F MR signal in mouse (n = 3) spleen and liver were 6.85 ± 0.45 and 3.20 ± 0.35 days, respectively. These results demonstrate that ABL-101 has F MR characteristics that are similar to those of PFCs developed specifically for MRI, while it has clearance half-lives similar to PFCs that have previously been used in large doses in non-MRI clinical trials. Overall, ABL-101 is thus a very promising candidate tracer for future clinical trials that use F MRI for cell tracking or the monitoring of inflammation.
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http://dx.doi.org/10.1002/nbm.4212DOI Listing
January 2020

Microarray Embedding/Sectioning for Parallel Analysis of 3D Cell Spheroids.

Sci Rep 2019 11 8;9(1):16287. Epub 2019 Nov 8.

Department of Biomedical Engineering, Rowan University, Glassboro, NJ, USA.

Three-dimensional cell spheroid models can be used to predict the effect of drugs and therapeutics and to model tissue development and regeneration. The utility of these models is enhanced by high throughput 3D spheroid culture technologies allowing researchers to efficiently culture numerous spheroids under varied experimental conditions. Detailed analysis of high throughput spheroid culture is much less efficient and generally limited to narrow outputs, such as metabolic viability. We describe a microarray approach that makes traditional histological embedding/sectioning/staining feasible for large 3D cell spheroid sample sets. Detailed methodology to apply this technology is provided. Analysis of the technique validates the potential for efficient histological analysis of up to 96 spheroids in parallel. By integrating high throughput 3D spheroid culture technologies with advanced immunohistochemical techniques, this approach will allow researchers to efficiently probe expression of multiple biomarkers with spatial localization within 3D structures. Quantitative comparison of staining will have improved inter- and intra-experimental reproducibility as multiple samples are collectively processed, stained, and imaged on a single slide.
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http://dx.doi.org/10.1038/s41598-019-52007-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841729PMC
November 2019

Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play.

Int J Drug Policy 2019 12 15;74:181-190. Epub 2019 Oct 15.

School of Public Health, Rutgers University, Piscataway, NJ, United States.

Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.
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http://dx.doi.org/10.1016/j.drugpo.2019.09.015DOI Listing
December 2019

A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning.

Health Policy 2019 11 23;123(11):1068-1075. Epub 2019 Jul 23.

Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom.

Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -"strife of interests" - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be diverse and dependent on country- or context-specific scenarios.
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http://dx.doi.org/10.1016/j.healthpol.2019.07.010DOI Listing
November 2019

Gay and bisexual men's views on reforming blood donation policy in Canada: a qualitative study.

BMC Public Health 2019 Jun 17;19(1):772. Epub 2019 Jun 17.

HIV Prevention Lab, Department of Psychology, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada.

Background: Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months.

Methods: To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada's three largest cities: Vancouver, (n = 17), Toronto (n = 15), and Montreal (n = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men's preferred policy directions and their opinions about a policy change proposed by Canada's blood operators: a 3-month deferral for all sexual activity between men. We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada.

Results: Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the "same for everyone" and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple "gender blind" and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) step in the right direction; (2) ambivalence and uncertainty; and (3) not an improvement.

Conclusion: A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.
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http://dx.doi.org/10.1186/s12889-019-7123-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580549PMC
June 2019

Comparative Longitudinal Study on the Impact Root Canal Treatment and Other Dental Services Have on Oral Health-related Quality of Life Using Self-reported Health Measures (Oral Health Impact Profile-14 and Global Health Measures).

J Endod 2019 Aug 13;45(8):985-993.e1. Epub 2019 Jun 13.

Adelaide Dental School, Adelaide, Australia. Electronic address:

Introduction: The literature assessing quality of life for subjects who have undergone root canal treatment (RCT) is scarce. The aim of this study was to compare the effect of RCT with other dental services (exodontia, restorative, prosthodontics, periodontics, and negative controls [preventative and scale and clean]) on oral health-related quality of life.

Methods: A random sample of 3000 adults aged 30-61 years was obtained from the Australian electoral roll in 2009. Data were collected through questionnaires, dental service logbooks, and treatment receipts. The impact their dentition had at baseline and the 2-year follow-up for the Oral Health Impact Profile-14 and the self-rated dental health score followed by "global transition statement of change" (GTSC) was assessed. Binary regression models were used to compare the outcomes.

Results: Responses were collected from 1096 respondents (response rate = 36.5%). After adjustment (for age, sex, household income, and reason for visit), the RCT group had significant differences (P ≤ .05) to other dental services at the 2-year follow-up using the Oral Health Impact Profile-14 (odds ratio = 0.34; 95% confidence interval, 0.12-0.96) and GTSC (odds ratio = 0.29; 95% confidence interval, 0.09-0.88) but not with individual treatment groups. Using the self-rated dental health score/GTSC, only the prosthodontic treatment group had a significant difference to the RCT group at baseline, whereas the negative controls (P ≤ .01) had significant differences to the RCT group with the odds for improved health 5 times higher, at 2-year follow-up.

Conclusions: The RCT group presented with similar oral health-related quality of life when compared with the other individual treatment groups; however, they consistently reported poorer oral health outcomes when the negative controls were included.
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http://dx.doi.org/10.1016/j.joen.2019.05.002DOI Listing
August 2019