Publications by authors named "Lisa Jamieson"

182 Publications

Associations between dental care approachability and dental attendance among women pregnant with an Indigenous child: a cross-sectional study.

BMC Oral Health 2021 Sep 17;21(1):451. Epub 2021 Sep 17.

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

Background: Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child.

Methods: Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR).

Results: Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74-0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06-1.45).

Conclusion: Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease.
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http://dx.doi.org/10.1186/s12903-021-01816-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446472PMC
September 2021

"What are we doing to our babies' teeth?" Barriers to establishing oral health practices for Indigenous children in South Australia.

BMC Oral Health 2021 Sep 6;21(1):434. Epub 2021 Sep 6.

Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, 5000, Australia.

Background: During the 1970s, optimal oral health was experienced more frequently amongst Indigenous children in Australia than their non-Indigenous counterparts. As a result of public health interventions targeting oral disease, oral health has improved for most children; however, Indigenous children today experience oral disease at alarmingly high rates. A history of colonisation, assimilation, racism and cultural annihilation has had profound impacts on oral health for Indigenous peoples; compounded by environmental dispossession and a shift from traditional diets to one of processed and nutrient-poor foods, often high in sugar.

Methods: This project aimed to identify factors related to the increased occurrence of caries in Indigenous children. Using purposive sampling from the larger project, this paper thematically analyses 327 motivational interviews to explore current barriers impeding parental efforts to establish oral health and nutrition practices for Indigenous children. Representation of socioeconomic positions of families were compared across themes, as based on maternal age, employment, residency and number of children in care.

Results: Findings resulted in a conceptual model of barriers that exist across knowledge, social, structural and parental factors. Major thematic results include: social consumption of processed foods, busy households, misleading nutrition marketing, sugar cravings and lack of oral health and nutrition knowledge.

Conclusion: A discussion of the findings results in the following recommendations increased oral health promotion efforts in non-metropolitan areas; utilisation of community experiences in creating strategies that encourage oral health and nutrition knowledge; and the extension of oral health initiatives and future research to include all family members. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12611000111976; registered 01/02/2011.
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http://dx.doi.org/10.1186/s12903-021-01791-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422744PMC
September 2021

Exploratory Graph Analysis of the Strengths and Difficulties Questionnaire for Aboriginal and/or Torres Strait Islander Children.

Front Psychol 2021 18;12:573825. Epub 2021 Aug 18.

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

In Australia, one of the most frequently used measures for assessing social and emotional well-being (SEWB) of Aboriginal and/or Torres Strait Islander children is the Strengths and Difficulties Questionnaire (SDQ). Previous studies on state-level validations have indicated the problems associated with the original five-factor SDQ structure, especially in the dimension of Peer Problems. The aim of this study was to use a novel psychometric methodology, namely Exploratory Graph Analysis (EGA), to evaluate the dimensionality of caregiver-informant SDQ version 4-10 years at a national level in Australia. Data for this study were retrospectively collected from two independent longitudinal studies: the Longitudinal Study of Indigenous Children (LSIC) and South Australian Aboriginal Birth Cohort (SAABC). The caregiver-informed SDQ version 4-10 years was applied across several study waves, including more than 4,000 responses. To conduct EGA, Gaussian graphical models (GGMs) were estimated using the Least Absolute Shrinkage and Selection Operator. About 2,500 bootstrap samples were also employed to investigate dimensions and item stability. The findings indicated robust evidence against the construct validity of the original five-factor SDQ structure. Future studies should conduct a direct external validation of the findings with Aboriginal and/or Torres Strait Islander parents/carers and community groups to develop the guidelines for future use of the instrument among Aboriginal and/or Torres Strait Islander children in Australia.
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http://dx.doi.org/10.3389/fpsyg.2021.573825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416422PMC
August 2021

Addressing the oral health workforce needs of Aboriginal and Torres Strait Islander Australians.

Aust Health Rev 2021 Aug;45(4):407-410

Adelaide Dental School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia. Email:

Tooth decay and gum disease, the main dental diseases affecting Australians, can cause pain and deformity as well as affecting eating and speech. Dental practitioners are efficient and effective in relieving dental pain, and they can effectively restore oral function. There is good evidence that better health care outcomes for Aboriginal and Torres Strait Islander patients are associated with care from Aboriginal and Torres Strait Islander health professionals. Unfortunately, the representation of Aboriginal and Torres Strait Islander people within the dental practitioner workforce is very low. We argue that a strategic approach, along with additional investment, is needed to increase the number of Aboriginal and Torres Strait Islander people qualified as dental practitioners.
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http://dx.doi.org/10.1071/AH20295DOI Listing
August 2021

Population-based utility scores for HPV infection and oropharyngeal squamous cell carcinoma among Indigenous Australians.

BMC Public Health 2021 07 26;21(1):1455. Epub 2021 Jul 26.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health & Medical Sciences Building, Adelaide, 5005, Australia.

Background: Oropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals' preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians.

Methods: Development and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test.

Results: Data from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91-0.92 in 'screened, cytology normal, HPV vaccination' and 'screened, HPV positive, endoscopy normal', to less than 0.90 (ranging from 0.87-0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75-0.79) in 'early stage throat cancer'. Higher utility scores were observed for 'screened, cytology normal and HPV vaccination' among younger participants (18-40 years), for 'early stage invasive throat cancer' among females, and for 'oral intraepithelial neoplasia' and 'early stage invasive throat cancer' among metropolitan-dwelling participants.

Conclusion: Among a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians.
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http://dx.doi.org/10.1186/s12889-021-11496-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314643PMC
July 2021

Use of oral health care services in the United States: unequal, inequitable-a cross-sectional study.

BMC Oral Health 2021 07 23;21(1):370. Epub 2021 Jul 23.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, 5005, Australia.

Background: Social determinants drive disparities in dental visiting. Disparities can be measured simply by comparing outcomes between groups (inequality) but can also consider concepts of social justice or fairness (inequity). This study aimed to assess differences in dental visiting in the United States in terms of both social inequality and inequity.

Methods: Data were obtained from a cross-sectional study-the National Health and Nutrition Examination Survey (NHANES) 2015-2016, and participants were US adults aged 30+ years. The outcome of interest, use of oral health care services, was measured in terms of dental visiting in the past 12 months. Disparity was operationalized through education and income. Other characteristics included age, gender, race/ethnicity, main language, country of birth, citizenship and oral health status. To characterize existing inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration index (ACI and RCI), the slope index of inequality (SII) and relative index of inequality (RII) and through concentration curves (CC). Indirect standardization with a non-linear model was used to measure inequity.

Results: A total of 4745 US adults were included. Bivariate analysis showed a gradient by both education and income in dental visiting, with a higher proportion (> 60%) of those with lower educational attainment /lower income having not visited a dentist. The concentration curves showed pro-higher education and income inequality. All measures of absolute and relative indices were negative, indicating that from lower to higher socioeconomic position (education and income), the prevalence of no dental visiting decreased: ACI and RCI estimates were approximately 8% and 20%, while SII and RII estimates were 50% and 30%. After need-standardization, the group with the highest educational level had nearly 2.5 times- and the highest income had near three times less probability of not having a dental visit in the past 12 months than those with the lowest education and income, respectively.

Conclusion: The findings indicate that use of oral health care is threatened by existing social inequalities and inequities, disproportionately burdening disadvantaged populations. Efforts to reduce both oral health inequalities and inequities must start with action in the social, economic and policy spheres.
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http://dx.doi.org/10.1186/s12903-021-01708-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299583PMC
July 2021

Population-based utility scores for HPV infection and cervical squamous cell carcinoma among Australian Indigenous women.

PLoS One 2021 22;16(7):e0254575. Epub 2021 Jul 22.

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

Objective: Working in partnership with Indigenous communities in South Australia, we aimed to develop, pilot test and estimate utility scores for health states relating to cervical cancer screening, precancer, and invasive cervical cancer and precancer/cancer treatment among Indigenous women.

Methods: Development and pilot testing of hypothetical cervical cancer health states, specifically through the lens of being an Indigenous Australian woman, was done with an Indigenous Reference Group in conjunction with five female Indigenous community members. Six health states were developed. These included: (1) Screened: cytology normal; (2) human papillomaviruses (HPV) positive with cytology normal; (3) low grade cytology (LSIL);(4) high grade cytology (HSIL); (5) early stage cervical cancer and; (6) later stage cervical cancer. Utility scores were calculated using a two-stage standard gamble approach among a large cohort of Indigenous Australian women taking part in a broader study involving oral HPV infection. The mean and standard deviation (SD) of the rank, percentage of respondents with a utility = 1 (perfect health) and utility score of each health state was summarised. Mean (SD) and medians and inter-quartile range (IQR) over 12 months and lifetime duration were calculated. Potential differences by age and residential location were assessed using the Wilcox Sum Rank test.

Results: Data was obtained from 513 Indigenous women aged 19+ years. Mean utility scores were higher for the four non-cancer health states than for invasive cervical cancer states (p-values <0.05). Lower mean utility scores were observed for late stage cervical cancer, with 0.69 at 12 months and 0.70 for lifetime duration (Intra-class correlation coefficients = 0.425). Higher utility scores were observed for the four non-cancer health states among non-metropolitan participants (ranged from 0.93 to 0.98) compared with metropolitan participants (ranged from 0.86 to 0.93) (p-values<0.05).

Conclusion: Among a large cohort of Indigenous Australian women, the reduction in quality of life (which utilities reflect) was perceived to be greater with increasing severity of cervical cancer health states. There were differences observed by geographic location, with positive cervical screening and precursor cancer-related quality of life being much higher among non-metropolitan-dwelling participants. These utility values, from one of the largest such studies ever performed in any population will be uniquely able to inform modelled evaluations of the benefits and costs of cervical cancer prevention interventions in Indigenous women.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254575PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298063PMC
July 2021

Dietary Intake and Anthropometric Measurement at Age 36 Months Among Aboriginal and/or Torres Strait Islander Children in Australia: A Secondary Analysis of the Baby Teeth Talk Randomized Clinical Trial.

JAMA Netw Open 2021 Jul 1;4(7):e2114348. Epub 2021 Jul 1.

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

Importance: Interventions to reduce early childhood caries should be examined for their effects on anthropometry given their design to improve children's diets.

Objective: To compare the outcomes of dietary intake, anthropometric measurements, and blood pressure measurements between children at age 36 months in the immediate intervention group vs those in the delayed intervention group.

Design, Setting, And Participants: This secondary analysis was a follow-up to the 2-group Baby Teeth Talk randomized clinical trial conducted across the state of South Australia, Australia. Participants were Aboriginal and/or Torres Strait Islander children and their caregivers who were randomized to the immediate intervention group or delayed intervention group. The intervention was provided from February 1, 2011, to May 31, 2012. The prespecified follow-up when the participating children were aged 36 months was conducted from November 1, 2014, to February 28, 2016, in participant homes or public locations. Data were analyzed from October 5, 2018, to April 29, 2019.

Interventions: The immediate intervention group received the intervention during pregnancy and at 6, 12, and 18 months of age. The delayed intervention group received the intervention at 24, 30, and 36 months of age. Both groups received an intervention consisting of free dental care for mothers, fluoride varnish on children's teeth, anticipatory guidance on oral health and dietary advice, and motivational interviewing.

Main Outcomes And Measures: Dietary intake was measured with a caregiver-completed, 17-item food frequency questionnaire. Frequency of consumption of discretionary foods and beverages were the main dietary outcomes. Children's weight, height, and mid-upper arm circumference were measured and converted to age- and sex-specific z scores. Body mass index z score was the main anthropometric outcome.

Results: A total of 330 children were followed up to age 36 months among the 448 mothers and 454 children who were randomized to the 2 groups. At baseline, the women had a mean (SD) age of 24.9 (5.9) years, and the children had a mean (SD) weight of 3.3 (0.6) kilograms at birth, and 205 were boys (46%); sex was not recorded for 63 children (14%). Diet outcomes were similar between the groups. For example, the mean (SD) intake of discretionary beverages by the immediate intervention group was similar to that by the delayed intervention group (507 [536] mL/d vs 520 [546] mL/d; adjusted mean difference [MD], -16 [95% CI, -133 to 102] mL/d; P = .79). Height was similar between the 2 groups, but the mean (SD) z scores of weight (0.7 [1.0] vs 0.4 [1.0]; adjusted MD, 0.3 [95% CI, 0.1-0.5]; P = .02), arm circumference (1.6 [1.0] vs 1.3 [0.9]; adjusted MD, 0.2 [95% CI, 0.1-0.5]; P = .03), and body mass index (1.1 [1.1] vs 0.9 [0.9]; adjusted MD, 0.2 [95% CI, 0.0-0.4]; P = .04) were higher in the immediate intervention group than the delayed intervention group.

Conclusions And Relevance: This study found no differences in dietary intakes between children who received an intervention to reduce dental caries early and those who received it later. At age 36 months, children in the immediate intervention group had greater z scores for weight, arm circumference, and body mass index than their counterparts in the delayed intervention group, suggesting a potential implication of oral health interventions for anthropometric outcomes.

Trial Registration: ANZCTR Identifier: ACTRN12611000111976.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.14348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267605PMC
July 2021

Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review.

BMJ Open 2021 06 30;11(6):e050113. Epub 2021 Jun 30.

Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.

Rationale: Indigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers.

Objective: This is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers.

Methods: Two investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a 'meta-study' approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated.

Results: Five core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation.

Conclusion: The social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers.

Prospero Registration Number: CRD42020207643.
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http://dx.doi.org/10.1136/bmjopen-2021-050113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246376PMC
June 2021

Exploratory Graph Analysis of the Strengths and Difficulties Questionnaire in the Longitudinal Study of Australian Children.

Assessment 2021 Jun 19:10731911211024338. Epub 2021 Jun 19.

The University of Adelaide, Adelaide, South Australia, Australia.

In Australia, the Strengths and Difficulties Questionnaire (SDQ) has been implemented in several national studies, including the Longitudinal Study of Australian Children (LSAC). However, three previous state-level validations indicated problems with instrument dimensionality, warranting further research. To address this gap, the current study employed exploratory graph analysis to investigate dimensionality of the caregiver-completed SDQ version 4 to 10 years in a nationally representative sample of Australian children. Data were from a dual cohort cross-sequential study (LSAC) that included more than 20,000 responses. Gaussian graphical models were estimated in each study wave and exploratory graph analysis applied. Structural consistency, item stability and network loadings were evaluated. The findings provided mixed support for the original SDQ five-factor structure. The Peer Problem scale displayed low structural consistency since items clustered with the Emotional Symptoms and Prosocial behavior, generating four-dimensional structures. Implications for future use of the SDQ version 4 to 10 years in Australia are provided.
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http://dx.doi.org/10.1177/10731911211024338DOI Listing
June 2021

Dental Health Inequalities among Indigenous Populations: A Systematic Review and Meta-Analysis.

Caries Res 2021 9;55(4):268-287. Epub 2021 Jun 9.

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

The aim of this systematic review and meta-analysis was to document the disparity in dental caries experiences among indigenous and nonindigenous populations globally by measuring dental caries prevalence and severity. An electronic database (MEDLINE) was initially searched using relevant keywords. This was followed by use of the search string in the following electronic databases: Scopus, EBSCOhost, Cochrane, and Open Grey. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction, which was facilitated using JBI SUMARI software. The primary outcome was the decayed missing filled teeth (DMFT) score and dental caries prevalence. Subgroup analysis was done by country of publication to identify causes of heterogeneity. Forest plots were used with the standardized mean difference (SMD) and publication bias was assessed using the Egger test with funnel plot construction. For the final review, 43 articles were selected and 34 were meta-analyzed. The pooled mean DMFT for both the permanent dentition (SMD = 0.26; 95% CI 0.13-0.39) and deciduous dentition (SMD = 0.67; 95% CI 0.47-0.87) was higher for the Indigenous population than for the general population. Indigenous populations experienced more decayed teeth (SMD = 0.44; 95% CI 0.25-0.62), a slightly higher number of missing teeth (SMD = 0.11< 95% CI -0.05 to 0.26), and lesser filled teeth (SMD = -0.04; 95% CI -0.20 to 0.13) than their nonindigenous counterparts. The prevalence of dental caries (SMD = 0.27; 95% CI 0.13-0.41) was higher among indigenous people. Globally, indigenous populations have a higher caries prevalence and severity than nonindigenous populations. The factors which have led to such inequities need to be examined.
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http://dx.doi.org/10.1159/000516137DOI Listing
June 2021

Cohort profile: indigenous human papillomavirus and oropharyngeal squamous cell carcinoma study - a prospective longitudinal cohort.

BMJ Open 2021 06 3;11(6):e046928. Epub 2021 Jun 3.

Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia.

Purpose: Our aims are to: (1) estimate prevalence, incidence, clearance and persistence of oral human papillomavirus (HPV) infection among Indigenous Australians; (2) identify risk factors associated with oropharyngeal squamous cell carcinoma (OPSCC)-related HPV types (HPV 16 or 18); (3) develop HPV-related health state valuations and; (4) determine the impact on OPSCC and cervical cancers, and the cost-effectiveness of extending publicly-funded HPV vaccination among Indigenous Australians.

Participants: Participants were recruited from February 2018 to January 2019. Twelve-month follow-up occurred from March 2019 to March 2020. Participants provided socio-demographic characteristics, health-related behaviours including tobacco and alcohol use and sexual history. Health state preferences in regard to HPV vaccination, knowledge regarding HPV infection, OPSCC and cervical cancer were collected using a two-stage standard gamble approach. Participants provided saliva samples and DNA for microbial genotyping was extracted.

Findings To Date: Of the 910 participants who were positive for β-globin at baseline, 35% had any oral HPV infection. The most prevalent HPV types were 13 or 32 (Heck's disease; 23%). The second most prevalent types were associated with OPSCC (HPV 16 or 18; 3.3%). Of the 645 participants who were positive for β-globin at 12-month follow-up, 43% had any HPV infection. Of these, 33% were HPV types 13 or 32 and 2.5% were HPV 16 or 18. Some 588 participants had β-globin positive oral samples at baseline and 12-month follow-up. The prevalence of any oral HPV infection increased from 34% at baseline to 44% at 12-month follow-up; due to increases in HPV types 13 or 32 (20% at baseline and 34% at 12-month follow-up).

Future Plans: Further funding will be sought to continue follow-up of this cohort, and to include (after a full medical history) a thorough clinical examination of the external head and neck; a complete oral examination and examination of the oropharynx. Blood tests for early stage OPSCC will also be undertaken.
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http://dx.doi.org/10.1136/bmjopen-2020-046928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183277PMC
June 2021

Dynamics in oral health-related factors of Indigenous Australian children: A network analysis of a randomized controlled trial.

Community Dent Oral Epidemiol 2021 May 28. Epub 2021 May 28.

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

Objectives: Network analysis is an innovative, analytic approach that enables visual representation of variables as nodes and their corresponding statistical associations as edges. It also provides a new way of framing oral health-related questions as complex systems of variables. We aimed to generate networks of oral health variables using epidemiological data of Indigenous children, and to compare network structures of oral health variables among participants who received immediate or delayed delivery of an oral health intervention.

Methods: Epidemiological data from 448 mother-child dyads enrolled in a randomized controlled trial of dental caries prevention in South Australia, Australia, were obtained. Networks were estimated with nodes representing study variables and edges representing partial correlation coefficients between variables. Data included dental caries, impact on quality of life, self-rated general health, self-rated oral health, dental service utilization, knowledge of oral health, fatalism and self-efficacy in three time points. Communities of nodes, centrality, clustering coefficient and network stability were estimated.

Results: The oral health intervention interacted with the network through self-rated general health and knowledge of oral health. Networks depicting groups shortly after receiving the intervention presented higher clustering coefficients and a similar arrangement of nodes. Networks tended to return to a preintervention state.

Conclusion: The intervention resulted in increased connectivity and changes in the structure of communities of variables in both intervention groups. Our findings contribute to elucidating dynamics between variables depicting oral health networks over time.
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http://dx.doi.org/10.1111/cdoe.12661DOI Listing
May 2021

A systematic review and meta-analysis of the prevalence of human papillomavirus infection in Indigenous populations - A Global Picture.

J Oral Pathol Med 2021 May 18. Epub 2021 May 18.

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

Background And Aim: Recent trends have shown a decline in the rates of human papillomavirus (HPV)-associated cervical cancer in the vaccinated population but there has been a spike in the HPV-associated oropharyngeal, anal and penile cancers in the majority of the unvaccinated population which are young and middle-aged males. Indigenous populations at an international level carry a disproportionate burden of most diseases. The aim of this meta-analysis was to ascertain the worldwide prevalence of HPV infection in Indigenous populations stratified by sex and site and to document the most commonly reported HPV types.

Methods: Published articles on HPV infection in Indigenous populations from PubMed, Scopus, EMBASE and Web of Science were systematically searched from inception until 23 December 2019.

Results: A total of 41 studies were included in the final analysis. The pooled worldwide prevalence of HPV infection (for both oral and genital sites, both males and females) in Indigenous populations was 34.2% (95% CI: 28.9%-39.8%). Subgroup analysis (geographical) showed that the pooled prevalence for African Indigenous, American Indigenous and Asian-Oceanic Indigenous populations were 33.0% (95% CI: 12.8%-57.1%), 33.0% (95% CI: 27.4%-38.9%) and 33.3% (95% CI: 0.17.5%-51.3%), respectively.

Conclusion: There are not enough data on the burden of the infection carried by males especially with respect to highly suspicious sites like oropharynx. Also, we conclude an overall high prevalence of HPV infection in the Indigenous populations and increasing their susceptibility to benign and malignant manifestations of HPV.
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http://dx.doi.org/10.1111/jop.13201DOI Listing
May 2021

The prevalence of dental caries among Indigenous populations compared to non-Indigenous populations: a quantitative systematic review protocol.

JBI Evid Synth 2021 May 17. Epub 2021 May 17.

Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, 5000.

Objective: The objective of this review is to evaluate if the prevalence of dental caries is higher among Indigenous populations compared to non-Indigenous populations.

Introduction: Globally, Indigenous populations have experienced substantial inequalities in health, including oral health care, when compared to their non-Indigenous counterparts. Indigenous populations experience a higher prevalence of dental caries, but most of this data has been collected from convenience samples not involving non-Indigenous groups. This review will highlight differences in the prevalence of dental caries globally among Indigenous groups compared to non-Indigenous groups.

Inclusion Criteria: The systematic review will include all studies that have compared the prevalence of dental caries (% of decayed teeth>0) and dental caries experince (mean score of decayed, missing, filled teeth) among Indigenous and non-Indigenous populations across all ages.

Methods: Initially, articles will be searched in MEDLINE, followed by a more comprehensive search on Scopus, EBSCOhost (Dentistry and Oral Sciences Sources), Cochrane Database, and Open Grey. The search will be conducted independently by two reviewers from database inception to September 2020. A reference list will be made identifying all eligible studies. Titles and abstracts will be reviewed, as well as the full text of articles that meet the inclusion criteria. To assess methodological quality, a standardized critical appraisal checklist for studies reporting prevalence will be selected, followed by standardized data extraction using the JBI tool. The results from included studies will be analyzed using JBI SUMARI.

Systematic Review Registration Number: PROSPERO CRD42020204311.
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http://dx.doi.org/10.11124/JBIES-20-00449DOI Listing
May 2021

Challenges in identifying indigenous peoples in population oral health surveys: a commentary.

BMC Oral Health 2021 04 28;21(1):216. Epub 2021 Apr 28.

Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil.

There are currently 370 million persons identifying as indigenous across 90 countries globally. Indigenous peoples generally face substantial exclusion/marginalization and poorer health status compared with non-indigenous majority populations; this includes poorer oral health status and reduced access to dental services. Population-level oral health surveys provide data to set priorities, inform policies, and monitor progress in dental disease experience/dental service utilisation over time. Rigorously and comprehensively measuring the oral health burden of indigenous populations is an ethical issue, though, given that survey instruments and sampling procedures are usually not sufficiently inclusive. This results in substantial underestimation or even biased estimation of dental disease rates and severity among indigenous peoples, making it difficult for policy makers to prioritise resources in this area. The methodological challenges identified include: (1) suboptimal identification of indigenous populations; (2) numerator-denominator bias and; (3) statistical analytic considerations. We suggest solutions that can be implemented to strengthen the visibility of indigenous peoples around the world in an oral health context. These include acknowledgment of the need to engage indigenous peoples with all data-related processes, encouraging the use of indigenous identifiers in national and regional data sets, and mitigating and/or carefully assessing biases inherent in population oral health methodologies for indigenous peoples.
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http://dx.doi.org/10.1186/s12903-021-01455-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082663PMC
April 2021

Developing an early childhood oral health impact-specific health-state classification system for a new preference-based instrument, the ECOHIS-4D.

Community Dent Oral Epidemiol 2021 Apr 18. Epub 2021 Apr 18.

University of Adelaide, Adelaide, SA, Australia.

Objectives: Most of the paediatric quality-of-life instruments in oral health research are not preference-based measures, thus cannot be used in economic evaluations. The Early Childhood Oral Health Impact Scale (ECOHIS) is one such instrument which assesses oral health impact on children's quality of life among three- to five-year-olds. With increasing demands for more resource allocation in oral health care, there is a need for an outcome metric which can be used as the outcome in economic evaluations. The aim of this study was to develop a preference-based, health-state classification system from the existing ECOHIS instrument.

Methods: The 13-item ECOHIS instrument was applied to the carers of 280 preschoolers who participated in a clinical trial in metropolitan Perth, Western Australia. Exploratory factor analysis was conducted to assess the dimensionality of the ECOHIS. Rasch analysis was used to eliminate and select items per determined dimensions and to reduce the number of response options for each item, because six levels were not amenable to valuation. The final classification system was determined through a combination of psychometric and expert advice.

Results: Items loaded on to four dimensions with the factor analysis. Using Rasch analysis, three items were selected from the first dimension (child functional and psychological impact) and one item from the second dimension (child social interaction impact). None were selected from the third dimension (parental distress and family function impact) as it is not an appropriate proxy method of measuring the level of impact on a child. The final classification system has four dimensions with three levels in each, and so it has been named the ECOHIS-4D.

Conclusions: The ECOHIS-4D classification system is a new preference-based instrument derived from the existing ECOHIS instrument. Future valuation studies will develop a utility value set for the health states defined by this classification system, and this will guide economic evaluations related to oral health interventions.
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http://dx.doi.org/10.1111/cdoe.12650DOI Listing
April 2021

The ethical urgency of tackling racial inequities in health.

EClinicalMedicine 2021 Apr 30;34:100816. Epub 2021 Mar 30.

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

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http://dx.doi.org/10.1016/j.eclinm.2021.100816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042339PMC
April 2021

Racism and oral health inequities; An overview.

EClinicalMedicine 2021 Apr 6;34:100827. Epub 2021 Apr 6.

Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil.

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http://dx.doi.org/10.1016/j.eclinm.2021.100827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027540PMC
April 2021

Oral health-related quality of life among Brazilian adults with mental disorders.

Eur J Oral Sci 2021 06 30;129(3):e12774. Epub 2021 Mar 30.

Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas, São Paulo, Brazil.

The aim of this study was to investigate associations of sociodemographic, lifestyle, medical conditions, and caries experience with oral health-related quality of life (OHRQoL) in a large sample of adults with mental disorders. A sample of 753 adults diagnosed with schizophrenia or depression, who were users of 10 public mental health outpatient clinics located in the city of São Paulo, Brazil, participated in the study. Participants provided data on sociodemographic characteristics, psychiatric diagnosis, medication use, and health behaviors. Oral examinations to evaluate dental caries (using the decayed, missing, and filled teeth ([DMFT] index) and dental plaque (using the Silness-Löe plaque index) were conducted. Oral health-related quality of life was evaluated using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire. Log-Poisson regression was used to evaluate associations between the outcome and independent variables. The prevalence of one or more OHIP-14 impacts occurring fairly often/often was 72.3%. Physical pain was the OHIP domain with the highest prevalence, followed by psychological discomfort. Multivariable analysis showed that higher prevalence of the reponses 'fairly often/often' in the OHIP-14 was associated with being female, aged 35 to 54 years, having a low family income, a diagnosis of depression, a smoking habit, and fewer than 20 teeth. Adults with mental disorders had a high prevalence of impacts on their OHRQoL, which were associated with caries experience, sociodemographic characteristics, type of psychiatric diagnosis, and behavioral risk indicators.
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http://dx.doi.org/10.1111/eos.12774DOI Listing
June 2021

Drop-the-: Bayesian CFA of the Multidimensional Scale of Perceived Social Support in Australia.

Front Psychol 2021 26;12:542257. Epub 2021 Feb 26.

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

Aim: We aimed to investigate whether the 12-item Multidimensional Scale of Perceived Social Support (MSPSS) constitutes a valid and reliable measure of social support for the general adult Australian population.

Methods: Data were from Australia's National Survey of Adult Oral Health 2004-2006 and included 3899 participants aged 18 years old and over. The psychometric properties were evaluated with Bayesian confirmatory factor analysis. One-, two-, and three-factor (Significant Other, Family and Friends) structures were tested. Model fit was assessed with the posterior predictive -value (PPP), Bayesian root mean square error of approximation (BRMSEA), and Bayesian comparative fit index (BCFI). Dimensionality was tested by comparing competing factorial structures with the Bayes factor (BF). Reliability was evaluated with the Bayesian Ω . Convergent validity was investigated with the Perceived Stress Scale (PSS) and discriminant validity with the Perceived Dental Control scale (PDC-3).

Results: The theoretical three-factor model (Significant Other, Family, and Friends) provided a good fit to the data [PPP < 0.001, BRMSEA = 0.089-95% credible interval (CrI) (0.088, 0.089); BCFI = 0.963-95% CrI (0.963, 0.964)]. The BF provided decisive support for the three-factor structure in relation to the other structures. The SO [BΩ = 0.95 - 95% CrI (0.90, 0.99)], FA (BΩ = 0.92 - 95% CrI (0.87, 0.97), and FR (BΩ = 0.92 - 95% CrI (0.88, 0.97)] subscales displayed excellent reliability. The MSPSS displayed initial evidence of convergent and discriminant validity.

Conclusion: The MSPSS demonstrated good psychometric properties and excellent reliability in a large Australian sample. This instrument can be applied in national surveys and provide evidence of the role of social support in the Australian population.
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http://dx.doi.org/10.3389/fpsyg.2021.542257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953044PMC
February 2021

Factors associated with poor oral health-related quality of life among non-institutionalized Brazilian older adults: Oral health and quality of life in older adults.

Spec Care Dentist 2021 May 11;41(3):391-398. Epub 2021 Mar 11.

Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Area of Health Education and Health Promotion, University of Campinas, Piracicaba, São Paulo, Brazil.

Aims: To investigate the factors associated with poor oral health-related quality of life (OHRQoL) in a sample of Brazilian older adults.

Methods And Results: A cross-sectional study was conducted with 535 non-institutionalized elders aged 60 years or older from Piracicaba, São Paulo, Brazil. OHRQoL was measured using the Geriatric Oral Health Assessment Index (GOHAI). Data on sociodemographic characteristics, self-perceived general health status, and health-related behaviors were obtained through a structured questionnaire. Data on chronic diseases were obtained from health records. Associations between exploratory factors and low OHRQoL (% GOHAI score <30) were evaluated using multivariate Poisson regression models to estimate adjusted prevalence ratios (PRs) and confidence intervals. The mean OHRQoL score was 30 (± 4.4). In bivariate analysis, being not married, smoking, and self-rated "fair/poor" general health status were associated with lower OHRQoL. In the adjusted model, self-rated "fair/poor" general health (PR: 1.25; 95% CI: 1.05-1.48), presence of chronic diseases (PR: 1.88; 95% CI: 1.37-2.58), smoking (PR: 1.25; 95% CI: 1.02-1.53), and reason for last dental appointment (PR: 1.34; 95% CI: 1.13-1.59) were associated with poor OHRQoL.

Conclusion: Non-institutionalized older adults with a history of chronic diseases, who smoke, have a negative perception of their general health, and had the last dental appointment motivated by pain present significantly higher prevalence rates of poor OHRQoL.
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http://dx.doi.org/10.1111/scd.12582DOI Listing
May 2021

Psychometric properties of the EQ-5D-5L for aboriginal Australians: a multi-method study.

Health Qual Life Outcomes 2021 Mar 10;19(1):81. Epub 2021 Mar 10.

Adelaide Dental School, The University of Adelaide, Adelaide, Australia.

Introduction: In Australia, health-related quality of life (HRQoL) instruments have been adopted in national population surveys to inform policy decisions that affect the health of Aboriginal and Torres Strait Islanders. However, Western-developed HRQoL instruments should not be assumed to capture Indigenous conceptualization of health and well-being. In our study, following recommendations for cultural adaptation, an Indigenous Reference Group indicated the EQ-5D-5L as a potentially valid instrument to measure aspects of HRQoL and endorsed further psychometric evaluation. Thus, this study aimed to investigate the construct validity and reliability of the EQ-5D-5L in an Aboriginal Australian population.

Methods: The EQ-5D-5L was applied in a sample of 1012 Aboriginal adults. Dimensionality was evaluated using Exploratory Graph Analysis. The Partial Credit Model was employed to evaluate item performance and adequacy of response categories. Area under the receiver operating characteristic curve (AUROC) was used to investigate discriminant validity regarding chronic pain, general health and experiences of discrimination.

Results: The EQ-5D-5L comprised two dimensions, Physiological and Psychological, and reliability was adequate. Performance at an item level was excellent and the EQ-5D-5L individual items displayed good discriminant validity.

Conclusions: The EQ-5D-5L is a suitable instrument to measure five specific aspects (Mobility, Self-Care, Usual activities, Pain/Discomfort, Anxiety/Depression) of Aboriginal and Torres Strait Islander HRQoL. A future research agenda comprises the investigation of other domains of Aboriginal and Torres Strait Islander HRQoL and potential expansions to the instrument.
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http://dx.doi.org/10.1186/s12955-021-01718-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945337PMC
March 2021

Black Lives Matter: A Decomposition of Racial Inequalities in Oral Cancer Screening.

Cancers (Basel) 2021 Feb 17;13(4). Epub 2021 Feb 17.

School of Public Health, The University of Adelaide, Adelaide 5005, Australia.

(1) Background: The Black Lives Matter movement has highlighted the discrepancies in public health in regard to race. This study aims to investigate tools that can be used to analyze and investigate this discrepancy, which can be applied to policymaking. (2) Methods: National Health and Nutrition Examination Survey (NHANES) data from 2011-2018 was combined ( = 22,617) to investigate discrepancies of oral cancer screening in Black Americans. We give examples of counterfactual techniques that can be used to guide policy. Inverse probability treatment weighting (IPTW) was used to remove all measured confounding in an interaction analysis to assess the combined effect of socioeconomic status and race. Blinder-Oaxaca decomposition was then used to investigate the intervenable factors associated with differences in race. (3) Results: Sub-additive interaction was found on additive and multiplicative scales when all measured confounding was removed via IPTW (relative excess risk due to interaction (RERI)(OR) = -0.55 (-0.67--0.42)). Decomposition analysis found that 32% of the discrepancy could be explained by characteristics of higher education and poverty status. (4) Conclusions: Black Americans in poverty are less likely to seek oral cancer screening than the additive likelihood would suggest. Blinder-Oaxaca decomposition is a strong tool to use for guiding policy as it quantifies clear breakdowns of what intervenable factors there are that would improve the discrepancy the most.
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http://dx.doi.org/10.3390/cancers13040848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922532PMC
February 2021

Poor self-rated oral health associated with poorer general health among Indigenous Australians.

BMC Public Health 2021 03 1;21(1):424. Epub 2021 Mar 1.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, 5005, Australia.

Background: Oral diseases negatively impact general health, affecting physical, psychological, social and emotional wellbeing, and ability to give back to community. The relationship between poor oral health, and general health and wellbeing among Indigenous Australians has not been documented. Working in partnership with seven Indigenous communities in South Australia, this study aimed to: 1) quantify self-rated oral health and health-related quality of life and; 2) investigate associations between poor self-rated oral health and general health among Indigenous Australian adults.

Methods: Data was collected from a large convenience sample of Indigenous Australians aged 18+ years from Feb 2018 to Jan 2019. General health-related quality of life, as the main outcome variable, was measured by calculating disutility scores with the five individual EQ-5D dimensions (EuroQol instrument: EQ-5D-5L), then classified as 'no problem' and 'at least one problem'. Self-reported oral health, as the main explanatory, was dichotomised into 'fair or poor' and 'excellent, very good or good'. Multivariable log-Poisson regression models were used to estimate associations between poor self-rated oral health and general health by calculating mean rate ratios (MRR) for disutility scores and prevalence ratios (PR) for individual dimensions, after adjusting for social-demographic characteristics and health-related behaviours.

Results: Data were available for 1011 Indigenous South Australian adults. The prevalence of 'fair or poor' self-rated oral health was 33.5%. The mean utility score was 0.82 (95% CI: 0.81-0.83). Compared with those rating their oral health as 'excellent or very good or good', those who rated their oral health as 'fair or poor' had a mean disutility score that was 1.6 (95% CI: 1.1-2.2) times higher, and the prevalence of at least one problem ranged from 90 to 160% higher for individual EQ-5D dimensions.

Conclusions: Fair or poor self-rated oral health among Indigenous persons in South Australia was associated with poor general health as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility, self-care and anxiety/depression. The findings emphasise the importance of oral health as predictors of general health among Indigenous Australians.
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http://dx.doi.org/10.1186/s12889-021-10426-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919297PMC
March 2021

Cohort profile: South Australian Aboriginal Birth Cohort (SAABC)-a prospective longitudinal birth cohort.

BMJ Open 2021 02 22;11(2):e043559. Epub 2021 Feb 22.

School of Public Health, University of Adelaide, Australia, Adelaide, South Australia, Australia.

Purpose: The South Australian Aboriginal Birth Cohort (SAABC) is a prospective, longitudinal birth cohort established to: (1) estimate Aboriginal child dental disease compared with population estimates; (2) determine the efficacy of an early childhood caries intervention in early versus late infancy; (3) examine if efficacy was sustained over time and; (4) document factors influencing social, behavioural, cognitive, anthropometric, dietary and educational attainment over time.

Participants: The original SAABC comprised 449 women pregnant with an Aboriginal child recruited February 2011 to May 2012. At child age 2 years, 324 (74%) participants were retained, at age 3 years, 324 (74%) participants were retained and at age 5 years, 299 (69%) participants were retained. Fieldwork for follow-up at age 7 years is underway, with funding available for follow-up at age 9 years.

Findings To Date: At baseline, 53% of mothers were aged 14-24 years and 72% had high school or less educational attainment. At age 3 years, dental disease experience was higher among children exposed to the intervention later rather than earlier in infancy. The effect was sustained at age 5 years, but rates were still higher than general child population estimates. Experiences of racism were high among mothers, with impacts on both tooth brushing and toothache. Compared with population estimates, levels of self-efficacy and self-rated oral health of mothers at baseline were low.

Future Plans: Our data have contributed to a better understanding of the environmental, behavioural, dietary, biological and psychosocial factors contributing to Aboriginal child oral and general health, and social and emotional well-being. This is beneficial in charting the trajectory of cohort participants' health and well-being overtime, particularly in identifying antecedents of chronic diseases which are highly prevalent among Aboriginal Australians. Funding for continued follow-up of the cohort will be sought.

Trial Registration Number: ACTRN12611000111976; Post-results.
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http://dx.doi.org/10.1136/bmjopen-2020-043559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903076PMC
February 2021

Modelling the Validity of Periodontal Disease Screening Questions in a Nondental Clinical Setting.

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

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

Objective: Periodontal examinations are time-consuming and potentially uncomfortable for recipients. We modelled if self-reported questions alone, or combined with objective evidence of periodontal bone loss observable from radiographs, are accurate predictors of periodontitis.

Methods: Self-reported data from the Australian National Survey of Adult Oral Heath 2004-06 were compared with clinical periodontal examinations to assess the validity of 8 periodontitis screening questions in predicting moderate/severe periodontitis. To model alveolar bone loss, a proxy variable simulating radiographic clinical attachment level (rCAL) was created. Three multivariable binary logistic regression models were constructed: responses to 8 screening questions alone (Model 1), screening questions combined with 5 classic periodontitis risk indicators (age, sex, smoking status, country of birth, and diabetes status) (Model 2), and the addition of rCAL (Model 3). Predictive validity was determined via sensitivity (Se) and specificity (Sp) scores and graphically represented using area under the receiver operator characteristic curves (AUROC).

Results: Data from 3630 participants periodontally examined determined that 32.4% exhibited periodontitis. Periodontitis risk indicators were all significantly associated with periodontitis case status. Six of 8 screening questions (Model 1) were weak periodontitis predictors (Se = 0.28; Sp = 0.89; AUROC = 0.61). Combining 13 variables for (Model 2) improved prediction (Se = 0.55; Sp = 0.81; AUROC = 0.77). The addition of rCAL (Model 3) improved diagnostic capacity considerably (AUROC = 0.86).

Conclusions: Self-reported questions combined with classic risk indicators are "useful" for periodontitis screening. Addition of radiographs markedly improved diagnostic validity. Based on modelling, nondental health care professionals may provisionally screen for periodontitis with minimal training.
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http://dx.doi.org/10.1016/j.identj.2020.12.013DOI Listing
February 2021

Oral health of aboriginal people with kidney disease living in Central Australia.

BMC Oral Health 2021 02 4;21(1):50. Epub 2021 Feb 4.

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

Background: Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease.

Methods: Sample frequencies and means were assessed in adults represented in six datasets including: (1) 102 Aboriginal Australians with kidney disease residing in Central Australia who participated in a detailed oral health assessment; (2) 312 Aboriginal participants of the Northern Territory's PerioCardio study; (3) weighted estimates from 4775 participants from Australia's National Survey of Adult Oral Health (NSAOH); (4) Australian 2016 Census (all Australians); (5) National Health Survey 2017-2018 (all Australians) and; (6) Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-2012 (all Australians). Oral health status was described by periodontal disease and experience of dental caries (tooth decay). Statistically significant differences were determined via non-overlapping 95% confidence intervals.

Results: Aboriginal Australians with kidney disease were significantly older, less likely to have a tertiary qualification or be employed compared with both PerioCardio study counterparts and NSAOH participants. Severe periodontitis was found in 54.3% of Aboriginal Australians with kidney disease, almost 20 times the 2.8% reported in NSAOH. A higher proportion of Aboriginal Australians with kidney disease had teeth with untreated caries and fewer dental restorations when compared to NSAOH participants. The extent of periodontal attachment loss and periodontal pocketing among Aboriginal Australians with kidney disease (51.0%, 21.4% respectively) was several magnitudes greater than PerioCardio study (22.0%, 12.3% respectively) and NSAOH (5.4%, 1.3% respectively) estimates.

Conclusions: Aboriginal Australians with kidney disease exhibited more indicators of poorer oral health than both the general Australian population and a general Aboriginal population from Australia's Northern Territory. It is imperative that management of oral health among Aboriginal Australians with kidney disease be included as part of their ongoing medical care.
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http://dx.doi.org/10.1186/s12903-021-01415-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863237PMC
February 2021

The impact of interpersonal racism on oral health related quality of life among Indigenous South Australians: a cross-sectional study.

BMC Oral Health 2021 02 4;21(1):46. Epub 2021 Feb 4.

Australian Research Centre for Population Oral Health, Adelaide Health and Medical Sciences, The University of Adelaide, 4 North Terrace, Adelaide, 5005, Australia.

Background: Interpersonal racism has had a profound impact on Indigenous populations globally, manifesting as negative experiences and discrimination at an individual, institutional and systemic level. Interpersonal racism has been shown to negatively influence a range of health outcomes but has received limited attention in the context of oral health. The aim of this paper was to examine the effects of experiences of interpersonal racism on oral health-related quality of life (OHRQoL) among Indigenous South Australians.

Methods: Data were sourced from a large convenience sample of Indigenous South Australian adults between February 2018 and January 2019. Questionnaires were used to collect data on sociodemographic characteristics, cultural values, utilization of dental services, and other related factors. OHRQoL was captured using the Oral Health Impact Profile (OHIP-14) questionnaire. We defined the dependent variable 'poor OHRQoL' as the presence of one or more OHIP-14 items rated as 'very often' or 'fairly often'. Experiences of racism were recorded using the Measure of Indigenous Racism Experiences instrument. Interpersonal racism was classified into two categories ('no racism' vs 'any racism in ≥ 1 setting') and three categories ('no racism', 'low racism' (experienced in 1-3 settings), and 'high racism' (experienced in 4-9 settings)). Logistic regression was used to examine associations between interpersonal racism, covariates and OHRQoL, adjusting for potential confounding related to socioeconomic factors and access to dental services.

Results: Data were available from 885 participants (88.7% of the total cohort). Overall, 52.1% reported experiencing any interpersonal racism in the previous 12 months, approximately one-third (31.6%) were classified as experiencing low racism, and one-fifth (20.5%) experienced high racism. Poor OHRQoL was reported by half the participants (50.2%). Relative to no experiences of racism in the previous 12 months, those who experienced any racism (≥ 1 setting) were significantly more likely to report poor OHRQoL (Odds Ratio (OR): 1.43; 95% Confidence Interval (CI): 1.08-1.92), after adjusting for age, education level, possession of an income-tested health care card, car ownership, self-reported oral health status, timing of and reason for last dental visit, not going to a dentist because of cost, and having no family support. This was particularly seen among females, where, relative to males, the odds of having poor OHRQoL among females experiencing racism were 1.74 times higher (95% CI: 1.07-2.81).

Conclusion: Our findings indicate that the experience of interpersonal racism has a negative impact on OHRQoL among Indigenous Australians. The association persisted after adjusting for potential confounding factors. Identifying this link adds weight to the importance of addressing OHRQoL among South Australian's Indigenous population by implementing culturally-sensitive strategies to address interpersonal racism.
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http://dx.doi.org/10.1186/s12903-021-01399-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860008PMC
February 2021

Motivations of postgraduate dental students in Australia and New Zealand to pursue a dental specialty training program and their concerns.

Heliyon 2021 Jan 25;7(1):e06060. Epub 2021 Jan 25.

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

Objectives: To determine the motivations of postgraduate dental students to pursue a specialist dental career and their concerns prior to and during the program.

Methods: A 3-part online survey comprising of participants' background, motivations and concerns and quality of life during the program, was distributed to students enrolled in the Doctor of Clinical Dentistry program in Australia and New Zealand from April to May 2018. Participation was voluntary and anonymous. Two separate reminders were provided two and four weeks after the initial survey was distributed.

Results: There was a 53.6% response rate (97/181 participants). The main factor for pursing a dental specialist degree was intellectual stimulation. Participants who were aged 40 years and above and those who were divorced/separated were most concerned about the amount of study required and finances during the program. Participants in their final year were most concerned about their personal relationships during the program. Orthodontic, oral medicine and paedodontic trainees reported concerns about the lack of exposure of their specialty during undergraduate training while periodontics and orthodontic trainees reported having the least exposure while working.

Conclusion: This study showed that dental specialist trainees in Australia and New Zealand were primarily motivated to pursue a specialty for intellectual stimulation. Most students were concerned about the amount of study required, finances and having a work/life balance during the training program. Most students planned to work as associates in private practice upon graduation. Financial benefits may be required to stimulate an interest in academia.

Clinical Significance: An understanding of the motivations of postgraduate students is important to help dental programs mentor students in their future career pathway, improve the selection of candidates for the specialty programs and identify key areas to provide support, prior to, or during the program.
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http://dx.doi.org/10.1016/j.heliyon.2021.e06060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841354PMC
January 2021
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